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For Department Use OnlyRequest #: IF ARIZONA DEPARTMENT OF INSURANCE PUBLIC RECORDS REQUEST FORM www.azinsurance.gov Please mail fax or deliver this form to:(DIV)Date Received: / /20 Life and Health
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Start by carefully reading and understanding each question or section of the division.
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Provide accurate and truthful information about your personal details, such as name, address, birthdate, and contact information.
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Answer the questions related to your health history, including any pre-existing conditions, past medical treatments, surgeries, and medications.
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Include information about your life insurance coverage if applicable, including policy numbers and other relevant details.
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Who needs life and health division?

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The life and health division is a section of a company that focuses on insurance products related to life and health coverage.
Any insurance company or organization offering life and health insurance products is required to file the life and health division.
The life and health division can be filled out by providing detailed information on insurance policies, claims, premiums, and other relevant data related to life and health insurance products.
The purpose of the life and health division is to track and report on the performance and financial status of life and health insurance products offered by the company.
Information such as policyholder data, claims data, premium income, reserves, and other relevant financial and operational information related to life and health insurance products must be reported on the life and health division.
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