Arizona Department of Insurance

Third Party (Life/Health) Administrator Registration Packet

1) Select a packet type

Packet Type

Apply for Registration

Renew Existing Registration

Update Existing Registration

Report Administrative Action

2) Fill in the following basic information

User Information

First Name*

Last Name*

Email Address*

Applicant Name*

3) Create your packet

NOTE: After you click the [Submit] button, the system will display a page containing your Packet ID. Please record this ID so you can access your packet later.

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