REINSURANCE INTERMEDIARY BROKER
Name:
________________________________________________
1. Name
and address of applicant.
2. Name
and address to be used in license.
3. Names
and biographical information of each such person to act as
or on the behalf of the reinsurance intermediary.
- This information must be kept current.
4. Affidavit
naming the Arkansas Insurance Commissioner as agent for service of process,
with the same effect as service to the licensee.
- This is a condition precedent to obtaining and/or
maintaining any license issued by the Arkansas Insurance Commissioner.
5. Affidavit
naming a resident of the State of
- This is a condition precedent to obtaining and/or
maintaining any license issued by the Arkansas Insurance Commissioner. No changes shall be effective until
acknowledged by the Commissioner.
6. Affidavit
from an authorized representative of the applicant that all such transactions
performed under the license shall provide the required contract provisions as
stated in Ark. Code Ann. §23-62-405.
7. Affidavit
from an authorized representative of the applicant that the licensee shall be
subject to the regulatory authority of the Arkansas Insurance Commissioner and
the Courts of the State of
8. a. THREE HUNDRED
DOLLAR ($300) fee for initial application
(nonrefundable).
b. SEVENTY-FIVE
DOLLAR ($ 75) fee for renewal (annual).
c. SEVENTY-FIVE
DOLLAR ($ 75) fee for designation of
Commissioner
as agent for service of process.
9. Annual
Financial Statement.
10. Copy of Certificate of Errors &
Omissions Policy.
*For
yearly renewal of Reinsurance Intermediary Broker status, the company should
acknowledge that all licensing information is current and remit the renewal
fee.
Submit
all of the above-required information to the attention of:
Angela Davis, Mgmt Project Analyst II
Arkansas Insurance Department
1200 West Third Street
Little Rock, AR 72201-1904
501-683-0231, fax 501-371-2747