23 CAR pt. 81, Appendix A. Commissioner's Report of Examination

ARKANSAS INSURANCE DEPARTMENT EXHIBIT A COMMISSIONER'S REPORT OF EXAMINATION STATE OF ARKANSAS DEPARTMENT OF INSURANCE APPROVAL OF LICENSE AS A VARIABLE ANNUITY AGENT . ______________________ When validated by the Department Name of Applicant of Insurance, this will be your notice of approval of your qualification for ______________________ a Variable Annuity agent's license. Address Enter Name and Address of broker or dealer and of the company to which approval of Application for Variable Annuity agent's license should be directed. _________________________ LICENSE APPROVED Broker-Dealer Date _________________________ ______________________________ Address Commissioner of Insurance _________________________. TEST SCORE:-EXAMINATION Company Securities Part I __________ Variable Annuities Part II __________ _________________________ If Test Waived, Indicate Variable . Contract Regulation Section Conferring Exemption _________________________ If a "securities examination" score (other than Part I of the NAIC examination) is offered in satisfaction of the requirement of Paragraph 9.3 of the Regulations, identify the test and score below. NAME OF TEST ______________________ TEST SCORE ________________________