Licensing Forms Index

The following is a list of licensing-related forms and instructions.

NEW LICENSE APPLICATIONS AND INSTRUCTIONS

Electronic Resident License (ERL) Application

  • Navigate to the National Insurance Producer Registry web site (www.nipr.com);
  • Find the section entitled "Resident" in the left column and select the Initial License link.
  • Review the "State Specific Requirements" for Arizona before beginning your application.
  • Select the "Begin ERL Application" link to complete your application.

Electronic Non-Resident License (ENRL) Application

  • Navigate to the National Insurance Producer Registry web site (www.nipr.com);
  • Find the section entitled "Non-Resident" in the left column and select the Initial License link.
  • Review the "State Specific Requirements" for Arizona before beginning your application.
  • Select the "Begin NRL Application" link to complete your application.

Application for an Individual Insurance License (Form L-169). An individual (resident or nonresident) can use this form to apply for a license as insurance producer, adjuster, bail bond agent, managing general agent, surplus lines broker, Mexican insurance surplus lines broker, or municipal risk management consultant.

Application for a License for a Business Entity (Form L-176). A business entity (resident or nonresident) can use this form to apply for a license as insurance producer, adjuster, bail bond agent, managing general agent, surplus lines broker, or Mexican insurance surplus lines broker. NOTE: Arizona does not license sole proprietorships as business entities.

Application for a Limited Line Business Entity Agent License (Form L-LTD). A business entity (resident or nonresident) can use this form to apply for a Portable Electronics Agent license, Rental Car Agent license, or Self Service Storage Agent license.

Application for a Temporary License (Form L-TEMP). An individual can use this form to apply for a temporary license under the conditions set forth in ARS § 20-294.

LICENSE RENEWAL APPLICATIONS AND INSTRUCTIONS 

National Insurance Producer Registry (NIPR). Update a licensee's address and telephone information, or renew a license.

License Renewal Application for an Individual (Form L-191). ONLY COMPLETE AND SUBMIT FORM L-191 (with required fees and other required materials) if you cannot use IPLUS to renew your license or print your renewal application..

License Renewal Application for a Business Entity (Form L-192)

OTHER LICENSING-RELATED FORMS

Licensing Eligibility Requirement (Form L-152). Each individual who is an Arizona resident and each individual applying for an adjuster or bail bond license (resident or nonresident) must complete this form and attach a copy of a required for of identification to be eligible for a license.

Report of a Change to Members, Officers or Directors (Form L-177). The designated responsible producer of a business entity must complete this form to report each change to the business entity's members, officers or directors. 

Certificate of Assumed Business Name (Form L-193). Complete and submit this form (whether you are an individual or business entity) to engage in business using a name other than your legal name.

Bond Of Bail Bond Agent (Form L-195). A bail bond agent must maintain a $10,000 bond in favor of the state. A power of attorney must accompany the bond.

NIPR Address Change Request (ACR). Individuals can use the NIPR ACR at no charge to report changes to addresses or phone numbers.

Bail Bond Agent Annual Report (Form L-BBAR). By April 1 each year, each bail bond agent must submit an annual report that lists all bail recovery agents that the bail bond agent employed, hired as independent contractor or otherwise utilized during the immediately preceding calendar year.

Notice of Bail Recovery Agent Utilization (Form L-BRA). Within 24 hours after retaining, employing, hiring as an independent contractor or otherwise utilizing a bail recovery agent, a surety company or bail bond agent must complete and submit this form.

Bail Recovery Agent Fingerprint Submission Registration (Form L-BFP). An individual must submit this form with fingerprints professionally applied to a fingerprint card before acting as a bail recovery agent.

License Information Change (Form L-CHG). An individual or business entity can use this form to report a change to the licensee's name (use Form L-193 to request permission to use an "assumed name"/"DBA"). A business entity must report changes to their primary business address and telephone number using this form.

Letter of Clearance Request (Form L-CLR). Use this form if you are relocating from Arizona to another state.

Letter of Certification Request (Form L-CRT)

Business Entity Branch Locations (Form L-LOC). Complete and submit this form to disclose branch locations and the desiganted responsible licensed producer (DRP) at each location.  

Voluntary Surrender of Insurance License (Form L-SURR). If you are moving from Arizona and wish to convert your Arizona resident license to an Arizona nonresident license, use Form L-CLR instead. Only use this form to permanently surrender a line of authority or your entire Arizona insurance license. You must wait at least one year before being eligible to reapply for a surrendered line of authority or a surrendered insurance license.

Arizona Application for Consent to Engage in the Business of Insurance under 18 USC § 1033. Complete this form if you have been convicted of a felony that you have not reported on an Arizona insurance license or renewal application. Complete this form if you have been convicted of an 18 USC § 1033 offense even if you disclosed it on an Arizona insurance license or renewal application.

 

 

APPLICATION REQUIREMENTS

Click on a license type listed below for a summary of application requirements.


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