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Finance Division

Phone: (501) 371-2673 or (501) 371-2680

Fax: (501) 371-2747

Email: insurance.finance@arkansas.gov

Financial Statement Filings Checklist and Other Required Filings for Insurance Companies

This page contains all of the required Arkansas Specific forms due in 2010. Download each form separately. Each section is color coded and lists all of the required forms for each type of insurance company.

The financial statement checklists

were last updated on January 6, 2010.

LIFE & HEALTH COMPANIES Financial Statement and Other Filings Checklist- (Word) (PDF) Premium Tax Filing Forms Company Financial Regulation Fee (CFRF) Anti Fraud Assessment Advertising Certificate of Compliance Mandatory AR Comprehensive Health Ins Pool Form AR Domestic Insurers- Affiliated Transaction Form	PROPERTY & CASUALTY COMPANIES Financial Statement and Other Filings Checklist- (Word) (PDF) Premium Tax Filing Forms Company Financial Regulation Fee (CFRF) Anti Fraud Assessment Property and Casualty Guaranty Fund Form New ACTS from 2005 Legislative Session ARRUA Premium Reporting Form- Due Annually, March 1st ARRUA Assessment- Due Annually December 31st Earthquake Market Analysis – Due Annually April 1st AR166- Due Annually May 1st Consumer Credit and Credit Scoring Report- Due annually March 31st ACT 1345 County Fire Loss Annual Report- Due Annually, June 1st Mandatory AR Comprehensive Health Ins Pool Form AR Domestic Insurers- Affiliated Transaction Form
FRATERNAL COMPANIES Financial Statement and Other Filings Checklist- (Word) (PDF) Annual Continuation Form Company Financial Regulation Fee (CFRF) Anti Fraud Assessment Advertising Certificate of Compliance- Mandatory AR Comprehensive Health Ins Pool Form	TITLE COMPANIES Financial Statement and Other Filings Checklist- (Word) (PDF) Premium Tax Filing Forms Company Financial Regulation Fee (CFRF) Anti Fraud Assessment Mandatory AR Comprehensive Health Ins Pool Form AR Domestic Insurers- Affiliated Transaction Form
HEALTH COMPANIES Financial Statement and Other Filings Checklist- (Word) (PDF) Premium Tax Filing Forms Company Financial Regulation Fee (CFRF) Anti Fraud Assessment Mandatory AR Comprehensive Health Ins Pool Form AR Domestic Insurers- Affiliated Transaction Form	RISK RETENTION GROUPS Contact Person: Jan Mills Financial Statement and Other Filings Checklist- (Word) (PDF) Premium Tax Filing Forms Mandatory AR Comprehensive Health Ins Pool Form
ACCREDITED AND TRUSTEED REINSURERS Contact Person: Jan Mills Accredited Renewal Information Trusteed Renewal Information	SURPLUS LINES COMPANIES Financial Statement and Other Filings Checklist- (Word) (PDF) Surplus Lines Broker: Premium tax to be paid by the Arkansas licensed broker who produced the business. Foreign Surplus Lines Contact: Kimberly Johnson Alien Surplus Lines Contact: Carol Stiffler Annual Continuation Form Earthquake Market Analysis – Due Annually April 1st Mandatory AR Comprehensive Health Ins Pool Form Information on Surplus Lines Coverage
AUTOMOBILE CLUBS AND/OR ASSOCIATIONS Contact Person: Jan Mills License Renewal Information- Due Annually April 1st	REINSURANCE INTERMEDIARY BROKER AND MANAGER LICENSE Contact Person: Jan Mills License Application- scroll to the bottom of the web page. Renewal Information- Due Annually on January 1st – scroll to the bottom of the web page.

Note: All financial statement filing and Certificate of Renewal fees are included on the premium tax forms. Please do not send a separate check for these two items.

For questions concerning annual filing requirements Click Here or call 501-371-2673