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Tax Forms and Instructions

NEWS:

Please review the following important information:

  • Select your entity type from the menu on the left side of this page to see the requirements applicable to your entity.
  • If you are filing on behalf of an entity that is required to complete the E-TAX workbook, please first review the E-TAX-I instructions, which provides guidance for how to enter information into the workbook.
  • For foreign/alien insurers, the Retaliation Schedule ("Schedule RT") In the E–TAX (Annual Tax and Fees) workbook will display some (but only some) of the taxes, fees, assessments that your domicile imposes on Arizona insurers, and will display all the taxes, fees and assessments that we believe Arizona has imposed upon you. The form has been designed to allow you to change and add to the information that we have presented. Notwithstanding the information that automatically displays or calculates, you are responsible for ensuring that Schedule RT is complete and accurate. Consider reporting additions or corrections to Schedule RT to Chief Operating Officer Scott Greenberg (sgreenberg@azinsurance.gov).
  • Do not submit prior versions of tax forms, even when submitting amendments to prior-year taxes. The E–TAX workbook has been designed so that it can be used for both original and amended tax filings, and will work for tax filings for Calendar Years 2006 through 2011.
  • Review the "UPDATES TO FORMS AND INSTRUCTIONS" section of this page to see recent improvements that may make your filing experience easier.
  • To report errors with forms or instructions, or to suggest ways to improve them, please send e-mail to Chief Operating Officer Scott Greenberg (sgreenberg@azinsurance.gov).

Effective July 21, 2011, House Bill 2112 (Laws 2011, Ch. 136) changed requirements for surplus lines brokers and industrial insureds. Click here for a summary.

GENERAL INSTRUCTIONS:

  • Surplus lines brokers: CLICK HERE
  • Insurers and others: Select the insurer type from the menu on the left side of this page. You will be brought to applicable forms and instructions. By or before the filing deadline to avoid penalties, interest and administrative action (ARS §§ 20-220, 20-223, 20-225, 20-233, et al), either:

    • Use OPTins (click here for details) to file electronically on or before the deadline; or,
    • Complete the appropriate report from this web site and send your taxes, fees, report and other required materials on or before the deadline. Important! You must use Microsoft Excel 2003 or newer to complete Microsoft Excel workbooks.

INSURERS, IMPORTANT! Also visit our Annual Statement Forms And Quarterly Filing Requirements page.

FOR HELP WITH A TAX OR FEE REPORT:

  • For insurers that must complete the E-TAX workbook: First review the E-TAX-I instructions document, which provides guidance on how to enter information into the E-TAX workbook. You may e-mail Chief Operating Officer Scott Greenberg (sgreenberg@azinsurance.gov) any questions not addressed by the E-TAX-I instructions.
  • Surplus lines brokers: Contact The Surplus Line Association of Arizona
    Phone: 602-279-6344 | E-mail: swede@sla-az.org | Web: www.sla-az.org.
  • All other tax/fee filers: Contact the Department of Insurance Tax Unit
    Phone: (602) 364-3997 | E-mail: syepez@azinsurance.gov | Web: www.azinsurance.gov

UPDATES TO FORMS AND INSTRUCTIONS:
To report errors with the workbook or to suggest ways to improve it, please send e-mail to Chief Operating Officer Scott Greenberg (sgreenberg@azinsurance.gov)

  • 04/18/2012: E–TAX was updated to exclude from calculation an entry on Line D16 for an original (not an amended) report.
  • 04/02/2012: E–TAX was updated with some retaliation information for South Carolina domiciled insurers and improved the local/regional tax calculation in SCHEDULE RT.
  • 03/23/2012: E–INSTALL was updated to provide a blank form rather than one partially completed with sample information..
  • 03/19/2012: E–LRTF was updated to automatically display the insurer's NAIC number with a state code in the filename column of the Florida worksheet, and to protect the NAIC number and insurer name fields on the state worksheets. E-TAX was updated to amend the calculations of revenue distributions on the TRANSMITTAL sheet and to improve the clarity of the E-INSTALL worksheet for taxpayers making original tax filings.
  • more... For all recent updates to forms and instructions, click here.

