Annual Statement Forms and Quarterly Filing Requirements

For more information please call (602) 364-3245

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Do not submit taxes or fees with an annual or quarterly filing.
For information on insurance premium taxes and annual fees,
visit our Tax Forms and Instructions webpage.


Fillable Form Instructions


Do not submit taxes or fees with your annual statement filing. For information on insurance premium taxes and annual fees, visit our Tax Forms and Instructions webpage.

FOREIGN AND ALIEN COMPANY TYPES LISTED BELOW THAT ELECTRONICALLY FILE THEIR ANNUAL STATEMENT* WITH THE N.A.I.C. ARE NOT REQUIRED TO FILE A HARD COPY WITH ARIZONA UNLESS NOTED OTHERWISE.

(*Including Actuarial Opinion, Management Discussion & Analysis Report, Audited Financial Report, State Pages and all applicable Supplements and Exhibits.)

CLICK ON YOUR COMPANY TYPE ON THE LEFT SIDE MENU FOR ARIZONA FORMS, DUE DATES AND INSTRUCTIONS.  You must file a hard copy of these forms by the due dates stated in the form.  To confirm your company type, click the "AZ-DOI Insurer Search" link below and find the record for your company.

Forms Included
Form Type
Form Name
ACCREDITED REINSURER
E-AR.I ANNUAL STATEMENT FILING INSTRUCTIONS
E-AR.WC IN LIEU OF ARIZONA SPECIAL SCHEDULE P FORMS E478 AND EWCA
E-478 ARIZONA SPECIAL SCHEDULE P REPORT FOR ARIZONA WORKERS' COMPENSATION DEPOSIT
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FRATERNAL BENEFIT SOCIETY
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-NAIC.FRATERNAL FILLABLE ANNUAL FILING CHECKLIST
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HEALTH CARE SERVICES ORGANIZATION
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-HCSO.13 FILLABLE CERTIFICATE OF ADVERTISING COMPLIANCE
E-NAIC.HEALTH FILLABLE ANNUAL FILINGS CHECKLIST
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LIFE CARE PROVIDER
E-176 FILLABLE RECORDS LOCATION INFORMATION
E-LIFECARE FILLABLE ANNUAL REPORT FORM
E-LIFECARE.AMEND FILLABLE AMENDMENT TO ANNUAL REPORT
E-LIFECARE.AS FILLABLE ANNUAL REPORT FILING CHECKLIST
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LIFE/DISABILITY OR PROPERTY/CASUALTY INSURER FILING A HEALTH BLANK
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-478 FILLABLE ARIZONA SPECIAL SCHEDULE P REPORT FOR ARIZONA WORKERS' COMPENSATION DEPOSIT
E-NAIC.HEALTH FILLABLE ANNUAL FILINGS CHECKLIST
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LIFE/DISABILITY INSURER NOT FILING HEALTH BLANK
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-NAIC.LD FILLABLE ANNUAL FILING CHECKLIST
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MORTGAGE GUARANTY INSURER
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-MG.CEDE SUPPLEMENTARY SCHEDULE F-5
E-MG.MPP FILLABLE REPORT OF POLICYHOLDERS POSITION
E-NAIC.PC FILLABLE ANNUAL FILING CHECKLIST
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PREPAID LEGAL INSURER
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-NAIC.PC FILLABLE ANNUAL FILING CHECKLIST
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PROPERTY/CASUALTY INSURER NOT FILING HEALTH BLANK
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-478 FILLABLE ARIZONA SPECIAL SCHEDULE P REPORT FOR ARIZONA WORKERS' COMPENSATION DEPOSIT
E-NAIC.PC FILLABLE ANNUAL FILING CHECKLIST
E-PC-INDINS FILLABLE POLICIES ISSUED TO INDUSTRIAL INSUREDS
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QUALIFIED REINSURER TRUST ARS § 20-261.01(A)(4) ORQUALIFIED REINSURER BASED ON SURPLUS ARS § 20-261.01(A)(3) AND (6) MUST FILE HARD COPY WITH ARIZONA
E-QRT.AS FILLABLE ANNUAL STATEMENT FILING WORKSHEET
E-QRT.I ANNUAL STATEMENT FILING INSTRUCTIONS
E-AR.WC IN LIEU OF ARIZONA SPECIAL SCHEDULE P FORMS E478 AND EWCA
E-478 ARIZONA SPECIAL SCHEDULE P REPORT FOR ARIZONA WORKERS' COMPENSATION DEPOSIT
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RISK RETENTION GROUP
E-RRG.I ANNUAL STATEMENT INSTRUCTIONS
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TITLE INSURER
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-NAIC.TITLE FILLABLE ANNUAL FILING CHECKLIST
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Do not submit taxes or fees with your annual statement filing. For information on insurance premium taxes and annual fees, visit our Tax Forms and Instructions webpage.

