Blank Arkansas Aid Li Tagy PDF Form

Blank Arkansas Aid Li Tagy PDF Form

The Arkansas Aid Li Tagy form is a crucial document required by the Arkansas Insurance Department for businesses seeking a title agency license. This form collects essential information about the business entity, including ownership details, contact information, and background checks. Completing this form accurately is vital for compliance and to ensure the smooth processing of your application; click the button below to get started.

The Arkansas Aid Li Tagy form is a crucial document for businesses seeking to operate as licensed title agencies in the state. This form, officially known as FORM AID-LI-TAGY, is managed by the Arkansas Insurance Department's License Division and requires detailed information about the business entity applying for the license. Applicants must provide their business name, incorporation details, and contact information, including phone numbers and email addresses. Additionally, the form requests information about the owners, partners, officers, and directors of the entity, including their titles and Social Security Numbers. A significant aspect of the form is the background information section, where applicants must disclose any criminal convictions, administrative proceedings, or financial judgments involving the business or its key personnel. This ensures that only qualified individuals are granted the privilege of operating within the title insurance industry. Furthermore, the form includes a certification section where the undersigned affirms the truthfulness of the information provided, underscoring the importance of accuracy and transparency in the application process. By thoroughly completing this form, businesses can take an essential step toward compliance and legitimacy in Arkansas's title insurance market.

Document Sample

FORM AID-LI-TAGY (9/07)

ARKANSAS INSURANCE DEPARTMENT

LICENSE DIVISION

1200 WEST 3RD STREET

LITTLE ROCK, AR 72201

PHONE: 501-371-2750

FAX: 501-683-2604

TITLE AGENCY

(Please Print or Type)

1

Business Entity Name

 

2 Incorporation/Formation

3 FEIN

 

 

 

Date

-

 

 

 

 

 

4

If assigned, National Producer Number (NP#)

5 If applicable, NASD Firm Central Registration Depository (CRD) Number

 

 

 

 

 

6List any other assumed, fictitious, alias or trade names under which you are doing business or intend to do business.

7State of Domicile

8Country of Domicile

9 Is the business entity affiliated with a financial institution/bank?

Yes

No

10Business Address

11City

12State

13Zip Code

14Foreign Country

15

Phone Number

16 Fax Number

17 Business Web Site Address

18 Business E-Mail Address

 

 

(

)

-

(

)

-

 

 

 

 

19

Mailing Address

 

20

P.O. Box

21 City

22 State 23 Zip Code

24Foreign Country

Designated/Responsible Licensed Title Agent

25Identify all Licensed Title Agents:

Name

 

SSN

-

-

Name

 

SSN

-

-

Name

 

SSN

-

-

Name

 

SSN

-

-

Owners, Partners, Officers and Directors

26Identify all owners with 10% interest or voting interest, partners, officers and directors of the business entity:

Name

 

Title

SSN/FEIN

-

-

Owner: Yes / No

 

 

 

 

 

 

 

 

 

Name

 

Title

SSN/FEIN

-

-

Owner: Yes / No

 

 

 

 

 

 

 

 

Name

 

Title

SSN/FEIN

-

-

Owner: Yes / No

 

 

 

 

 

 

 

 

Name

 

Title

SSN/FEIN

-

-

Owner: Yes / No

 

 

 

 

 

 

 

 

Name

 

Title

SSN/FEIN

-

-

Owner: Yes / No

Name

 

 

 

 

 

 

 

 

Title

SSN/FEIN

-

-

Owner: Yes / No

 

 

 

 

 

 

 

 

Name

 

Title

SSN/FEIN

-

-

Owner: Yes / No

 

 

 

 

 

 

 

 

Name

 

Title

SSN/FEIN

-

-

Owner: Yes / No

 

 

 

 

 

 

 

 

 

(State Use)

Form AID-LI-TAGY(9/07)

Page 2

Jurisdiction and Type of License/Registration Requested –

27Next to each jurisdiction, check the legal business type, license/registration type(s) and line(s) of authority for which you are applying.

