Phone: (501) 371-2605
Fax: (501) 682-6679
DUE BY JUNE 30TH EACH YEAR
We do not honor the postmark for any
filing. Filings must be received on or before the
· Per Section 3 of Act 337 of 1997:
All licensed insurers, including
but not limited to all licensed stock and mutual insurance
· Surplus line insurers and registered risk retention groups are not required to file this fee.
· Payment must be made payable to:
STATE INS DEPT
CRIMINAL INVESTIGATION DIV TRUST FUND
IF YOU NEED A COPY OF OUR W-9, YOU CAN PRINT
ONE FROM OUR ACCOUNTING DIVISION
· Please read the instructions attached to the form before completing.
Mail the form and your payment to: ARKANSAS INSURANCE DEPT
ATTN: ACCOUNTING DIVISION
1200 WEST THIRD STREET
LITTLE ROCK AR 72201-1904
The form must be completed online and then printed off to mail with your check.