Arizona Insurance Form Form L 169

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Arizona insurance form form l 169. The following requirements apply to both arizona residents and residents of other states nonresidents except as otherwise noted. R4 9 118 a send me a complaint form. Information concerning arizona insurance licenses is available at no charge from the license search menu option on our web site. Thu 09 11 2014 12 12.

Interactive forms may be opened online or downloaded to your pc and completed at a later time when offline. Nipr online applications are generally processed more quickly than applications submitted on paper. If you choose option two three or four mail your completed application to. When calling this number follow the step by step instructions to order receive the desired form by fax or mail.

Any insurer failing to pay taxes on time shall be charged a penalty of the greater of twenty five dollars or five percent of the tax due plus interest at the rate of one percent per month from the date the tax was due. Use this form to submit witness and exhibit evidence lists prior to a hearing as required by a a c. Insurance companies and the public are. Phoenix arizona 85007 2812.

Please direct questions regarding the filing of all workers compensation taxes to email protected or call 602 542 1836. Nipr applications are processed more quickly. Certificate of understanding eng span ub 99 y this form is to be completed and returned only if instructed by des unemployment insurance personnel to do so. Arizona department of revenue license registration section p o.

Interactive forms enable the user to enter information directly into the forms. Please use this form only if instructed to do so by des. Form l 176 if the applicant is a business entity. Arizona department of insurance form l 169.

You can either apply online through the national insurance producer registry nipr or you can submit a paper application form l 169 if the applicant an individual. Find in google maps phone. If you surrender insurance license authority arizona law prevents you from reapplying for the surrendered authority for one year. To receive a form ordered from this number by fax you must call from a fax line.

Forms which require a signature or other type of manual authentication need to be printed signed or authenticated then transmitted to this office. Arizona department of insurance 100 north 15th avenue suite 261 phoenix az 85007 2630 starting july 1 2020 we will be the department of insurance and financial institutions difi.