Legal Business Type:

C – Corporation

P – Partnership

LLC – Limited Liability Company

LLP – Limited Liability Partnership

Background Information

28Please read the following very carefully and answer every question. All copies of documents must be certified. All written statements submitted by the Applicant must include an original signature.

1. Has the business entity or any owner, partner, officer or director ever been convicted of, or is the business entity or any owner, partner,

Yes ___

No___

 

officer or director currently charged with, committing a crime, whether or not adjudication was withheld?

 

 

 

“Crime”

includes a misdemeanor , felony or a military offense. You may exclude misdemeanor traffic citations and juvenile offenses.

 

 

 

“Convicted” includes, but is not limited to, having been found guilty by verdict of a judge or jury, having entered a plea of guilty or nolo

 

 

 

contendre, or having been given probation, a suspended sentence or a fine.

 

 

 

If you answer yes, you must attach to this application:

 

 

 

a)

a written statement explaining the circumstances of each incident,

 

 

 

b)

a

certified copy of the charging document, and

 

 

 

c)

a

certified copy of the official document which demonstrates the resolution of the charges or any final judgment

 

 

2. Has the business entity or any owner, partner, officer or director ever been involved in an administrative proceeding regarding any

Yes ___

No___

 

professional or occupational license?

 

 

 

 

 

 

 

 

 

 

“Involved” means having a license censured, suspended, revoked, canceled, terminated; or, being assessed a fine

, a cease and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

desist order, a prohibition order, a compliance order,

placed on probation or surrendering a license to resolve an administrative

 

 

 

 

action. “Involved” also means being named as a party to an administrative or arbitration proceeding, which is related to a

 

 

 

 

professional or occupational license. “Involved” also means having a license application denied or the act of withdrawing an

 

 

 

 

application to avoid a denial. You may EXCLUDE terminations due solely to noncompliance with continuing education

 

 

 

 

requirements or failure to pay a renewal fee.

 

 

 

If you answer yes, you must attach to this application:

 

 

 

a) a written statement identifying the type of license and explaining the circumstances of each incident,

 

 

 

b) a certified copy of the Notice of Hearing or other document that states the charges and allegations, and

 

 

 

c) a certified copy of the official document which demonstrates the resolution of the charges or any final judgment.

 

 

3.

Has any demand been made or judgment rendered against the business entity or any owner, partner, officer or director for overdue

Yes ___

No___

 

monies by an insurer, insured or producer, or have you ever been subject to a bankruptcy proceeding?

 

 

 

If you answer yes, submit a statement summarizing the details of the indebtedness and arrangements for repayment.

 

 

4.

Has the business entity or any owner, partner, officer or director ever been notified by any jurisdiction to which you are applying of any

Yes ___

No___

 

delinquent tax obligation that is not the subject of a repayment agreement?

 

 

 

If you answer yes, identify the jurisdiction(s): _______________________________________

 

 

 

5. Is the business entity or any owner, partner, officer or director a party to, or ever been found liable in any lawsuit or arbitration proceeding

Yes ___

No___

 

 

 

 

involving allegations of fraud, misappropriation or conversion of funds, misrepresentation or breach of fiduciary duty?

 

 

 

If you answer yes, you must attach to this application:

 

 

 

a)

a written statement summarizing the details of each incident,

 

 

 

b)

a certified copy of the Petition, Complaint or other document that commenced the lawsuit or arbitration, and

 

 

 

c)

a certified copy of the official document which demonstrates the resolution of the charges or any final judgment.

 

 

6. Has the business entity or any owner, partner, officer or director ever had an insurance agency contract or any other business relationship

Yes ___

No___

 

with an insurance company terminated for any alleged misconduct?

 

 

If you answer yes, you must attach to this application:

a)a written statement summarizing the details of each incident and explaining why you feel this incident should not prevent you from receiving an insurance license, and

b)certified copies of all relevant documents.

