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Blank Arkansas Aid Li Tagy Form

The Arkansas Aid Li Tagy form is a crucial document used by businesses seeking to obtain a title agency license in Arkansas. This form collects essential information about the business entity, its owners, and its operations, ensuring compliance with state regulations. If you're ready to get started, fill out the form by clicking the button below.

Prepare Arkansas Aid Li Tagy

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Free Arkansas Aid Li Tagy File

Form Properties

Fact Name	Details
Form Title	AID-LI-TAGY
Governing Law	Arkansas Code Annotated, Title 23 - Insurance
Form Purpose	This form is used for licensing title agencies in Arkansas.
Submission Requirements	All information must be complete and accurate. Attachments are required for certain disclosures.
Contact Information	Arkansas Insurance Department, License Division, 501-371-2750
Business Identification	Requires details such as business name, FEIN, and National Producer Number if assigned.
Owner Disclosure	Must identify all owners with at least 10% interest, including their titles and Social Security Numbers.
Certification Requirement	The application must be signed by an officer, director, principal, or partner of the business entity.

Key takeaways

When filling out and using the Arkansas Aid Li Tagy form, several important considerations should be kept in mind:

Accurate Information: It is crucial to provide accurate and complete information throughout the form. Any false statements or omissions can lead to serious consequences, including license revocation.
Documentation: Required documents must be certified copies. This includes any supporting documents related to criminal charges, administrative proceedings, or bankruptcy proceedings.
Designated Agent: The form requires the designation of a Commissioner or Director of Insurance as an agent for service of process. This designation is important for legal communications regarding the business.
Child Support Compliance: Applicants must confirm compliance with any child support obligations. This is a critical requirement for all owners, partners, officers, or directors of the business entity.
Background Checks: The application process involves background checks. Be prepared for inquiries regarding any past legal issues or professional conduct that may affect licensure.
Non-Resident Licensing: For non-resident applications, it is necessary to hold a valid license in the home state for the lines of authority being requested in Arkansas.

Detailed Steps for Using Arkansas Aid Li Tagy

Filling out the Arkansas Aid Li Tagy form requires careful attention to detail. Completing this form correctly is crucial for your application process. Follow these steps to ensure that you provide all necessary information accurately.

Print or type your Business Entity Name in the designated space.
Indicate the Incorporation/Formation date.
Provide your FEIN (Federal Employer Identification Number).
If assigned, enter your National Producer Number (NP#).
If applicable, include your NASD Firm Central Registration Depository (CRD) Number.
List any other assumed, fictitious, alias, or trade names under which you are doing business.
Specify your State of Domicile.
Specify your Country of Domicile.
Indicate if your business entity is affiliated with a financial institution/bank by selecting Yes or No.
Fill in your Business Address, including city, state, and zip code.
If applicable, provide your Foreign Country.
Enter your Phone Number and Fax Number.
Provide your Business Web Site Address.
Fill in your Business E-Mail Address.
Complete your Mailing Address, including P.O. Box, city, state, and zip code.
If applicable, specify your Foreign Country for mailing.
Identify the Designated/Responsible Licensed Title Agent.
List all Licensed Title Agents with their names and Social Security Numbers.
Identify all owners, partners, officers, and directors with 10% interest or voting interest, including their titles and whether they are owners.
Check the appropriate legal business type and license/registration type(s) for each jurisdiction.
Answer all background information questions truthfully, providing attachments where necessary.
Complete the Applicants Certification and Attestation section, ensuring all statements are accurate and signed by an authorized individual.

After completing the form, review it for any errors or missing information. It is essential to ensure that all required attachments are included. Submit the form to the Arkansas Insurance Department License Division. Keep a copy for your records. You can expect to receive further instructions or notifications regarding your application status once it has been processed.

Common mistakes

Filling out the Arkansas Aid Li Tagy form can be a straightforward process, but many applicants make common mistakes that can delay their application. One frequent error is failing to provide complete business entity information. Ensure that every section, from the business name to the FEIN, is filled out accurately. Omitting even one detail can lead to unnecessary complications.

Another common mistake is not including all required signatures. The application must be signed by an officer, director, principal, or partner of the business entity. Incomplete signatures can result in rejection of the application. Remember, every signature counts.

Many applicants also overlook the importance of including certified copies of necessary documents. When the application asks for attachments, it is crucial to provide certified copies as requested. Failing to do so can lead to delays in processing.

Inaccurate answers to the background questions are another pitfall. Applicants sometimes misunderstand the questions or provide vague responses. It is essential to read each question carefully and provide clear, truthful answers. Misleading information can have serious consequences.

Some people forget to check the appropriate boxes for the type of license or registration they are applying for. This oversight can lead to confusion and delays. Make sure to review this section thoroughly to avoid any mistakes.

Another mistake is not updating contact information. If your phone number or email address has changed since the last application, be sure to provide the most current information. This ensures that you can be reached if there are questions or issues with your application.

Failing to include all owners, partners, officers, and directors in the application can also be problematic. Each individual with a significant interest in the business must be listed. Neglecting to do this could result in processing delays or complications.

Lastly, applicants sometimes forget to review their application before submission. Taking a moment to double-check all entries can save time and prevent errors. A thorough review can help catch mistakes that might otherwise go unnoticed.

Arkansas Aid Li Tagy 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

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
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