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Get Insurance Company Vs Agency Affidavit Of Intended Use Pennsylvania Form
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How to fill out the Insurance Company Vs Agency Affidavit Of Intended Use Pennsylvania Form online
This guide will provide you with a clear and concise approach to completing the Insurance Company Vs Agency Affidavit Of Intended Use Pennsylvania Form online. Whether you are an individual or representing a business, follow these steps to ensure accurate and efficient submission.
Follow the steps to successfully complete the affidavit form.
- Click ‘Get Form’ button to obtain the Insurance Company Vs Agency Affidavit Of Intended Use Pennsylvania Form and open it in an online editor.
- Select your business type by checking the relevant box: Individual, Partnership, Corporation, or Non-Profit.
- Type or print the Legal Business Name in the provided space, and include the D/B/A Name if applicable.
- Provide the name and title of the person responsible for the affidavit, followed by their business contact information, including the street address, city, state, zip code, business telephone number, fax number, email address, and website address.
- Fill in the Federal Employer ID Number. If your business is a corporation, also include the date and state of incorporation.
- Indicate the year your business was established, Dun & Bradstreet number, and NAIC number if applicable.
- Complete the Licensing Information section by providing your Certificate of Insurance/Authority number, state, and expiration date. Repeat for the Agency or Brokerage License and Agent or Broker License.
- Specify the location of records. If the address is the same as provided above, check the corresponding box.
- List the names, titles, and addresses of all individuals, partners, or corporate officers involved in managing the business. Include additional names as necessary.
- Initial next to each of the eight declaration statements to affirm your understanding and compliance with the commitments outlined in the form.
- Sign and date the form in the presence of a Notary, ensuring the notary's signature and title is also included.
- After completing the form, save your changes, and download a copy. You can then print or share the form as needed for submission.
Complete your Insurance Company Vs Agency Affidavit Of Intended Use Pennsylvania Form online today!
Yes, in Pennsylvania, an affidavit typically must be notarized to be legally enforceable. Notarization helps to verify that the document is authentic and that the affiant signs willingly and knowingly. When completing the Insurance Company Vs Agency Affidavit Of Intended Use Pennsylvania Form, make sure to include notarization to confirm its legal standing.
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