Donor Annuity Issuer's Contact Person: Donor Annuity Issuer's FEIN: STATE OF: COUNTY OF: , (both printed please), of the above named issuer, being duly sworn, each deposes and says that they are the above described officers of the said issuer, and that on , which is the fiscal year-end, the issuer has met all of the requirements of Section 627.481, FS., and Chapter 69O-202, Florida Administrative Code. (Typed Name) (Typed Name) (Signature) (Signature) (Title) (Title) Subscribed an.
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How to fill out the FL OIR-A3-1209 online
Filling out the FL OIR-A3-1209 form online is a straightforward process that allows you to submit important information related to donor annuity agreements. This guide will provide you with a clear, step-by-step approach to ensure that you complete the form accurately and efficiently.
Follow the steps to complete the form online:
- Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Enter the donor annuity issuer's name in the designated field at the top of the form. Make sure to provide the full and correct name to avoid any processing delays.
- Fill in the address details, including the street, city, state or province, and zip or postal code. Accurate information here is crucial for correspondence.
- Provide a contact phone number and extension, if necessary, for any follow-up communications regarding the form.
- If you wish to receive clarifications and communications via email, check the corresponding box and input your email address in the provided field.
- Enter the name of your contact person within the organization, followed by the Federal Employer Identification Number (FEIN) assigned to the donor annuity issuer.
- State the county and state where the donor annuity issuer is located by filling in the respective fields.
- Below the declaration section, enter the names and titles of the officers from the issuer who are completing and signing the statement.
- Each officer must sign and date the document. It is essential that these signatures be legible and match the printed names provided.
- Complete the notary section, which includes the notary's commission number and expiration date, as well as details about the identification produced. Ensure that this section is finalized according to your state's requirements.
- Once you have filled out all necessary fields, you can utilize the 'Save' button to store your progress periodically or 'Submit Final' once all data is complete. Remember that submission is final and cannot be edited afterward.
- After selecting 'Submit Final', finalize the submission process by clicking on 'Begin Submission Process' to ensure your filing is successfully sent to the Office of Insurance Regulation.
Start completing your FL OIR-A3-1209 form online today to ensure timely submission and compliance.
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