Get Ny Captive Biographical Affidavit Form

Filling out the Ny Captive Biographical Affidavit Form online can be a straightforward process when you understand the necessary steps. This guide provides clear instructions to help you accurately complete the form for your captive insurance company.

Follow the steps to successfully complete the Ny Captive Biographical Affidavit Form.

1. Press the ‘Get Form’ button to access the form, which will open in the editor for you to begin filling it out.
2. Provide the full name and address of the captive insurance company at the top of the form. Ensure this information is accurate as it identifies the company involved.
3. Enter your full name in the section labeled 'Affiant’s Full Name.' Remember that initials are not acceptable here.
4. Indicate whether you have ever had your name changed by selecting 'Yes' or 'No.' If 'Yes,' briefly explain the reason for the name change.
5. Fill in your Social Security number and your date and place of birth. This information is crucial for identification purposes.
6. Provide your current business address and business telephone number, ensuring they are up-to-date.
7. List all residences where you have lived in the past ten years, starting with your current address. Include the full address and the dates you lived there.
8. Document your educational history by detailing your high school, college, graduate, and any professional education, including dates, names of institutions, and degrees earned.
9. Record any memberships you hold in professional societies or associations in the designated section.
10. Describe your present or proposed position with the applicant company to clarify your role.
11. List your complete employment record for the past twenty years, including employers' names and addresses, titles held, and dates of employment.
12. Answer whether your current employer may be contacted by selecting 'Yes' or 'No.' Do the same for former employers.
13. Respond to questions regarding fidelity bonds, detailing any past experiences with denial or cancellation of bonds.
14. List any professional, occupational, or vocational licenses you currently hold or have held in the past, including specific details as requested.
15. Answer truthfully about any refusals, suspensions, or revocations of licenses you have faced in the past ten years.
16. Respond to inquiries about bankruptcy or any criminal convictions, providing details if applicable.
17. Continue with questions about your history with insurance companies, particularly any known insolvencies or related issues.
18. Finally, review the information for accuracy, then sign and date the document as the affiant. The form must then be notarized.
19. Once completed, save your changes, and choose to download, print, or share the form as needed.

Start filling out your Ny Captive Biographical Affidavit Form online today to ensure your compliance and readiness.