Licensing Section
Arizona Department of Insurance
100 North 15
th
Avenue, Suite 102, Phoenix, Arizona 85007-2624
Phone: (602) 364-4457 | Toll-free: (877) 660-0964
Web: https://insurance.az.gov | E-mail: Licensing@azinsurance.gov
L-152 Revised June 2018
FORM L-152: LICENSING ELIGIBILITY REQUIREMENT
Last Name First Name Middle Name
Residence Address (as shown
on license or license application):
City, State and ZIP code
Arizona Revised Statutes § 41-1080 requires you to submit ONE of the 13 forms of identification listed
below. If the identification document does not include a photograph, you must also submit a form of
government-issued identification that includes a photograph.
1. An Arizona driver license issued after 1996 or an Arizona non-operating identification license.
2. A driver license issued by a state that verifies lawful presence in the United States. Driver
licenses from IL, NM, UT, and WA are not acceptable.
3. A birth certificate or delayed birth certificate issued by any state, territory or possession of the
United States AND go
vernment-issued identification with a photograph
.
4. A United States certificate of birth abroad AND government-issued identification with a
photog
raph.
5. A United States passport.
6. A foreign passport with a United States visa.
7. An I-94 form AND government-issued identification with a photograph.
8. A United States citizenship and immigration services employment authorization document or
refuge
e travel document that contains a photograph.
9. A United States certificate of naturalization containing a photograph.
10. A United States certificate of citizenship containing a photograph.
11. A tribal certificate of Indian blood AND government-issued identification with a photograph.
12. A tribal or bureau of Indian affairs affidavit of birth AND government-issued identification with a
photog
raph.
13. Any other license that is issued by the federal government, any other state government an agency
of this state o
r a political subdivision of this state that requires proof of citizenship or lawful alien
status before issuing the license AND government-issued identification with a photograph.
By my signature below, I hereby certify, unde
r penalty of perjury that the copy of each document I am
providing is a true and accurate copy of the original document and that I am legally authorized to be
present in the United States.
FULL SIGNATURE OF LICENSEE DATE
