Get Application For Organization Reinsurance Intermediary - Insurance Ca

This guide provides clear instructions for completing the Application for Organization Reinsurance Intermediary form. It is designed to assist users in filling out the form accurately and efficiently in an online format.

Follow the steps to complete your application.

1. Click ‘Get Form’ button to obtain the application and open it in your chosen platform.
2. Choose the organization type by checking the appropriate box for either Corporation, Partnership, or Limited Liability Company. Provide the Federal Employer Identification Number (FEIN) in the required field.
3. Indicate your intended capacity for acting as a reinsurance intermediary by selecting either Reinsurance Intermediary-Broker or Reinsurance Intermediary-Manager.
4. If applicable, specify whether your organization intends to use a fictitious (DBA) name for transacting insurance or reinsurance business by checking 'Yes' or 'No' and listing the name if 'Yes' was selected.
5. Provide the principal business address in the designated fields, ensuring to include the full street address without a P.O. Box.
6. Fill out the mailing address, if different from the principal business address. Again, include a full street address.
7. Answer questions about any previous names used by your organization, verifying past insurance licenses, and detail if your organization has engaged in any business other than insurance or reinsurance.
8. Complete relevant sections for licenses previously held, including attaching additional documents if necessary. Users should list details of any owners, officers, directors, or partners as requested.
9. Confirm any disciplinary actions or criminal convictions related to the organization or its key personnel by selecting 'Yes' or 'No' for the relevant sections and providing required details.
10. If your organization is a Limited Liability Company, complete additional requirements, including a statement on licensees and financial security information.
11. Designate an agent for service of process if the application is for a nonresident organization and ensure this information is accurate.
12. Finally, review the entire application for completeness and accuracy. Prepare to sign and date the form before submitting it.
13. Once completed, save your changes, and download or print the form. Be sure to send the application along with any necessary fees to the appropriate address.

Complete your application for the organization reinsurance intermediary online today.