DOMESTIC COMPANIES MUST FILE A HARD-COPY ANNUAL STATEMENT*, IN DUPLICATE, WITH THE ARIZONA DEPARTMENT OF INSURANCE.

(*Including Actuarial Opinion, Management Discussion & Analysis Report, Audited Financial Report, Arizona State Page and all applicable Supplements and Exhibits.)

CLICK ON YOUR COMPANY TYPE ON THE LEFT SIDE MENU FOR ARIZONA FORMS, DUE DATES AND INSTRUCTIONS.  You must file a hard copy of these forms by the due dates stated in the form.  To confirm your company type, click the "AZ-DOI Insurer Search" link below and find the record for your company.
 
Forms Included
Form Type
Form Name

HEALTH CARE SERVICES ORGANIZATION
E-176 FILLABLE RECORDS LOCATION INFORMATION
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-HCSO.13 FILLABLE CERTIFICATE OF ADVERTISING COMPLIANCE
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-NAIC.HEALTH FILLABLE ANNUAL FILINGS CHECKLIST
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HOSPITAL, MEDICAL, DENTAL AND OPTOMETRIC SERVICE CORPORATION
E-176 FILLABLE RECORDS LOCATION INFORMATION
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-HMDO.178 FILLABLE SERVICE CORPORATION CERTIFICATE OF DISCLOSURE
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-NAIC.HEALTH FILLABLE ANNUAL FILINGS CHECKLIST
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LIFE CARE PROVIDER
E-176 FILLABLE RECORDS LOCATION INFORMATION
E-LIFECARE FILLABLE ANNUAL REPORT FORM
E-LIFECARE.AMEND FILLABLE AMENDMENT TO ANNUAL REPORT
E-LIFECARE.AS FILLABLE ANNUAL REPORT FILING CHECKLIST
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LIFE AND/OR DISABILITY INSURER FILING A HEALTH BLANK
E-176 FILLABLE RECORDS LOCATION INFORMATION     
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-185 OUTLINE FOR COMPLIANCE WITH INSURANCE HOLDING COMPANY SYSTEMS 
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.GFE AUDITED FINANCIAL REPORT EXEMPTION GUIDELINES
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-NAIC.HEALTH FILLABLE ANNUAL FILINGS CHECKLIST
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LIFE AND/OR DISABILITY INSURER NOT FILING A HEALTH BLANK
E-176 FILLABLE RECORDS LOCATION INFORMATION     
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-185 OUTLINE FOR COMPLIANCE WITH INSURANCE HOLDING COMPANY SYSTEMS 
E-AFR FILLABLE AUDITED FINANCIAL REPORT FILING TRANSMITTAL FORM
E-AFR.GFE AUDITED FINANCIAL REPORT EXEMPTION GUIDELINES
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-NAIC.LD FILLABLE ANNUAL FILINGS CHECKLIST
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LIFE / DISABILITY REINSURER 
E-176 FILLABLE RECORDS LOCATION INFORMATION     
E-178   FILLABLE CERTIFICATE OF DISCLOSURE 
E-185 OUTLINE FOR COMPLIANCE WITH INSURANCE HOLDING COMPANY SYSTEMS 
E-AFR FILLABLE AUDITED FINANCIAL REPORT FILING TRANSMITTAL FORM
E-AFR.GFE AUDITED FINANCIAL REPORT EXEMPTION GUIDELINES
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-AFR.OHE STANDARDIZED ORGANIZATIONAL HARDSHIP EXEMPTION GUIDELINES     
E-LR.AS FILLABLE ANNUAL STATEMENT FILINGS WORKSHEET
E-LR.I ANNUAL STATEMENT FILING INSTRUCTIONS
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS RANSMITTAL FORM
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MECHANICAL REIMBURSEMENT REINSURER 
E-176 FILLABLE RECORDS LOCATION INFORMATION
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.GFE AUDITED FINANCIAL REPORT EXEMPTION GUIDELINES
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-AFR.MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-MRR.104 FILLABLE APPLICATION FOR CERTIFICATE OF AUTHORITY RENEWAL
