Form AID-LI-ARF-RTA "Arkansas Replacement License Renewal for Title Agents" - Arkansas

What Is Form AID-LI-ARF-RTA?

This is a legal form that was released by the Arkansas Insurance Department - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

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-ARF-RTA by clicking the link below or browse more documents and templates provided by the Arkansas Insurance Department.

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Download Form AID-LI-ARF-RTA "Arkansas Replacement License Renewal for Title Agents" - Arkansas

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FORM AID-LI-ARF-RTA (5/20)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
1 COMMERCE WAY, SUITE 104, LITTLE ROCK, AR 72202
PHONE: 501-371-2750, FAX: 501-683-2604
Website
https://insurance.arkansas.gov/pages/industry-regulation/
licensing/
ARKANSAS REPLACEMENT LICENSE RENEWAL
FOR TITLE AGENTS
Enclosed Fees: Renewal Fee_______ + Late Fee_______ + CE Filing Fee_________= $_________Total
Producers required continuing education must pay a filing fee of $10.00 for 1 year
Name _______________________________________________________________ License # _____________________
Last
First
Middle Initial
Current Mailing Address: _________________________________________________________________________________
P.O. Box or Street Number
City
State
Zip
Current Business Address: __________________________________________________________________________________
P.O. Box or Street Number
City
State
Zip
Current Residence Address: ________________________________________________________________________________
S
City
State
Zip
treet Number
Home Phone Number: ___________________ Business Phone Number: ____________________ Fax # ________________
E-Mail Address: _______________________________________________________________
THESE QUESTIONS MUST BE ANSWERED: If you ans
wer yes, you m ust attach to this renew al form (a) a written statement explaining the
circumstances of each incident, (b) a copy of any legal notice and (c) a copy of the official documentation showing the resolution or final judgment.
1.
Have you been convicted of or currently charged with a crime (whether or not adjudication was withheld) since the last renewal of this license?
Yes
No
2.
Have you or any business in which you are or were an owner, partner, officer, or director or any business in which you are or were an owner, partner,
officer or director been involved in an administrative proceeding regarding any professional or occupational license since the last renewal of this
license?
Yes
No
3.
Has any demand been made or judgment rendered against you for overdue monies by an insurer, insured, or producer since you last renewed this
license?
Yes
No
4.
Have you been subject to a bankruptcy proceeding since you last renewed this license?
Yes
No
5.
Have you been notified by any jurisdiction of any delinquent tax obligation
Yes
No
a) If yes, do you have a repayment agreement
Yes
No
6.
Since your last renewal, are you a party to, or have you been found liable in, any lawsuit or arbitration proceeding involving allegations of fraud,
misappropriation or conversion of funds, misrepresentation or breach of fiduciary duty?
Yes
No
7.
Do you have a child support obligation in arrearage?
Yes
No
If you answer yes to Question 7,
a) By how many months are you in arrearage?
_______Months
b) Are you currently subject to a repayment agreement:
Yes
No
c) Are you the subject of a child support related subpoena/warrant?
Yes
No
I hereby certi fy that, under p enalty of perjury, all of the infor mation submitted in th is application and attach ments is true and complete. I a m
aware that submitting false information or omitting pertinent o r material information in connection with this appli cation is gr ounds for license
revocation or denial of the license renewal and may subject me to criminal penalties.
SIGNATURE: ______________________________________________________________________ DATE: ________________________
(Wet ink signature is required---Do not use stamped signature)
Title Agents are required to complete 6 hrs of continuing education each year of which 1 hr must be in ethics. No courses can be repeated within 2
full years from completion and filing of the course. All hours must be completed and filed with the Department prior to renewal of the license. Late
filing of continuing education is s ubject to penalties of $25.00 for the first 30 da ys, $50.00 for days 31 to 60, $100 for days 61 to 90 days, and $150
penalty after 90 days.
A license that has been inactive for more than 365 days cannot be reinstated—the individual must start over as having never been licensed.
MAKE CHECK PAYABLE TO THE ARKANSAS INSURANCE DEPARTMENT TRUST FUND.
PLEASE MAIL PAYMENTS AND TH
E
COMPLETED FORM to the attention of the License Division at the address listed above.
For 2011
Renewal Fee:
$35.
00
CE Filing Fees: $10.00
