| |
Select
form number below for more information. |
|
| FORM
NO. |
FORM
NAME |
DIVISION |
| AID
AC CFRF |
COMPANIES'
FINANCIAL REGULATION FEE |
ACCOUNTING |
| AID
AC EST-Q |
ESTIMATED
INSURANCE PREMIUM TAX |
ACCOUNTING |
| AID
AC FBS |
ANNUAL
REPORT OF FEES OF ALL FRATERNAL BENEFIT SOCIETIES |
ACCOUNTING |
| AID
AC FMAA-T |
ANNUAL
REPORT OF PREMIUMS AND TAXES OF ALL FARMERS MUTUAL AID ASSOC |
ACCOUNTING |
| AID
AC FPRF |
ANNUAL
REPORT OF PREMIUMS AND TAXES OF AUTHORIZED AND FORMERLY AUTHORIZED
P&C INSURERS FOR THE FIRE PROTECTION PREMIUM TAX FUND |
ACCOUNTING |
| AID
AC HMO-T |
ANNUAL
REPORT OF PREMIUMS, CO-PAYMENTS, TAXES AND FEES OF ALL OF
HEALTH MAINTENANCE ORGANIZATIONS |
ACCOUNTING |
| AID
AC HM-T |
ANNUAL
REPORT OF PREMIUM TAXES HOSPITAL/MEDICAL SERVICE CORP |
ACCOUNTING |
| AID
AC LD-T |
ANNUAL
REPORT OF PREMIUMS, TAXES AND FEES OF ALL LIFE AND ACCIDENT AND HEALTH
INSURANCE COMPANIES |
ACCOUNTING |
| AID
AC LD-T(D) |
ANNUAL
REPORT OF PREMIUMS, TAXES AND FEES OF ALL ARKANSAS DOMESTIC
LIFE AND ACCIDENT AND HEALTH INSURANCE COMPANIES |
ACCOUNTING |
| AID
AC PC-T |
ANNUAL
REPORT OF PREMIUMS, TAXES AND FEES OF ALL PROPERTY & CASUALTY
INSURANCE COMPANIES |
ACCOUNTING |
| AID
AC PC-T(D) |
ANNUAL
REPORT OF PREMIUMS, TAXES AND FEES OF ALL ARKANSAS DOMESTIC
PROPERTY & CASUALTY INSRUANCE
COMPANIES |
ACCOUNTING |
| AID
AC RRG-T |
ANNUAL
REPORT OF PREMIUMS, TAXES AND FEES OF ALL REGISTERED RISK RETENTION
GROUPS |
ACCOUNTING |
| AID
AC SL-2 |
AFFIDAVIT
OF SURPLUS LINE BROKER |
ACCOUNTING |
| AIC
AC SL-4 |
ANNUAL
STATEMENT OF SURPLUS LINE BROKER |
ACCOUNTING |
| AID
AC SLI-T |
ANNUAL
CONTINUATION FEE |
ACCOUNTING |
| AID
AC TI-T |
ANNUAL
REPORT OF PREMIUMS, TAXES AND FEES OF ALL TITLE AND AVIATION
TITLE INSURANCE COMPANIES |
ACCOUNTING |
| SCHEDULE WC |
NOW COLLECTED BY THE ARKANSAS
WORKERS’ COMPENSATION COMMISSION |
|
| AID
AD SPEAKER |
SPEAKER
REQUEST FORM |
ADMINISTRATION |
| AID
CS COMPLAINT |
CONSUMER
COMPLAINT FORM |
CONSUMER
SERVICES |
| AID CS
PROVIDER |
HEALTH
CARE PROVIDER COMPLAINT FORM |
CONSUMER
SERVICES |
| AID-CS-ER |
EXTERNAL REVIEW REQUEST FORM |
CONSUMER
SERVICES |
| AID-CS-ER-EXPEDITED |
CERTIFICATION OF TREATING HEALTH CARE
PROVIDER FOR EXPEDITED CONSIDERATION OF A PATIENT'S EXTERNAL REVIEW
APPEAL |
CONSUMER
SERVICES |
| AID-CS-ER-EXPERIMENTAL |
PHYSICIANS CERTIFICATION
EXPERIMENTAL/INVESTIGATIONAL DENIALS |
CONSUMER
SERVICES |
| AID
CI FRAUD |
UNIFORM
SUSPECTED INSURANCE FRAUD REPORTING FORM |
CRIMINAL
INVESTIGATION |
| AID FI
CP |
ASSIGNMENT
AND PLEDGE OF CERTIFICATE OF DEPOSIT |
FINANCE |
| AID FI
EMLF |
DEPOSIT
AGREEMENT FOR EMPLOYEE LEASING FIRMS/GROUPS |
FINANCE |
| AID FI
NB/CP |
NOTARY
BOND SURETY CORP SECURITY DEPOSIT CERTIFICATE OF PLEDGE |
FINANCE |
| AID FI
NB/SUR |
NOTARY
BOND SURETY CORP SECURITY DEPOSIT-CERTIFICATE OF DEPOSIT |
FINANCE |
| AID FI
NB/SUR |
NOTARY
BOND SURETY CORP SECURITY DEPOSIT |
FINANCE |
| AID FI RDC |
RESERVE
DEPOSIT CHECK FOR LICENSED LIFE &/OR ANNUITY COMPANIES |
FINANCE |
| AID FI
SEC/HMO-1 |
DEPOSIT
AGREEMENT FOR HEALTH MAINTENANCE ORGANIZATION (HMO) |
FINANCE |
| AID FI
SEC/LD-1 |
DEPOSIT
AGREEMENT FOR LIFE AND/OR DISABILITY INSURANCE |
FINANCE |
| AID FI
SEC/MC |
DEPOSIT
AGREEMENT FOR AUTOMOBILE CLUB OR ASSOCIATION |
FINANCE |
| AID FI
SEC/PC-1 |
DEPOSIT
AGREEMENT FOR ALL KINDS OF INSURANCE OTHER THAN LIFE, DISABILITY OR
SURETY |
FINANCE |
| AID FI
SEC/RP |
REGISTERED
POLICIES DEPOSIT FOR LIFE INSURANCE &/OR ANNUITY CONTRACTS |
FINANCE |
| AID FI
SEC/SPL-1 |
DEPOSIT
AGREEMENT FOR SURPLUS LINES INSURANCE CARRIER |
FINANCE |
| AID FI
SEC/SUR-1 |
DEPOSIT
AGREEMENT FOR SURETY INSURANCE ONLY |
FINANCE |
| AID FI
SEC/SVD-1 |
SPECIAL
VOLUNTARY DEPOSIT AGREEMENT |
FINANCE |
| AID FI
SEC/SVD-2 |
SPECIAL
VOLUNTARY DEPOSIT AGREEMENT FOR ALL POLICYHOLDERS & CREDITORS |
FINANCE |
| AID FI
SEC/SVD-3 |
SPECIAL
VOLUNTARY DEPOSIT AGREEMENT |
FINANCE |
| AID
FI
F1 |
APPLICATION
FOR A PREPAID FUNERAL BENEFITS LICENSE |
FINANCE-PREPAID |
| AID
FI
F2 |
APPLICATION
FOR RENEWAL OF A PREPAID FUNERAL BENEFITS LICENSE |
FINANCE-PREPAID |
| AID
FI
F3 |
AGREEMENT
TO HOLD, INVEST AND ADMINISTER PREPAID FUNERAL BENEFITS TRUST |
FINANCE-PREPAID |
| AID
FI
F4 |
CERTIFICATION
OF NET WORTH BY APPLICANT FOR INITIAL LICENSE OR RENEWED LICENSE |
FINANCE-PREPAID |
| AID
FI
F5 |
APPLICANT’S
AFFIDAVIT OF NO EXISTING PREPAID CONTRACTS |
FINANCE-PREPAID |
| AID
FI
F6 |
APPLICATION