PLEASE HELP US IMPROVE OUR SERVICE TO YOU:
INSURERS AND OTHERS: Forms, Instructions and Deadlines
Business Type
 Filing Deadline Forms and Instructions
Accredited Reinsurer - Foreign/Alien March 1 E–ANNUALFEES (XLS): Annual Fees Report (v. 20120214)
Fraternal Benefit Society - Domestic March 1
Life and Disability Reinsurer - Domestic March 31
Mechanical Reimbursement Reinsurer - Domestic April 1
Qualified Reinsurer - Trust or Based on Surplus February 28
Title Insurer - Domestic March 31
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Business Type
 Filing Deadline Forms and Instructions
Title Insurer - Foreign March 1 E–ANNUALFEES (XLS): Annual Fees Report (v. 20120214)
E–TITLE (PDF): Retaliation Report for a Foreign/Alien Title Insurer
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Business Type
 Filing Deadline Forms and Instructions
Unaffiliated Credit Life and Disability Reinsurer If fiscal year ends December 31st, due August 1;
otherwise, due September 1.		 E-UCLDR (PDF): Unaffiliated Credit Life & Disability Reinsurer Annual Fees Report
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Business Type
 Filing Deadline Forms and Instructions
AHCCCS Contractor March 15,
June 15, September 15,
December 15		 E–QTR (PDF): Quarterly Premium Tax Report
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Business Type
 Filing Deadline Forms and Instructions
Industrial Insured March 1 E–Indins (PDF): Premium Receipts Tax Return for insurance procured from unauthorized insurers on or before July 20, 2011
February 15,
May 15,
August 15,
November 15		 E–II (PDF): Premium Receipts Tax Return for insurance procured from unauthorized insurers on or after July 21, 2011
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Business Type
 Filing Deadline Forms and Instructions
Orphan Premiums Report - Nonadmitted Insurer March 1 E–TAX–ALT (XLS): Premium Receipts Tax Report for orphan premiums from unauthorized insurers
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Business Type
 Filing Deadline Forms and Instructions
Life Care Provider Not applicable No tax for fee due. See Annual Statement Forms And Quarterly Filing Requirements web page.
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Business Type
 Filing Deadline Forms and Instructions
Risk Retention Group - Domestic March 31 (only for RRG's; March 1 for other domestic insurers)

E-LRTF (XLS): Local/Regional Taxes and Fees Paid by Arizona Domestic Insurers. Also see the Captive Insurer Year-end Filing web page (v. 20120319).

  • If you did not conduct business in any state shown on the SUMMARY worksheet, you may file the SUMMARY worksheet and Schedule T on paper.
  • Otherwise, you must submit the E–LRTF workbook in Microsoft Excel 2003 format either as an OPTins attachment or on a CD–ROM.
  • If submitting on a CD-ROM, write "E–LRTF," your NAIC number, the insurer's name and the tax year on the CD–ROM.
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Business Type
 Filing Deadline Forms and Instructions

Employee Benefit Trust or
Voluntary Employees Beneficary Association (with a "Certificate of Exemption")

Fraternal Benefit Society - Foreign/Alien

Health Care Services Organization

Hospital, Medical, Dental and Optometric Service Corporation

Life and/or Disability Insurer

Mortgage Guaranty Insurer

Prepaid Dental Plan Organization

Prepaid Legal Insurer

Property and/or Casualty Insurer

Risk Retention Group - Foreign

Service Corporation

 

 March 1

All insurers listed in this section:

  • E-TAX-I (PDF): Annual Tax and Fees Report Instructions (v. 20120214)
  • E-TAX (XLS): Annual Tax and Fees Report (v. 20120418)
Additionally, you may need one or more of the forms provided below...

If you a domestic insurer:

  • E-LRTF (XLS): Local/Regional Taxes and Fees Paid by Arizona Domestic Insurers (required of all Arizona domestic insurers listed in this section) (v. 20120319).
    • If you did not conduct business as an authorized insurer in any state shown on the SUMMARY worksheet, you may file the SUMMARY worksheet and Schedule T on paper.
    • Otherwise, you must submit the E–LRTF workbook in Microsoft Excel 2003 format either as an OPTins attachment or on a CD–ROM.
    • If submitting on a CD-ROM, write "E–LRTF," your NAIC number, the insurer's name and the tax year on the CD–ROM.