E-MRR.AS FILLABLE ANNUAL STATEMENT FILINGS WORKSHEET
E-MRR.I ANNUAL STATEMENT FILING INSTRUCTIONS
E-MRR.PLR FILLABLE ANNUAL REPORT OF POLICY AND LOSS RESERVES
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MORTGAGE GUARANTY INSURER
E-176 FILLABLE RECORDS LOCATION INFORMATION
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-185 OUTLINE FOR COMPLIANCE WITH INSURANCE HOLDING COMPANY SYSTEMS 
E-ACTOP FILLABLE ACTUARIAL OPINION EXEMPTION GUIDELINES     
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.GFE AUDITED FINANCIAL REPORT EXEMPTION GUIDELINES
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-MG.CEDE   SUPPLEMENTARY SCHEDULE F-5 REPORT
E-MG.MPP FILLABLE REPORT OF POLICYHOLDERS POSITION
E-NAIC.PC FILLABLE ANNUAL FILINGS CHECKLIST
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PREPAID DENTAL PLAN ORGANIZATION
E-176 FILLABLE RECORDS LOCATION INFORMATION     
E-185 OUTLINE FOR COMPLIANCE WITH INSURANCE HOLDING COMPANY SYSTEMS 
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-NAIC.HEALTH   ANNUAL FILINGS CHECKLIST
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PROPERTY / CASUALTY INSURER FILING A HEALTH BLANK
E-176 FILLABLE RECORDS LOCATION INFORMATION     
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-185 OUTLINE FOR COMPLIANCE WITH INSURANCE HOLDING COMPANY SYSTEMS 
E-478 FILLABLE ARIZONA SPECIAL SCHEDULE P REPORT FOR ARIZONA WORKERS' COMPENSATION DEPOSIT
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.GFE AUDITED FINANCIAL REPORT EXEMPTION GUIDELINES
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-NAIC.HEALTH   ANNUAL FILINGS CHECKLIST
E-PC.350 FILLABLE PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURANCE REPORT
E-PC.INDINS FILLABLE REPORT OF POLICIES ISSUED TO INDUSTRIAL INSUREDS
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PROPERTY / CASUALTY INSURER NOT FILING A HEALTH BLANK
E-176 FILLABLE RECORDS LOCATION INFORMATION     
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-185 OUTLINE FOR COMPLIANCE WITH INSURANCE HOLDING COMPANY SYSTEMS 
E-478 FILLABLE ARIZONA SPECIAL SCHEDULE P REPORT FOR ARIZONA WORKERS' COMPENSATION DEPOSIT
E-ACTOP ACTUARIAL OPINION EXEMPTION GUIDELINES     
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.GFE AUDITED FINANCIAL REPORT EXEMPTION GUIDELINES
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-NAIC.PC FILLABLE ANNUAL FILINGS CHECKLIST
E-PC.350 FILLABLE PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURANCE REPORT
E-PC.INDINS FILLABLE REPORT OF POLICIES ISSUED TO INDUSTRIAL INSUREDS
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TITLE INSURER
E-176 FILLABLE RECORDS LOCATION INFORMATION
E-178 FILLABLE CERTIFICATE OF DISCLOSURE
E-185 OUTLINE FOR COMPLIANCE WITH INSURANCE HOLDING COMPANY SYSTEMS 
E-AFR FILLABLE AUDITED FINANCIAL REPORT TRANSMITTAL FORM
E-AFR.GFE AUDITED FINANCIAL REPORT EXEMPTION GUIDELINES
E-AFR.IC FILLABLE AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
E-MDA FILLABLE MANAGEMENT DISCUSSION AND ANALYSIS TRANSMITTAL FORM
E-NAIC.TITLE FILLABLE ANNUAL FILINGS CHECKLIST
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UNAFFILIATED CREDIT LIFE AND DISABILITY REINSURER
E-178UCLDR FILLABLE CERTIFICATE OF DISCLOSURE
E-UCLDR.AS FILLABLE ANNUAL STATEMENT FILINGS WORKSHEET
E-UCLDR.Cert FILLABLE CERTIFICATION
E-UCLDR.I   ANNUAL STATEMENT INSTRUCTIONS
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