FOR CHANGE OF OWNERSHIP OF PREPAID FUNERAL BENEFITS CONTRACTS AND TRUST
FUNDS |
FINANCE-PREPAID |
| AID
FI
F7 |
ASSIGNMENT
AND ACCEPTANCE OF PREPAID FUNERAL BENEFITS CONTRACTS AND TRUST FUNDS |
FINANCE-PREPAID |
| AID
FI
F8 |
TRANSFEREE’S
CERTIFICATION OF NET WORTH IN A CHANGE OF OWNERSHIP TRANSACTION |
FINANCE-PREPAID |
| AID
FI
F9 |
APPLICATION
TO TRANSFER TRUST FUNDS |
FINANCE-PREPAID |
| AID
FI
CA |
CUSTODIAL
AGREEMENT |
FINANCE-PREPAID |
| AID
FI
C1 |
SELLER’S
AFFIDAVIT OF CONTRACT PERFORMANCE: REQUEST TO WITHDRAW FUNDS OR PROCEEDS |
FINANCE-PREPAID |
| AID
FI
C2 |
SELLER’S
AFFIDAVIT FOR CANCELLATION AND REFUND OF PREPAID FUNERAL BENEFITS
CONTRACT PROCEEDS |
FINANCE-PREPAID |
| AID
FI
C3 |
AFFIDAVIT
AND REQUEST OF PURCHASER TO CANCEL A PREPAID FUNERAL BENEFITS CONTRACT |
FINANCE-PREPAID |
| AID-LG-ER-ANNUAL |
INDEPENDENT REVIEW ORGANIZATION
EXTERNAL REVIEW ANNUAL REPORT FORM |
LEGAL |
| AID-LI-AC |
ADDRESS
CHANGE FORM |
LICENSE |
| AID-LI-ADJ |
ADJUSTER
LICENSE APPLICATION |
LICENSE |
| AID-LI-AGY-ADD |
PRODUCER ADDITION FORM |
LICENSE |
| AID-LI-ANF |
ASSUMED
BUSINESS NAME |
LICENSE |
| AID-LI-APT-TERM |
UNIFORM APPOINTMENT/TERMINATION FORM |
LICENSE |
| AID-LI-ARF-RBE |
REPLACEMENT
LICENSE RENEWAL FOR BUSINESS ENTITIES |
LICENSE |
| AID-LI-ARF-RP |
REPLACEMENT
LICENSE RENEWAL FOR PRODUCERS |
LICENSE |
| AID-LI-LS |
LICENSE SURRENDER FORM |
LICENSE |
| AID-LI-CA |
CONSULTANT
APPLICATION |
LICENSE |
| AID-LI-I48 |
AGENT
APPOINTMENT |
LICENSE |
| AID-LI-I48-A |
AMEND
AGENCY APPOINTMENT |
LICENSE |
| AID-LI-I48-AGENCY |
AGENCY
APPOINTMENT |
LICENSE |
| AID-LI-I71 |
APPOINTMENT
TERMINATION |
LICENSE |
| AID-LI-MGA40 |
MANAGING
GENERAL AGENT LICENSE APPLICATION |
LICENSE |
| AID-LI-MGA41 |
MANAGING
GENERAL AGENT COMPANY APPOINTMENT |
LICENSE |
| AID-LI-MGA42 |
MANAGING
GENERAL AGENT TERMINATION OF APPOINTMENT |
LICENSE |
| AID-LI-MGA43 |
MANAGING
GENERAL AGENT BOND |
LICENSE |
| AID-LI-MGA45 |
MANAGING
GENERAL AGENT CONTRACT |
LICENSE |
| AID-LI-CAR |
RENTAL
CAR COMPANY APPLICATION |
LICENSE |
| AID-LI-RP |
RESIDENT
PRODUCER LICENSE APPLICATION |
LICENSE |
| AID-LI-SELF |
SELF-FUNDED,
TRUSTS, METS AND MEWAS |
LICENSE |
| AID-LI-SLB |
SURPLUS
LINES BROKER/PRODUCER LICENSE APPLICATION |
