Authorized Signatures For Agent Licensing

ARKANSAS INSURANCE DEPARTMENT LEGAL DIVISION 1200 West Third Street Little Rock, AR 72201-1904 501-371-2820 FAX 501-371-2629 Bulletin 10-95 September 26, 1995 AUTHORIZED SIGNATURES FOR AGENT LICENSING This bulletin supersedes all bulletins regarding authorized signatures for agent appointment and agent appointment deletion forms. Effective October 1, 1995, the Arkansas Insurance Department will institute new programming for the record keeping of signatures of company officials that are authorized to appoint or delete the appointment of agents for the company. The companies are required to submit a sample signature of all officials authorized to appoint agents on Form AA 1. The form must be completed and received by the License Division of the Insurance Department no later than November 1, 1995. A sample of Form AA 1 is attached to this bulletin, and must be reproduced for the company’s submission of authorized individuals for the November 1, 1995 deadline. No other format will be accepted as the company’s authorization. This AA 1 form submittal will supersede any present information contained in the Department’s files. If the company desires proof of processing by the License Division, the company is required to submit a duplicate copy of the completed form and a stamped, self-addressed envelope. The duplicate copy will be validated and returned to the company for the company’s records. All future additions or deletions of authorized individuals must be submitted on Form AA 2. A sample of Form AA 2 is attached to this bulletin, and must be reproduced for the company’s submission for all amendments of the authorized signature list. No other format will be accepted as the company’s authorized amendment of authorized signatures. If the company desires proof of processing by the License Division, the company is required to submit a duplicate copy of the completed form and a stamped, self-addressed envelope. The duplicate copy will be validated by the License Division and returned to the company for the company’s records. Any questions concerning this bulletin should be directed to Fred Stiffler, Jr. Director, License Division of this Department, at (501) 686-2840. Lee Douglass INSURANCE COMMISSIONER Bulletin 10-95 FORM AA 1 ARKANSAS INSURANCE DEPARTMENT 1123 SOUTH UNIVERSITY, SUITE 400 LITTLE ROCK, ARKANSAS 72204 PHONE (501) 686-2840 LEE DOUGLASS, INSURANCE COMMISSIONER Page _____ of _____ pages Name of Company ________________________________________________________________ Company NAIC #: __________________ Date form completed: ____________________________ Name of Individual Completing this form: _____________________________________________ Phone Number of above individual: (__ ) ____ - _______ Ext._________________________ ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) ________________________________________ ______________________________________ (Sample Signature) (Type Name of Signature) 2 FORM AA 2 ARKANSAS INSURANCE DEPARTMENT 1123 SOUTH UNIVERSITY, SUITE 400 LITTLE ROCK, ARKANSAS 72204 PHONE: (501) 686-2840 LEE DOUGLASS, COMMISSIONER OF INSURANCE Amendment to Company’s Authorized Signature List: Company’s Name: ________________________________________________________________ Company NAIC #: _______________ Please ________________________________ (ADD or DELETE) __________________________________ from the company’s list of authorized (Type Name of Individual) individuals to appoint agents or delete agent appointments for the above company/ I hereby authorize this amendment to our company’s approval individuals list at the Arkansas Insurance Department. _________________________________________________ Typed Name of Official _________________________________________________ Signature of Official _________________________________________________ Date Signed 3