Get Multiple Employer Welfare Arrangements - Alaska Department Of ...

This guide will provide you with comprehensive and user-friendly instructions on how to effectively complete the Multiple Employer Welfare Arrangements form for the Alaska Department of Commerce, Community, and Economic Development. By following these steps, you can ensure that all required information is accurately provided for your Certificate of Authority application.

Follow the steps to fill out the form accurately and efficiently.

1. Click the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Begin filling out the form by entering the name of the applicant in the designated field. If this is an amendment to change the name, indicate the former name as well.
3. Complete the home office address, mailing address, telephone, fax, and email address fields accurately.
4. Provide the premium tax statement address along with the corresponding telephone, fax, and email information.
5. Indicate the state of domicile and federal identification number in their respective fields.
6. Fill in the date of the last amendment of the charter and bylaws, as well as the date of the subscribers agreement, if applicable.
7. Specify whether the organization is a non-profit by marking 'Yes' or 'No.'
8. Provide details about the organization’s trade, profession, or industry, as well as information on soliciting business in Alaska.
9. Indicate whether you have contracted with a licensed third-party administrator and provide their name and license number if applicable.
10. State how many employees the arrangement will provide benefits for, and how many will participate.
11. Answer questions regarding public participation and licensing of insurance producers.
12. Complete the verification statement by having it signed by an officer of the applicant before a Notary Public.
13. Prepare all additional required documents listed in the application, such as financial statements and operational plans, before final submission.
14. Review the completed form and all attachments for accuracy, then save your changes, download the form, print, or share as necessary for submission.

Take the next step and complete your Multiple Employer Welfare Arrangement application online today.