LICENSE |
| AID-LI-SLBB |
SURPLUS
LINES BROKER/PRODUCER BOND |
LICENSE |
| AID-LI-SLBE |
SURPLUS
LINES PRODUCER FOR BUSINESS ENTITY APPLICATION |
LICENSE |
| AID-LI-TA |
TITLE
AGENT |
LICENSE |
| AID-LI-RTA |
TITLE
AGENT REPLACEMENT RENEWAL (ARF) FORM |
LICENSE |
| AID-LI-TAGY |
TITLE
AGENCY |
LICENSE |
| AID-LI-ARF-TI-AGY-R |
TITLE
AGENCY REPLACEMENT RENEWAL (ARF) FORM |
LICENSE |
| AID-LI-AGY-ADD-TI |
TITLE
AGENCY PRODUCER ADDITION |
LICENSE |
| AID-LI-AGY-TERM-TI |
TITLE
AGENCY PRODUCER TERMINATION |
LICENSE |
| AID-LI-TPA |
THIRD
PARTY ADMINISTRATOR |
LICENSE |
| AID-LI-TPA-BOND |
THIRD
PARTY ADMINISTRATOR BOND |
LICENSE |
| AID-LI-UBE |
UNIFORM
BUSINESS ENTITY |
LICENSE |
| AID-LI-AGY-ADD |
BUSINESS
ENTITY PRODUCER ADDITION |
LICENSE |
| AID-LI-UBE-TERM |
BUSINESS
ENTITY PRODUCER TERMINATION |
LICENSE |
| AID-LI-LSBI |
LIFE SETTLEMENT BROKER INDIVIDUAL APPLICATION |
LICENSE |
| AID-LI-LSBE |
LIFE SETTLEMENT BROKER BUSINESS ENTITY
APPLICATION |
LICENSE |
| AID-LI-LSPN |
LIFE SETTLEMENT PRODUCER NOTICE FORM |
LICENSE |
| AID-LH-LSP |
LIFE SETTLEMENT PROVIDER APPLICATION |
LIFE & HEALTH |
| AID-LH-LSPA |
LIFE SETTLEMENT PROVIDER ANNUAL REPORT |
LIFE & HEALTH |
| APCGF-1 |
MANDATORY
PROPERTY & CASUALTY GUARANTY FUND INFORMATION SHEET |
LIQUIDATION |
| AID
PC ADVMAIL |
ADVISORY
ORGANIZATION--UPDATED CONTACT INFORMATION |
PROPERTY
& CASUALTY |
| AID
PC APCS |
AUTOMOBILE
PREMIUM COMPARISON SURVEY |
PROPERTY
& CASUALTY |
| AID
PC ARRUA |
ARRUA
FORM |
PROPERTY
& CASUALTY |
| AID
PC EC |
EARTHQUAKE
COVERAGE REPORT |
PROPERTY
& CASUALTY |
| PEO-P |
PROFESSIONAL
EMPLOYER ORGANIZATION (PEO) APPLICATION |
PROPERTY
& CASUALTY |
| PEO-G |
GROUP
PEO APPLICATION |
PROPERTY
& CASUALTY |
| PEO-E |
PEO
EXEMPT APPLICATION |
PROPERTY
& CASUALTY |
| ESAO-A1 |
EMPLOYER
ASSURANCE SERVICE ORGANIZATION APPLICATION |
PROPERTY
& CASUALTY |
| PEO-C |
CHANGE
OF CONTROL OF A PEO FORM |
PROPERTY
& CASUALTY |
| PEO-PR |
PEO
RENEWAL APPLICATION |
PROPERTY
& CASUALTY |
| PEO-GR |
GROUP
PEO RENEWAL APPLICATION |
PROPERTY
& CASUALTY |
| PC
EL-Quarterly RPT |
PEO
QUARTERLY REPORT |
PROPERTY
& CASUALTY |
| AID
PC F-1 |
FORM
FILING ABSTRACT |
PROPERTY
& CASUALTY |
| AID
PC FEE1 |
FEE