Form AID-LI-TAGY(9/07)

Page 3

Applicants Certification and Attestation

29The undersigned owner, partner, officer or director of the business entity hereby certifies, under penalty of perjury, that:

1.All of the information submitted in this application and attachments is true and complete and I am aware that submitting false information or omitting pertinent or material information in connection with this application is grounds for license or registration revocation and may subject me and the business entity to civil or criminal penalties.

2.Where required by law, the business entity hereby designates the Commissioner, Director or Superintendent of Insurance, or an appropriate representative in each jurisdiction for which this application is made to be its agent for service of process regarding all insurance matters in the respective jurisdiction and agree that service upon the Commissioner or Director of that jurisdiction is of the same legal force and validity as personal service upon the business entity.

3.The business entity grants permission to the Commissioner or Director of Insurance in each jurisdiction for which this application is made to verify any information supplied with any federal, state or local government agency, current or former employer or insurance company.

4.Every owner, partner, officer or director of the business entity either a) does not have a current child-support obligation, or b) has a child-support obligation and is currently in compliance with that obligation.

5.I authorize the jurisdictions to give any information they may have concerning me to any federal, state or municipal agency, or any other organization and I release the jurisdictions and any person acting on their behalf from any and all liability of whatever nature by reason of furnishing such information.

6.I acknowledge that I understand and comply with the insurance laws and regulations of the jurisdictions to which I am applying for licensure/registration.

7.If required, I have received a Certificate of Good Standing from the jurisdiction's Secretary of State in which I am applying.

8.For Non-Resident License Applications, I certify that I am licensed and in good standing in my home state/resident state for the lines of authority requested from the non-resident state.

Attachments

Must be signed by an officer, director, principal or partner of the business entity:

Month DayYear

____________________________________________

Signature

_________________________________________________

Typed or Printed Name

_________________________________________________

Title

_________________________________________________

Social Security Number

_________________________________________________

Address

_________________________________________________

City

State

Zip

File Specifics

Fact Name Details
Form Title Arkansas Aid Li Tagy Form (AID-LI-TAGY)
Governing Body Arkansas Insurance Department
Form Version Version dated September 2007
Purpose Used for licensing title agencies in Arkansas.
Contact Information Phone: 501-371-2750; Fax: 501-683-2604
Required Attachments Various documents including criminal history, administrative proceedings, and financial obligations.
Business Entity Types Corporation, Partnership, Limited Liability Company, Limited Liability Partnership
Affiliation Question Inquires if the business entity is affiliated with a financial institution.
Legal Compliance Applicants must comply with Arkansas insurance laws and regulations.

How to Use Arkansas Aid Li Tagy

Filling out the Arkansas Aid Li Tagy form requires careful attention to detail. Each section of the form gathers essential information about your business entity, its owners, and any relevant background. Completing the form accurately is crucial for a smooth application process.

  1. Business Information: Begin by entering your business entity name, incorporation or formation date, and FEIN (Federal Employer Identification Number).
  2. Provide your National Producer Number (if applicable) and NASD Firm Central Registration Depository Number (if applicable).
  3. List any other names your business operates under.
  4. Indicate your state and country of domicile.
  5. Answer whether your business is affiliated with a financial institution or bank.
  6. Fill in your business address, including city, state, zip code, and foreign country (if applicable).
  7. Provide your phone number, fax number, business website address, and business email address.
  8. Complete the mailing address section, including P.O. Box (if applicable), city, state, zip code, and foreign country.
  1. Designated/Responsible Licensed Title Agent: Identify all licensed title agents associated with your business, including their names and Social Security Numbers.
  2. Owners, Partners, Officers, and Directors: List all individuals with a 10% interest or voting interest in the business, including their names, titles, Social Security Numbers, and whether they are owners.
  3. License/Registration Request: Check the appropriate boxes for the legal business type and the license/registration type(s) you are applying for.
  4. Background Information: Carefully read and answer all background questions. Attach any required documentation if you answer "yes" to any questions.
  5. Certification and Attestation: Ensure the undersigned owner, partner, officer, or director certifies the truthfulness of the information provided. Include a signature, typed or printed name, title, Social Security Number, and address.

