Arkansas Insurance Department

AID Home
Accounting Home

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

·         IF YOU NEED A COPY OF OUR W-9, YOU CAN PRINT ONE FROM OUR ACCOUNTING DIVISION
WEBPAGE

 

·         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.

 

                                       ANTI-FRAUD ASSESSMENT FORM & INSTRUCTIONS