SCHEDULE FOR PROPERTY & CASUALTY INSURERS |
PROPERTY
& CASUALTY |
| AID
PC FEE2 |
MISCELLANEOUS
FEE SCHEDULE |
PROPERTY
& CASUALTY |
| AID
PC H-1 |
HOMEOWNERS
ABSTRACT |
PROPERTY
& CASUALTY |
| AID
PC HPCS |
HOMEOWNERS
PREMIUM COMPARISON SURVEY |
PROPERTY
& CASUALTY |
| AID
PC MHPCS |
MOBILEHOMEOWNERS
PREMIUM COMPARISON SURVEY |
PROPERTY
& CASUALTY |
| AID
PC PG RENEW |
PURCHASING
GROUP RENEWAL REGISTRATION FORM |
PROPERTY
& CASUALTY |
| AID
PC PGAPP |
PURCHASING
GROUP-NOTICE AND REGISTRATION |
PROPERTY
& CASUALTY |
| AID
PC PGMAIL |
PURCHASING
GROUP--UPDATED CONTACT INFORMATION |
PROPERTY
& CASUALTY |
| AID
PC PGRENEW |
PURCHASING
GROUP RENEWAL REGISTRATION FORM |
PROPERTY
& CASUALTY |
| AID
PC RF-1 |
RATE
FILING ABSTRACT |
PROPERTY
& CASUALTY |
| AID
PC RF-2 |
INSURER
RATE FILING |
PROPERTY
& CASUALTY |
| AID
PC RF-WC |
WORKERS'
COMPENSATION ABSTRACT |
PROPERTY
& CASUALTY |
| AID
PC RRFT |
PROPERTY
& CASUALTY TRANSMITTAL DOCUMENT |
PROPERTY
& CASUALTY |
| AID
PC SELF |
REPORT
OF INDEPENDENTLY-PROCURED INSURANCE TAX |
PROPERTY
& CASUALTY |
| AID
PC SLMAIL |
SURPLUS
LINES--UPDATED CONTACT INFORMATION |
PROPERTY
& CASUALTY |
| AID
PC SL-3 |
DISCLOSURE
TO SURPLUS LINE INSURED |
PROPERTY
& CASUALTY |
| AR-3 |
PHYSICIANS
REPORT OF INJURY AND TREATMENT |
PUBLIC
EMPLOYEE CLAIMS |
| AR-D |
DEATH
& PERMANENT TOTAL DISABILITY ACCEPTANCE/UPDATE |
PUBLIC
EMPLOYEE CLAIMS |
| AR-N |
EMPLOYEE'S
NOTICE OF INJURY |
PUBLIC
EMPLOYEE CLAIMS |
| AR-S |
SUPPLEMENTAL
REPORT |
PUBLIC
EMPLOYEE CLAIMS |
| AR-V |
VERIFICATION
OF PERMANENT TOTAL DISABILITY |
PUBLIC
EMPLOYEE CLAIMS |
| AR-W |
WAGE
STATEMENT IMMEDIATELY PRECEDING INJURY DATE |
PUBLIC
EMPLOYEE CLAIMS |
| IA-1 |
WORKERS
COMPENSATION -FIRST REPORT OF INJURY OR ILLNESS |
PUBLIC
EMPLOYEE CLAIMS |
| MILEAGE |
MILEAGE
REIMBURSEMENT FORM |
PUBLIC
EMPLOYEE CLAIMS |
| PECD1 |
EMPLOYEE'S
REPORT OF ACCIDENT-PUBLIC EMPLOYEE CLAIMS DIVISION |
PUBLIC
EMPLOYEE CLAIMS |
| PECD2 |
INFORMATION
REQUESTED BY PUBLIC EMPLOYEE CLAIMS DIVISION |
PUBLIC
EMPLOYEE CLAIMS |
| AID
RM
ADD VEHICLE |
REQUEST
TO ADD VEHICLES TO STATE MASTER VEHICLE POLICY |
RISK
MANAGEMENT |
| AID
PS ADD VEHICLE |
REQUEST
TO ADD VEHICLES TO THE SCHOOL VEHICLE POLICY |
RISK
MANAGEMENT |