After completing the form, review all sections to confirm that the information is accurate and complete. Gather any necessary attachments as specified in the background information section. Once everything is in order, submit the form to the Arkansas Insurance Department for processing.

Your Questions, Answered

  1. What is the purpose of the Arkansas Aid Li Tagy form?

    The Arkansas Aid Li Tagy form is used to apply for a license or registration for title agencies in Arkansas. This form collects essential information about the business entity, including its ownership structure, affiliations, and any relevant background information necessary for regulatory compliance.

  2. Who needs to fill out the Arkansas Aid Li Tagy form?

    Any business entity that wishes to operate as a title agency in Arkansas must complete this form. This includes corporations, partnerships, limited liability companies, and limited liability partnerships. The form must be filled out by an owner, partner, officer, or director of the business entity.

  3. What information is required on the form?

    The form requires various details, including:

    • Business entity name and address
    • Federal Employer Identification Number (FEIN)
    • National Producer Number (if applicable)
    • Names and Social Security Numbers of all licensed title agents
    • Information about owners, partners, officers, and directors
    • Background information regarding any legal issues, such as criminal convictions or administrative proceedings
  4. Are there any specific background questions on the form?

    Yes, the form includes several background questions that applicants must answer. These questions cover topics such as criminal convictions, administrative proceedings related to professional licenses, bankruptcy, tax obligations, and any history of lawsuits involving fraud or misconduct. If any questions are answered affirmatively, additional documentation must be provided.

  5. What happens if I provide false information on the form?

    Providing false information or omitting material facts can lead to serious consequences. The Arkansas Insurance Department may revoke the license or registration. Additionally, submitting false information may expose the individual and the business entity to civil or criminal penalties.

  6. Is there a fee associated with submitting the Arkansas Aid Li Tagy form?

    The form itself does not specify a fee, but applicants should check with the Arkansas Insurance Department for any applicable licensing fees or processing costs that may be required upon submission of the form.

  7. How do I submit the Arkansas Aid Li Tagy form?

    The completed form can be submitted via mail or fax to the Arkansas Insurance Department's License Division. The address and fax number are provided on the form itself. It is advisable to keep a copy of the submitted form for your records.

  8. What should I do if I have questions while filling out the form?

    If you have questions while completing the form, you can contact the Arkansas Insurance Department directly at their phone number, 501-371-2750. They can provide guidance and clarify any uncertainties you may have regarding the application process.

  9. What is the significance of the designated/responsible licensed title agent section?

    This section requires the identification of a licensed title agent responsible for overseeing the agency's operations. This individual must hold a valid license and is crucial for ensuring compliance with state regulations. Having a designated agent helps maintain accountability within the agency.

Common mistakes

  1. Omitting Required Information: One common mistake is failing to provide all necessary details, such as the business entity name, FEIN, or National Producer Number. Incomplete forms can lead to delays or rejections.

  2. Incorrectly Filling Out Jurisdiction Information: Applicants often misidentify the jurisdiction or legal business type. It's crucial to double-check that the selected options match the intended license or registration.

  3. Neglecting to Attach Supporting Documents: Many forget to include required attachments, such as certified copies of documents related to criminal charges or administrative proceedings. This can result in the application being deemed incomplete.

  4. Using Inaccurate Contact Information: Providing incorrect phone numbers, email addresses, or mailing addresses can hinder communication from the Arkansas Insurance Department. Always verify that your contact details are accurate.

  5. Failing to Sign the Application: An unsigned application is automatically invalid. Ensure that an authorized person, such as an officer or partner, signs the form before submission.

