E-AFR.IC.RE (v. 20191104)
Financial Affairs Division
Arizona Department of Insurance
100 North 15
th
Avenue, Suite 261, Phoenix, Arizona 85007-2630
Phone: (602) 364-3999
Web: https://insurance.az.gov
AUDITED FINANCIAL REPORT INTERNAL CONTROL FILINGS TRANSMITTAL FORM
DUE AUGUST 1
GENERAL INSTRUCTIONS: In addition to your Audited Financial Report (AFR), you are required to
file with us internal control documents that are prepared in accordance with the NAIC Annual
Financial Reporting Model Regulation.
THIS E-AFR.IC TRANSMITTAL FORM MUST BE COMPLETED AND ATTACHED TO THE
INTERNAL CONTROL DOCUMENTS THAT ARE FILED WITH US BY AUGUST 1:
• Communication of Internal Control Related Matters Noted in an Audit – Must comply
with Section 11 of the NAIC Annual Financial Reporting Model Regulation.
• Management’s Report of Internal Control Over Financial Reporting – Must comply with
Section 17 of the NAIC Annual Financial Reporting Model Regulation. Not required if
annual premiums are less than $500,000,000.
E-mail completed form to financialfilings@azinsurance.gov
. DO NOT send a hard copy.
Name the document using this format “Internal Control-NAIC Number-Insurer Name” (e.g.
Internal Control-55555-INSURERNAME).
A penalty fee of up to $25 per day may be assessed for any part of your AFR filing that is
filed late. ARS § 20-223.
SPECIAL INSTRUCTION FOR COMPANIES FILING CONSOLIDATED REPORTS:
Each company in the group must separately file a copy of each internal control document with us
along with a transmittal Form E-AFR.IC.RE attached.
IMPORTANT – ENTER THE CALENDAR YEAR OF THE ATTACHED FILING:
Enter the NAIC number and name of the insurance company whose individual
internal control
is attached or on whose behalf a copy of a consolidated internal control document is
Name of Insurance Company
Contact Name Title
Email Address Telephone Number
