Get For Department Use Only - California Department Of Insurance ...

Filling out the For Department Use Only form for the California Department of Insurance is a vital step for businesses seeking a Life Settlement Broker License. In this guide, we will walk you through the process of completing this form online, ensuring you have all the necessary information for a successful submission.

Follow the steps to effectively complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Business entity types: Indicate the type of business entity by checking only one box. The options include Limited Liability Company, Corporation, Nonprofit Corporation, General Partnership, Unincorporated Association, and Limited Liability Partnership/Limited Partnership.
3. Enter the business entity name in the field provided, making sure to type it clearly.
4. Input your Federal Employer Identification Number in the designated space.
5. Provide the business address, ensuring it is a physical address (P.O. Box is not acceptable). Confirm that all address details, including city, state, and zip code, are accurate.
6. Fill in the business phone number, ensuring the area code is included.
7. If applicable, enter your business email address for correspondence.
8. Specify the mailing address where correspondence should be sent (P.O. Box is acceptable).
9. Answer the fictitious name question: indicate whether the business entity intends to use a fictitious name, and if yes, list that name.
10. Provide information about any alternate names the business has used and include reasons if applicable.
11. Answer whether the business entity has ever held an insurance license in any state, including California. If yes, provide all relevant details.
12. Identify all Designated/Responsible Licensed Life Settlement Brokers by submitting their names, Social Security Numbers, and license numbers.
13. In the Background Information section, answer the questions concerning criminal history, administrative proceedings, and legal obligations. Attach required documentation if applicable.
14. Complete the Applicant’s Certification section by ensuring it is signed and dated appropriately by all necessary parties.
15. Review the entire application for completeness and accuracy before final submission.
16. Once filled out, users can save changes, download, print, or share the form as needed.

Complete your documents online today for a smoother application process!