Get Tpa Application For Name Change - Delaware Insurance Commissioner

This guide will assist you in completing the Tpa Application for Name Change issued by the Delaware Insurance Commissioner. By following these detailed instructions, you can ensure that your application is filled out accurately and submitted correctly.

Follow the steps to successfully complete your form online.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred online editor.
2. Begin filling out the form by entering your new name in the designated field labeled 'NEW NAME.' Make sure to write it clearly and correctly.
3. In the next section, record your old name under 'OLD NAME.' This should reflect the name you are currently using legally.
4. Specify the effective date of this name change in the 'EFFECTIVE DATE' field. Use the format MM/DD/YYYY to avoid confusion.
5. Fill in your home office address. Ensure to provide the complete address in the space provided under 'HOME OFFICE ADDRESS.'
6. Complete the 'ADMINISTRATIVE/MAILING ADDRESS' section. This may be different from your home office address, so make sure to clearly delineate these locations.
7. Provide your main phone number and fax number in their respective fields. These numbers will be used for any follow-up communications.
8. Enter your Federal Employer Identification Number (FEIN) in the appropriate field. This number is essential for processing your application.
9. Sign the document in the field labeled 'BY.' Include your printed name, title, and any other required identification in the next sections for thoroughness.
10. Fill in your complete address and contact information in the designated fields. This helps in ensuring that any correspondence regarding your application can reach you.
11. Finally, indicate the date of submission at the bottom of the form. Review all entries for accuracy before finalizing.
12. Once you have completed the form, you can save your changes, download, print, or share the form as needed for your records.

Begin your online application process now and ensure a smooth name change with the Delaware Insurance Commissioner.