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Accounting Division

Phone:  (501) 371-2605

Fax:  (501) 682-6679

Email:  insurance.accounting@arkansas.gov

ANTI-FRAUD ASSESSMENT

 

DUE BY JUNE 30TH EACH YEAR

 

We do not honor the postmark for any filing.  Filings must be received on or before the

due date or late penalties will be assessed in accordance with ACT 337 of 1997; A.C.A.

§23-100-101, ET SEQ.

 

Per Section 3 of Act 337 of 1997: 

 All licensed insurers, including but not limited to all licensed stock and mutual insurance

companies, reinsurers, health maintenance organizations, fraternal benefit societies,

hospital and medical service corporations, stipulated premium insurers, farmers’ mutual aid

associations, and pre-paid legal insurers, shall pay this fee each year by June 30th

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

 

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.

 

Antifraud Assessment-PDF

 

PRIOR YEARS FORMS

 

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