Arizona Department of Insurance and Financial Institutions Forms

This Form is used for applying for an Individual Protected Cell (PC) license as part of the Protected Cell Captive Insurer (PCCI) in Arizona.

This form is used for applying to change a Life Care Provider Permit in the state of Arizona.

This Form is used for applying for a Life Care Provider Permit in the state of Arizona.

This Form is used for applying to become a Life Settlement Provider in Arizona. It is an application for a Certificate of Authority to operate as a Life Settlement Provider.

This Form is used for reporting the stockholders/owners of a life settlement provider in Arizona.

This form is used for applying for purchasing group registration in Arizona. It is used by individuals or organizations who want to register as a purchasing group in the state.

This document is used for appointing a statutory agent for a life settlement provider in the state of Arizona.

This document provides instructions for completing Form E-185CHC, which is used when making changes to the Form C Summary of Registration Statement in Arizona.

This form is used for obtaining a bond for a service company in the state of Arizona.

This form is used for transmitting the annual audited financial report for a senior residential entrance fee contract provider in Arizona.

This form is used for registering providers of senior residential entrance fee contracts in Arizona.

This Form is used for applying for the designation of a domestic surplus lines insurer in Arizona.

This form is used for renewing the service company permit in Arizona.

This form is used to assess the antifraud plan of life settlement providers in Arizona.

This form is used for creating a biographical list of service companies in Arizona.

This form is used for assigning a certificate of deposit or time deposit to the Arizona State Treasurer in Arizona.

This form is used for applying for a service company permit in the state of Arizona. It is required for businesses that provide services such as cleaning, landscaping, or home repairs.

This form is used for applying and ordering the release of excess deposits in Arizona.

This document is for reporting the officers, directors, members, partners, and designated employees of a Life Settlement Provider in Arizona.

This form is used for requesting the release of a letter of credit in the state of Arizona.

This Form is used for transmitting the annual report and renewal fee for captive insurers registered with the Risk Retention Groups in the state of Arizona.

This document is a checklist for the Service Company Permit Application in Arizona. It provides a list of required documents and information to be submitted for obtaining the permit.

This Form is used for recording and documenting property that has been used as collateral for a credit transaction in the state of Arizona.

This document is used to report the experience of credit life, disability, and unemployment insurance in Arizona. It provides data and insights on the claims, payments, and overall performance of these types of insurance policies in the state.

This Form is used for obtaining a Certificate of Surplus Lines Broker in Arizona.

This document is used to certify compliance with advertising regulations in the state of Arizona.

This form is used for disclosing information related to potential conflicts of interest under Arizona law.

This form is used for amending the Life Care Provider Annual Report in the state of Arizona. It is specific to providers operating under the E-LIFECARE.AMEND program.

This form is used for annual statement reporting by domestic life and disability reinsurers in Arizona. It serves as a worksheet to gather relevant information for reporting purposes.

This document is a checklist used by life care providers in Arizona to file their annual report with E-LIFECARE.AS.

This Form is used for providing instructions on how to complete and file "A Statement Regarding the Acquisition of Control of or Merger With a Domestic Insurer" in the state of Arizona.

This form is used for submitting the audited financial report and internal control filings in Arizona.

This Form is used for Arizona domestic companies to request a standardized organizational hardship exemption and submit an audited financial report. It is specifically for Arizona domestic companies.

This Form is used for submitting an annual report of policy and loss reserves for domestic mechanical reimbursement reinsurers in Arizona. It also serves as an application for certificate of authority renewal.

This form is used for reporting producer controlled property and casualty insurance in Arizona.

This form is used for notifying Arizona domestic companies about automatic exemption from filing an audited financial report.

This Form is used for Mortgage Guaranty Insurer's to report the policyholders' position in Arizona.