Form AID-LI-AGY-ADD-TI "Addition to Title Agency License" - Arkansas

What Is Form AID-LI-AGY-ADD-TI?

This is a legal form that was released by the Arkansas Insurance Department - a government authority operating within Arkansas. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on May 1, 2020;
  • The latest edition provided by the Arkansas Insurance Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AID-LI-AGY-ADD-TI by clicking the link below or browse more documents and templates provided by the Arkansas Insurance Department.

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FORM AID-LI-AGY-ADD-TI (5/20)
ARKANSAS INSURANCE DEPARTMENT
1 COMMERCE WAY, SUITE 104
LITTLE ROCK, ARANSAS 72202
PHONE 501-371-2750
FAX-501-683-2604
Website
https://insurance.arkansas.gov/pages/industry-regulation/licensing/
ADDITION TO TITLE AGENCY LICENSE
Agency Name:_________________________________________________________________________
Agency Address: ______________________________________________________________________
Street or P.O. Box
City
State
Zip
Agency Contact Person:_________________________________________________________________
Contact Persons phone number ___________________________________________________________
Agency Tax ID #:___________________________
ADDING A PRODUCER TO THE TITLE AGENCY LICENSE
Fees:
$10.00 for each addition. Make checks payable to the Arkansas Insurance Department Trust Fund.
Please add the following producer(s) to the title agency license.
Producer’s Name:___________________________________________________________________
Producer’s License #:________________________________________________________________
Add the Producer for the following lines of Insurance: ______________________________________
Producer’s Name:___________________________________________________________________
Producer’s License #:________________________________________________________________
Add the Producer for the following lines of Insurance: _____________________________________
Producer’s Name:___________________________________________________________________
Producer’s License #:________________________________________________________________
Add the Producer for the following lines of Insurance: ______________________________________
Authorized Agency Signature ________________________________________________________
Date Signed: ___________________
FORM AID-LI-AGY-ADD-TI (5/20)
ARKANSAS INSURANCE DEPARTMENT
1 COMMERCE WAY, SUITE 104
LITTLE ROCK, ARANSAS 72202
PHONE 501-371-2750
FAX-501-683-2604
Website
https://insurance.arkansas.gov/pages/industry-regulation/licensing/
ADDITION TO TITLE AGENCY LICENSE
Agency Name:_________________________________________________________________________
Agency Address: ______________________________________________________________________
Street or P.O. Box
City
State
Zip
Agency Contact Person:_________________________________________________________________
Contact Persons phone number ___________________________________________________________
Agency Tax ID #:___________________________
ADDING A PRODUCER TO THE TITLE AGENCY LICENSE
Fees:
$10.00 for each addition. Make checks payable to the Arkansas Insurance Department Trust Fund.
Please add the following producer(s) to the title agency license.
Producer’s Name:___________________________________________________________________
Producer’s License #:________________________________________________________________
Add the Producer for the following lines of Insurance: ______________________________________
Producer’s Name:___________________________________________________________________
Producer’s License #:________________________________________________________________
Add the Producer for the following lines of Insurance: _____________________________________
Producer’s Name:___________________________________________________________________
Producer’s License #:________________________________________________________________
Add the Producer for the following lines of Insurance: ______________________________________
Authorized Agency Signature ________________________________________________________
Date Signed: ___________________