Total: $45.00
If renewing after renewal date: Fee of $35.00 plus $10.00 CE filing Fee plus late fee of $70.00
Total: $115.00
Department Use Only:
Route Slip or Check No. _____________________
or
Cash Receipt No. ___________________
Date Received: _____________________________
Record Posted _______________________
FORM AID-LI-ARF-RTA (5/20)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
1 COMMERCE WAY, SUITE 104, LITTLE ROCK, AR 72202
PHONE: 501-371-2750, FAX: 501-683-2604
Website
https://insurance.arkansas.gov/pages/industry-regulation/
licensing/
ARKANSAS REPLACEMENT LICENSE RENEWAL
FOR TITLE AGENTS
Enclosed Fees: Renewal Fee_______ + Late Fee_______ + CE Filing Fee_________= $_________Total
Producers required continuing education must pay a filing fee of $10.00 for 1 year
Name _______________________________________________________________ License # _____________________
Last
First
Middle Initial
Current Mailing Address: _________________________________________________________________________________
P.O. Box or Street Number
City
State
Zip
Current Business Address: __________________________________________________________________________________
P.O. Box or Street Number
City
State
Zip
Current Residence Address: ________________________________________________________________________________
S
City
State
Zip
treet Number
Home Phone Number: ___________________ Business Phone Number: ____________________ Fax # ________________
E-Mail Address: _______________________________________________________________
THESE QUESTIONS MUST BE ANSWERED: If you ans
wer yes, you m ust attach to this renew al form (a) a written statement explaining the
circumstances of each incident, (b) a copy of any legal notice and (c) a copy of the official documentation showing the resolution or final judgment.
1.
Have you been convicted of or currently charged with a crime (whether or not adjudication was withheld) since the last renewal of this license?
Yes
No
2.
Have you or any business in which you are or were an owner, partner, officer, or director or any business in which you are or were an owner, partner,
officer or director been involved in an administrative proceeding regarding any professional or occupational license since the last renewal of this
license?
Yes
No
3.
Has any demand been made or judgment rendered against you for overdue monies by an insurer, insured, or producer since you last renewed this
license?
Yes
No
4.
Have you been subject to a bankruptcy proceeding since you last renewed this license?
Yes
No
5.
Have you been notified by any jurisdiction of any delinquent tax obligation
Yes
No
a) If yes, do you have a repayment agreement
Yes
No
6.
Since your last renewal, are you a party to, or have you been found liable in, any lawsuit or arbitration proceeding involving allegations of fraud,
misappropriation or conversion of funds, misrepresentation or breach of fiduciary duty?
Yes
No
7.
Do you have a child support obligation in arrearage?
Yes
No
If you answer yes to Question 7,
a) By how many months are you in arrearage?
_______Months
b) Are you currently subject to a repayment agreement:
Yes
No
c) Are you the subject of a child support related subpoena/warrant?
Yes
No
I hereby certi fy that, under p enalty of perjury, all of the infor mation submitted in th is application and attach ments is true and complete. I a m
aware that submitting false information or omitting pertinent o r material information in connection with this appli cation is gr ounds for license
revocation or denial of the license renewal and may subject me to criminal penalties.
SIGNATURE: ______________________________________________________________________ DATE: ________________________
(Wet ink signature is required---Do not use stamped signature)
Title Agents are required to complete 6 hrs of continuing education each year of which 1 hr must be in ethics. No courses can be repeated within 2
full years from completion and filing of the course. All hours must be completed and filed with the Department prior to renewal of the license. Late
filing of continuing education is s ubject to penalties of $25.00 for the first 30 da ys, $50.00 for days 31 to 60, $100 for days 61 to 90 days, and $150
penalty after 90 days.
A license that has been inactive for more than 365 days cannot be reinstated—the individual must start over as having never been licensed.
MAKE CHECK PAYABLE TO THE ARKANSAS INSURANCE DEPARTMENT TRUST FUND.
PLEASE MAIL PAYMENTS AND TH
E
COMPLETED FORM to the attention of the License Division at the address listed above.
For 2011
Renewal Fee:
$35.
00
CE Filing Fees: $10.00
Total: $45.00
If renewing after renewal date: Fee of $35.00 plus $10.00 CE filing Fee plus late fee of $70.00
Total: $115.00
Department Use Only:
Route Slip or Check No. _____________________
or
Cash Receipt No. ___________________
Date Received: _____________________________
Record Posted _______________________