If you are a foreign insurer and the E-TAX workbook tells you to complete the E-TAX-AGENTS workbook:

  • E-TAX-AGENTS (XLS): Insurance Producer Appointments Report (v. 20120209). You must submit this in Microsoft Excel 2003 format on a CD–ROM or as an OPTins attachment. If submitting a CD–ROM, write "E-TAX-AGENTS," your NAIC number, the insurer's name and the tax year on the CD–ROM.

If you are reporting small employer health benefits plan exempt premiums:

  • E-SGHI (XLS): Accountable Health Plan Small Group Health Insurance (v. 20120127). You must submit this in Microsoft Excel 2003 format on a CD–ROM or as an OPTins attachment. If submitting a CD–ROM, write "E-SGHI," your NAIC number, the insurer's name and the tax year on the CD–ROM.

If you are reporting enterprise zone (E-ZONE) credits:

IMPORTANT! To be eligible for an Enterprise Zone Credit: By March 1, you must provide to the Department of Insurance your E–ZONE workbook accompanied by evidence that you submitted your completed Form A and Form A–2 to the Arizona Commerce Authority by or before March 1.

If you are reporting quality jobs tax credits (QJTC):

  • Application for Quality Jobs Tax Credits. Submit an Adobe Acrobat file (PDF) containing a legible, scanned copy of the document that you submitted to the Arizona Commerce Authority, including the signed and dated "Affidavit" (Section H); and,
  • QJTC Form 2 that you submitted to the Arizona Commerce Authority saved in Microsoft Excel 2003 (XLS) format .
  • Submit these files on a CD–ROM or as OPTins attachments. If submitting on CD–ROM, write "QTJC," your NAIC number, the insurer's name and the tax year on the CD–ROM.
If you are reporting military reuse zone (M–ZONE) credits, contact the Department of Insurance Tax Unit by phone at (602) 364-3997 or by e-mail at syepez@azinsurance.gov
March 15,
April 15,
May 15,
June 15,
July 15,
August 15

If the insurer has a premium tax liability of $2,000 or more:

  • E-INSTALL (XLS): Installment Report (v. 20120323) OR you can use the version of E–INSTALL provided in the E–TAX workbook
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SURPLUS LINES BROKERS: Forms, Instructions and Deadlines

HOUSE BILL ("HB") 2112 (LAWS 2011, CH. 136) CHANGED SURPLUS LINES BROKER REQUIREMENTS. Click here for highlights and a link to HB 2112.

DEADLINES FOR TRANSACTIONS EFFECTIVE ON OR AFTER JULY 21, 2011:

  • By February 15,  you must file a report containing :
    • July 1 through December 31 single-state transactions AND
    • October 1 through December 31 multistate transactions
  • By May 15, you must file a quarterly report for January 1 through March 31 multistate transactions;
  • By August 15, you must file a report containing:
    • January 1 through June 30 single-state transactions AND
    • April 1 through June 30 multistate transactions.
  • By November 15, you must file a quarterly report for July 1 through September 30 multistate transactions;

ARS § 20-415

IF YOU DO NOT HAVE AN ARIZONA SURPLUS LINES BROKER INSURANCE LICENSE: Effective July 21, 2011, you must have an Arizona surplus lines broker license to procure insurance for which Arizona is the home state. For insurance procured prior to July 21, 2011, report tax on premiums from multi-state exposures for which the insured's home state is outside Arizona by reviewing Form E-159MS INSTRUCTIONS and then completing Form E-159MS.

IF YOU HAVE AN ARIZONA SURPLUS LINES BROKER INSURANCE LICENSE, you must complete the following steps before the legal deadline to avoid being subject to civil penalties.

Use the Surplus Line Association of Arizona (“SLA”) to report surplus lines transactions. The SLA system accepts both single-state and multistate transactions.

  • For insurance effective prior to July 21, 2011, report each transaction for which some or all of the insured property or risk is located in Arizona. Make sure to enter the correct "original effective date" for the policy, which will cause the SLA system to properly calculate taxes.
  • For insurance effective on or after July 21, 2011, report each transaction for which Arizona is the home state and do not report a transaction for which Arizona is not the home state. Click here for a summary of HB 2112, which includes a description of when Arizona is the home state.

Timely submit your Surplus Lines Tax Report to the Arizona Department of Insurance. The SLA has modified their system to accommodate the new Arizona reporting requirements. .
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