Surplus Lines Broker License Application: Business Entity

The following are requirements for a business entity applying to become a surplus lines broker. The requirements apply to both, businesses that have the principal business address within Arizona (resident) and businesses that have the principal business address in another state (nonresidents), except as otherwise noted:

NOT EVERYONE QUALIFIES FOR AN INSURANCE LICENSE

The Department can deny a license for any cause listed in Arizona Revised Statutes ("ARS") § 20-295. You should review this statute before deciding to spend the time, effort and money (fees are nonrefundable) to apply for a license. If you apply for a license, you must truthfully and completely answer questions asked on the application, and you may need to provide additional documentation.

PROVIDE FINGERPRINTS FOR PRINCIPALS

If the applicant is organized in Arizona and does not already hold an Arizona insurance producer license, if the applicant will be relocating to Arizona from another state, or if the applicant is not currently licensed in the applicant's home state with substantially similar license authority, each member, officer, director, trustee, etc. ("principal") of the applicant must satisfy the following requirements for submitting fingerprints to the Arizona Department of Insurance:

  • Have a clear set of fingerprints applied to the fingerprint card by the professional fingerprinting technician. Prometric, Arizona's insurance examination provider, along with some other vendors, use electronic systems to optically image fingerprints, which tend to produce more accurate results.
  • Make sure that the fingerprinting technician
  • verifies your identity using your government-issued photo ID;
  • completes Form L-FPV (Fingerprint Verification Form);
  • seals the completed Form L-FPV with the completed fingerprint card in a fingerprint card envelope;
  • writes his/her name across the edge of the flap of the envelope so that the upper parts of the letters are on the flap and the lower parts of the letters are off the flap (but on the envelope).
  • Submit the UNOPENED ENVELOPE containing the completed fingerprint card and Form L-FPV along with your license application.
  • Add to your license fee payment the FBI fingerprint card processing fee for each fingerprint card submitted.
IMPORTANT! The Department will refuse to accept a fingerprint card if the fingerprint card envelope appears to have been opened or if the Form L-FPV is not included in the envelope with the card.

PAY REQUIRED (NON-REFUNDABLE) FEES

Non-refundable fees:
SURPLUS LINES BROKER LICENSE FEE

For either

  • Surplus Lines Broker
  • Mexican Insurance Surplus Lines Broker
$500.00

to add authority to an existing license that expires in two years or less

OR
$1,000.00

for authority that expires in more than two years

OTHER INSURANCE LICENSE FEE

One fee per other class of license (insurance producer, insurance adjuster, etc.).  A person who holds more than one line of authority within a class of license only pays one fee (e.g. an insurance producer who holds life, property and casualty lines of authority only pays one $120.00 fee for the insurance producer license class).

$120.00
  • You can pay with a credit card if you submit your application online through the National Insurance Producer Registry (the fastest and easiest way to complete your licensing transaction).
  • You can pay by check or money order, made payable to "Insurance Licensing Section" if you send or deliver your payment with your license application and other required materials to the Department of Insurance.

SUBMIT A LICENSE APPLICATION

Submit your license application: You can either apply online through the National Insurance Producer Registry (NIPR) or you can submit a paper application available at the bottom of this page.  NIPR online applications are almost always processed more quickly than applications submitted on paper. 

AFTER WE HAVE REVIEWED YOUR APPLICATION...

We will review your application and you will receive one of the following:

  • A notice telling you that your application was approved.  Use License Search to view your license on our web site to ensure that your license information appears correctly.  Use the National Insurance Producer Registry (NIPR) to correct or update information.
  • A notice telling you that your renewal application was denied.  The notice will tell you the reason for the denial and will provide you with instructions concerning your right to appeal the decision.
  • A notice telling you that your renewal application was deficient.  This notice will be emailed to you.  You must provide the Department with any additional materials identified in the deficiency notice or accompanying instructions.  You must cure all identified deficiencies or we may deny your license and you will forfeit the fees you paid.
NOTE:  We do not produce paper license certificates.  Licenses are accessible online through the LICENSE SEARCH option on our web site's main menu.

VIEW YOUR LICENSE

Your license will be available from the License Search option on this web site as soon as the Arizona Department of Insurance verifies you meet all license requirements.  You will not receive a printed license certificate. 

License applications can take up to one month to process.  You must not conduct insurance business until you are licensed.

FORM L-193: CERTIFICATE OF ASSUMED NAME

Use this form for each name, other than your genuine legal name, that you intend to use in conjunction with your insurance business.  If you have established a business entity and want to use the name of the business entity in conjunction with your insurance transactions, the business entity must also hold an insurance license. 

Surplus Lines Broker License Application: Business Entity

 

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All insurance professionals (both residents and nonresidents) can apply for licenses, renew licenses, and update addresses and phone numbers online through the National Insurance Producer Registry (NIPR), at www.nipr.com.  

NIPR license and renewal applications are easy to complete, and we can usually process them faster than applications that are mailed to us. NIPR charges a small transaction fee (around $5 to $7) to process a license application and fee payment.  Many people have found that overall, the added convenience plus the time and postage savings are worth paying the fee. 

USE NIPR FOR FREE to change an address, e-mail address or phone number!