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.
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
Owners, Partners, Officers and Directors
26Identify all owners with 10% interest or voting interest, partners, officers and directors of the business entity:
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)
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
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.
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
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
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
involving allegations of fraud, misappropriation or conversion of funds, misrepresentation or breach of fiduciary duty?
a written statement summarizing the details of each incident,
a certified copy of the Petition, Complaint or other document that commenced the lawsuit or arbitration, and
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
with an insurance company terminated for any alleged misconduct?
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.
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
Social Security Number
Address
City
State
Zip
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.
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.
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.
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.
The form requires various details, including:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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: