Get Pa Dl-9106 2013

This guide provides clear instructions on how to complete the PA DL-9106 form online, ensuring that all required information is filled out accurately. Following these steps will help avoid any potential delays in processing your affidavit.

Follow the steps to complete the PA DL-9106 form accurately.

1. Click the ‘Get Form’ button to access the document and open it in your preferred online editor.
2. Initiate by selecting your business type by checking the appropriate box — Individual, Partnership, Corporation, or Non-Profit.
3. Enter your legal business name in the designated field. If applicable, also provide your 'Doing Business As' (D/B/A) name.
4. Fill in the name and title of the person responsible for completing the affidavit.
5. Provide your physical business address, including city, state, and zip code.
6. Input the business telephone number and fax number, followed by your email address and website address, if available.
7. Complete the federal employer identification number (FEIN) field, and if applicable, provide the date and state of incorporation, year established, Dun & Bradstreet number, and NAIC number.
8. List all state licensing information that permits you to operate in the insurance business, including your certificate of insurance/authority number and its expiration date.
9. Identify the location of your records for inspection purposes. If the address is the same as your physical address, check the appropriate box.
10. Outline the ownership structure by listing individuals, partners, or corporate officers participating in the management of the business, including their titles and contact information.
11. Initial each of the eight declaration statements affirming the understanding and accuracy of the information provided.
12. Sign and date the form in the presence of a notary, ensuring all signatures and dates are correctly completed.
13. Mail the completed and notarized affidavit to iiX at the specified address for submission to PENNDOT for approval.
14. Remember that you must complete and resubmit a new affidavit whenever any information about your company changes.

Start filling out the PA DL-9106 online today to ensure compliance and efficiency.