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Arizona: NIPR Paper Licensing
Arizona: Paper Licensing

This page provides state-specific checklists, application forms and contacts for paper resident and non-resident licensing in the State of Arizona.

 

Non-Resident Licensing Checklist for Business Entities

Appointment Requirements
  • None
Financial Responsibility
  • None
Other Requirements
  • Applicants for the nonresident adjuster line of authority MUST utilize Arizona form L-176 and follow the instructions specific to adjusters.Nonresident adjuster applicants may not apply electronically or with the uniform application.

  • The Electronic Nonresident Licensing (e-NRL) process and the Uniform Business Entity Application may only be used in Arizona by a non-resident applicant licensed by the applicant's home state. Arizona-resident business entities must use Arizona's Form L-176, available from the PRODUCERS page of the Arizona Department of Insurance web site.

    License fees are non-refundable. Attach a non-refundable check or money order payable to "Insurance Licensing Section" as follows:

    • $120 for one or more license lines of authority other than surplus lines (regardless of the number of license lines of authority)
    • $1,000 for surplus lines license authority;
    • $1,120 for surplus lines authority and one or more other-than-surplus-lines license lines of authority
  • Although not required as a qualification for an insurance license, a business entity incorporated or organized in another state is generally required to obtain approval from the Arizona Corporation Commission [(602) 542-3135, or www.azcc.gov/Divisions/Corporations ] prior to operating a business in Arizona.

  • A business that wants to use a name in conjunction with insurance business that is different than the business's genuine, legal name, must submit "Form L-193: Certificate of Assumed Name" to the Insurance Licensing Section.

    A business that wants to reserve an assumed business name as a trade name in Arizona (to prevent the use of the business name by someone else) must register the trade name with the Arizona Secretary of State
    [website: www.azsos.gov; phone: (602) 542-6187].

  • The application must be signed by a member, officer or director or DRLP of the business entity.

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Non-Resident Licensing Checklist for Individuals

Appointment Requirements
  • None
Financial Responsibility
  • None
Other Requirements
  • Applicants for the nonresident adjuster line of authority MUST utilize Arizona form L-169 and follow the instructions specific to adjusters. (http://www.azinsurance.gov/producers/forms/form_l-169.pdf) Nonresident adjuster applicants may not apply electronically or with the uniform application.
  • The Electronic Nonresident Licensing (e-NRL) process and the NAIC Uniform Application may only be used in Arizona by a non-resident applicant licensed in the applicant's home state. Arizona residents must use Arizona's Form L-169, available from the PRODUCERS page of the Arizona Department of Insurance web site (http://www.azinsurance.gov/ ).
  • License fees are non-refundable. If sending a paper version of the NAIC Uniform Application, attach a check or money order payable to "Insurance Licensing Section" as follows:

    • $1,000 for surplus lines license authority;
    • $120 for one or more license lines of authority other than surplus lines (regardless of the number of license lines of authority)
    • $1,120 for surplus lines authority and one or more other-than-surplus-lines license lines of authority
  • No letter of certification is required.

    A person who wants to use a name in conjunction with insurance business that is different than the person's genuine, legal name, must submit "Form L-193: Certificate of Assumed Name" to the Insurance Licensing Section. A person who wants to reserve an assumed business name as a trade name in Arizona (to prevent the use of the business name by someone else) must register the trade name with the Arizona Secretary of State [website: www.azsos.gov; phone: (602) 542-6187].

  • Please make sure to sign the application.

Note: AZ applicants must agree that they are not applying for a producer license for the use of principally procuring insurance that covers themselves, a member of their family or relatives to the second degree, their own personal property or insurable interests and/or the property or insurable interests of their relatives to the second degree, their employer or employees, or a firm or corporation in which they own a substantial interest or of which they are an employee. [Arizona Revised Statutes 20-285 (B)(1-5)]

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DISCLAIMER

The National Insurance Producer Registry ("NIPR") populates the State Matrix of Business Rules ("State Matrix") with information provided directly from participating state insurance departments. Participating states are encouraged to provide updated information when appropriate. NIPR does not guarantee the completeness, accuracy or adequacy of the information in the State Matrix. The information in the State Matrix does not constitute legal advice and use of this information is at user's own risk and responsibility. Any questions regarding the interpretation of the rules or the accuracy of the information should be directed to the appropriate state insurance department.

Uniform Application for Business Entities

 

Uniform Application for Individuals

NON-RESIDENT LICENSING

Arizona does accept the Uniform Licensing Application for nonresident business entities and individuals.

RESIDENT LICENSING

Arizona does accept the Uniform Licensing Application for resident business entities or individuals.

CONTACT INFORMATION

Mail Applications to:
Arizona Department of Insurance 

Insurance Licensing Section
100 N 15th Avenue, Suite 261
Phoenix, Arizona 85007-2630

Non-Resident Contacts

Business and Individual 
licensing@azinsurance.gov
Phone: 602-364-4457