Get Pa Dl-9106 2022-2025

The PA DL-9106 form is essential for insurance companies and agencies to affirm their intended use of driver record information. This guide will provide you with clear, step-by-step instructions on how to efficiently complete the form online.

Follow the steps to complete the PA DL-9106 online.

1. Click the ‘Get Form’ button to obtain the document and access it in your browser.
2. Indicate whether this submission is an update to an existing subaccount by selecting 'Yes' or 'No'. If 'Yes', enter the current subaccount number.
3. Fill in the insurance company/agency details, selecting the appropriate business type from options like individual, partnership, corporation, or non-profit.
4. Provide the legal business name and, if applicable, the d/b/a (doing business as) name.
5. Enter the person's name responsible for the submission, along with their title.
6. Complete the physical address, city, state, and zip code fields.
7. List the business telephone number, fax number, email address, and website address.
8. Fill in the Federal Employer ID number, and for corporations, provide the date and state of incorporation.
9. Indicate the year the business was established and include the Dun & Bradstreet number and NAIC number if applicable.
10. Provide the licensing information, including the certificate of insurance/authority number, state, and expiration date.
11. List each partner or corporate officer involved in the business management, including their name, title, phone number, and email address.
12. Initial each declaration statement to affirm compliance with the stated intents and then sign the form in the presence of a notary.
13. After completing the form, ensure it is notarized and prepare it for submission to your information provider.
14. Lastly, save all changes, and opt to download, print, or share the completed form as needed.

Begin the process of completing the PA DL-9106 online today!