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Applicant Name NAIC No. FEIN Uniform Consent to Service of Process Original Designation Amended Designation must be submitted directly to states Insurer Name Previous Name if applicable Home Office Address City State Zip NAIC CoCode The entity named above organized under the laws of for purposes of complying with the laws of the State s designate hereunder relating to the holding of a certificate of authority or the conduct of an insurance busine.

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How to fill out the 03 45636377 online

Filling out the 03 45636377 form online is a straightforward process that requires careful attention to detail. This guide will walk you through each section of the form to ensure you complete it accurately.

Follow the steps to successfully fill out the form.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Fill in the Applicant Name at the top of the form, making sure to include any necessary identifiers like the NAIC number and FEIN number.
  3. Indicate whether you are submitting an Original Designation or an Amended Designation, marking the appropriate checkbox.
  4. Complete the Insurer Name field, ensuring it matches the official name of the entity.
  5. If applicable, include the Previous Name of the entity in the designated field.
  6. Enter the Home Office Address, including city, state, and zip code, with particular attention to accuracy.
  7. Provide the NAIC CoCode associated with your entity.
  8. In the consent section, ensure you clearly understand the legal implications before signing. An authorized officer needs to sign and date the document.
  9. Complete Exhibit A by placing an 'X' next to the names of all the states where the designated agent is appointing for service of process.
  10. If applicable, complete Exhibit B, which lists the entities with full names and addresses where service of process will be forwarded.
  11. Review the Resolution Authorizing Appointment of Attorney section, ensuring it's signed by the authorized officer and the Secretary.
  12. After completing all sections, save your changes, and consider downloading, printing, or sharing the completed form as required.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232