Follow the steps to complete your application accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by filling in the demographic information section. Enter the business entity name, incorporation or formation date (MM/DD/YY), any DBA or trade name, the state of domicile, and the business address along with the phone number and mailing address.
3. Provide additional demographic details, including the FEIN or License number, fax number, business website address, and the email address of the business.
4. In the background information section, carefully read each question. Respond with 'Yes' or 'No' to inquiries regarding criminal convictions, administrative proceedings, or any pending lawsuits. If you answer 'Yes' to any questions, prepare to attach the required documentation as specified in the form.
5. Complete the Applicant’s certification and attestation section. This includes certifying the truthfulness of all information provided, consenting to service of process, and acknowledging understanding of the relevant insurance laws.
6. Ensure that the form is signed and dated by an officer, director, or partner of the business entity. Include the printed name, title, social security number, and relevant address.
7. Finally, attach the payment of $250 in the form of a check or money order payable to the Director of Insurance, and prepare to submit the entire application.
8. After ensuring all information is complete and accurate, save your changes, and download or print the form for your records. You can then proceed to share or send the completed form as required.

Get started on completing your IL IOCI13-139 form online today!