|
Service Request Form
|
Form Name
|
Change Name
Correct SSN or FEIN
Trade Name Notification
Clearance Letter (moving out of Virginia)
Change of Address (used by non-resident agents only moving from one state to another)
|
Form 5001
|
|
Request for Agency License Withdrawal/Termination
|
Agency Withdrawal
|
|
Request for List of Resident Agents for Continuing Education Mailings
|
Guidelines and Form
|
|
Lines of Authority - Full Lines
|
Form Name
|
Life & Annuities
Variable Contract
Health
Personal Lines
Property & Casualty
Title
Title Instructor Certification and
Affidavit of Course Completion
|
Form 3001
Certification and Affidavit
|
|
Lines of Authority - Limited Lines
|
Form Name
|
Limited Lines Credit
Limited Lines Life & Health
Limited Lines Property & Casualty
Motor Vehicle Rental Contract
|
Form 3001
|
|
Lines of Authority - Temporary
|
Form Name
|
Temporary Life & Health
Temporary Life & Health (Debit Only)
Temporary Property & Casualty
|
Form 3001
|
|
Lines of Authority - Non-Standard
|
Form Name
|
Consultant (Life & Health)
Consultant (Property & Casualty)
Viatical Settlement Broker
|
Form 3001
(initial)
|
Surplus Lines Broker
|
Form 3001
(initial)
SLB-2
|
|
Lines of Authority - Business Entity (Agency)
|
Form Name
|
Life & Annuities
Variable Contracts
Health
Property & Casualty
Title
|
Form 4052
|
|
Lines of Authority - Non-Standard Business Entity (Agency)
|
Form Name
|
Consultant (Life & Health)
Consultant (Property & Casualty)
Viatical Settlement Broker
|
Form 4052
(initial)
|
Surplus Lines Broker
|
Form 4052 (initial)
SLB-2
|
|
License Type - Reinsurance Intermediary
|
Form Name
|
|
Initial Application
|
RI-app
|
|
Renewal Application
|
RI-renew
|
|
Appointment
|
Form Name
|
|
Appointment Form
|
Form 4151
|
|
Appointment Cancellation Form
|
Form 4921
|
|
RESA Forms
|
Form Name
|
|
Title Settlement Agent/Agency Financial Responsibility Certification Form
|
TSA Form
|
|
Title Settlement Agent Surety Bond
|
TSA Surety Bond
|
|
Waiver of Blanket Fidelity Bond or Employee Dishonesty Insurange Policy for Title
Insurance Settlement Agents
|
TSA Waiver
|
|
Settlement Agent Registration Form - Individual
|
RESA Individual
|
|
Settlement Agent Registration Form - Corporation or Other Legal Entity
|
RESA Corp
|
|
Unlicensed Ocean Marine Disclosure Form
|
Form Name
|
|
Unlicensed Ocean Marine Disclosure Form
|
Unlicensed Ocean Marine Disclosure Form
|