  6. Misunderstanding Background Questions: Some applicants misinterpret the questions regarding criminal history or administrative actions. It's essential to read these questions carefully and answer truthfully.

  7. Ignoring Child Support Obligations: Not disclosing current child support obligations can lead to complications. Applicants must be aware of their responsibilities and indicate compliance if applicable.

  8. Submitting Outdated Forms: Using an old version of the form can cause issues. Always ensure you are using the most recent form, as requirements may change over time.

Documents used along the form

The Arkansas Aid Li Tagy form is an essential document for businesses seeking to operate as licensed title agents in Arkansas. However, it is often accompanied by various other forms and documents that provide additional information and fulfill legal requirements. Below is a list of commonly used forms that complement the Aid Li Tagy form.

  • Certificate of Good Standing: This document certifies that a business entity is authorized to operate in the state and has complied with all necessary regulations. It is often required for licensing applications.
  • Business Entity Registration: This form registers the business with the state. It includes basic information such as the business name, type, and address, ensuring that the entity is recognized legally.
  • National Producer Number (NP#) Application: This application is necessary for obtaining a unique identification number for insurance producers. It helps track the activities of licensed agents across states.
  • Background Check Authorization Form: This form allows the state to conduct background checks on the owners and key personnel of the business. It ensures that all individuals meet the ethical standards required for licensing.
  • Financial Disclosure Statement: This document provides a detailed account of the business's financial status. It may include information about debts, assets, and any pending lawsuits that could affect the business's operations.
  • Affidavit of Compliance: This sworn statement confirms that the business complies with all applicable laws and regulations. It serves as a declaration of the entity's commitment to ethical practices.
  • Insurance Agency Contract: If the business intends to work with an insurance company, this contract outlines the terms of the relationship, including duties, responsibilities, and compensation.
  • Partnership Agreement: For businesses operating as partnerships, this document details the terms of the partnership, including profit-sharing, responsibilities, and procedures for resolving disputes.
  • Operating Agreement: This document is crucial for Limited Liability Companies (LLCs). It outlines the management structure and operational procedures, ensuring clarity among members.

Each of these documents plays a critical role in the overall licensing process for title agencies in Arkansas. They provide necessary details that help regulatory bodies assess the qualifications and compliance of the business seeking a license. Properly completing and submitting these forms can facilitate a smoother approval process and enhance the credibility of the business in the industry.

Similar forms

The Arkansas Aid Li Tagy form shares similarities with the Uniform Business Entity Application (UBE). Both documents are used to gather essential information about a business entity seeking licensing in their respective fields. The UBE requires details such as the business name, address, and ownership structure, much like the Arkansas form. Additionally, both forms inquire about any past legal issues involving the entity or its owners, ensuring that licensing authorities have a comprehensive understanding of the applicant's background.

Another related document is the National Producer Number (NPN) application. This form is crucial for individuals and entities looking to obtain a unique identifier for their insurance business. Like the Arkansas Aid Li Tagy form, it collects information about the business structure, ownership, and operational details. Both forms aim to ensure that the applicant meets the necessary qualifications and has a clean record, which is essential for maintaining trust in the insurance industry.

The Insurance Agency License Application is also comparable to the Arkansas Aid Li Tagy form. This document is specifically designed for insurance agencies seeking to operate legally within a state. Similar to the Aid Li Tagy form, it requires information about the agency's ownership, structure, and any past legal troubles. Both forms serve to protect consumers by ensuring that only qualified and trustworthy entities are granted licenses.

The Title Insurance Agency License Application mirrors the Arkansas Aid Li Tagy form in its purpose and structure. This application is specifically tailored for title insurance agencies, requiring similar information regarding business ownership, affiliations, and any legal issues. Both forms are critical in assessing the qualifications of the applicant, ensuring compliance with state regulations and protecting the interests of consumers in real estate transactions.

The Mortgage Broker License Application is another document that aligns closely with the Arkansas Aid Li Tagy form. It collects essential information about a mortgage brokerage's business structure, ownership, and any legal issues. Like the Aid Li Tagy form, this application aims to verify the integrity and qualifications of the business, ensuring that only reputable entities can operate in the mortgage industry.

Lastly, the Business License Application serves a similar function to the Arkansas Aid Li Tagy form. This document is used by various types of businesses to obtain necessary permits to operate legally. Both forms require detailed information about the business, including ownership and any past legal issues. They both play a vital role in maintaining regulatory standards and ensuring that businesses are compliant with local laws, ultimately fostering a trustworthy environment for consumers.

Dos and Don'ts

When filling out the Arkansas Aid Li Tagy form, there are specific actions to take and avoid to ensure a smooth application process. Below is a list of important dos and don'ts.

  • Do print or type all information clearly to prevent misunderstandings.
  • Do provide complete and accurate information for each section, including names, addresses, and identification numbers.
  • Do attach all required documents, including certified copies, when necessary.
  • Do review the form thoroughly before submission to ensure all questions are answered.
  • Don't leave any questions unanswered; every section must be filled out as required.
  • Don't submit false or misleading information, as this can lead to penalties.
  • Don't forget to sign and date the application; an unsigned form may be rejected.
  • Don't assume that previous applications or information are still valid; provide current details.

Misconceptions

Misconceptions about the Arkansas Aid Li Tagy form can lead to confusion and potential errors in the application process. Here are eight common misconceptions along with clarifications:

  • It is only for new businesses. Many believe that the Aid Li Tagy form is exclusively for newly established businesses. In reality, it is also applicable for existing businesses seeking to update their licensing or registration information.
  • Only corporations need to fill out this form. Some individuals think that only corporations are required to use this form. However, it is designed for various business entities, including partnerships, LLCs, and LLPs.
  • All questions must be answered, regardless of relevance. There is a misconception that every question on the form must be answered, even if it does not pertain to the applicant. In fact, only relevant questions should be completed, and irrelevant sections can be left blank.
  • Attachments are optional. Many applicants mistakenly believe that providing attachments is optional. In truth, certain questions require supporting documents to be submitted along with the application.
  • Past criminal convictions disqualify applicants automatically. Some think that any past criminal conviction will lead to an automatic denial of the application. While such convictions must be disclosed, each case is evaluated individually based on the circumstances.
  • The form can be submitted without a signature. A common error is assuming that the form can be submitted without a signature. The application must be signed by an authorized individual to be considered valid.
  • Only the business owner needs to provide information. There is a belief that only the business owner’s information is necessary. However, the form requires details about all owners, partners, officers, and directors, ensuring comprehensive disclosure.
  • Filing the form guarantees a license. Some applicants think that submitting the Aid Li Tagy form guarantees the issuance of a license. This is not the case; the application is subject to review and approval by the appropriate regulatory authority.

Key takeaways

Filling out the Arkansas Aid Li Tagy form is a crucial step for businesses seeking licensure in the title insurance industry. Here are five key takeaways to consider:

  • Accurate Information is Essential: Every section of the form must be completed accurately. This includes details about the business entity, its owners, and any relevant affiliations. Missing or incorrect information can lead to delays or rejections.
  • Documentation Requirements: Certain questions require supporting documents. For example, if there are any criminal convictions or administrative proceedings, applicants must attach detailed explanations and certified copies of relevant documents.
  • Licensure Type Matters: Applicants should clearly indicate the type of license or registration they are seeking. Understanding the distinctions between different business types—such as corporations, partnerships, or limited liability companies—is vital for correct classification.
  • Compliance with Child Support Obligations: The form requires disclosure of any child support obligations. Compliance is necessary for licensure, and failure to meet this requirement could impact the application process.
  • Signature and Certification: The application must be signed by an authorized individual, such as an officer or partner. This signature certifies that all provided information is true and complete, and acknowledges understanding of the applicable laws and regulations.