Form AID-LI-TPA-BOND "Third Party Administrator Bond" - Arkansas

What Is Form AID-LI-TPA-BOND?

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

ADVERTISEMENT
ADVERTISEMENT

Download Form AID-LI-TPA-BOND "Third Party Administrator Bond" - Arkansas

Download PDF

Fill PDF online

Rate (4.7 / 5) 83 votes
FORM AID-LI-TPA-BOND (5/20)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
1 COMMERCE WAY, SUITE 104
LITTLE ROCK, AR 72202
PHONE: 501-371-2750
FAX: 501-683-2604
THIRD PARTY ADMINISTRATOR BOND
Bond No.________________
KNOW ALL MEN BY THESE PRESENTS:
That we, ________________________________________________ of ________________________________, as
Principal, and ____________________________________________of _________________________________,
being duly qualified to transact business in the state of Arkansas as Surety, are held and firmly bound unto the State
of Arkansas, in the full and just sum of Twenty-Five Thousand Dollars ($25,000) lawful money of the United States
for payment of which sum, will and truly be made, we hereby bind ourselves, our and each of our heirs, executors
and administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITIONS OF THIS OBLIGATION IS SUCH THAT:
WHEREAS, the above bounden principal has taken all necessary legal steps as required by the Insurance
Commissioner of the State of Arkansas to qualify as a Third Party Administrator and doing and performing such
other acts as may be necessary to comply with all requirements of the Arkansas
Insurance Code, as amended,
including the maintenance of this Bond, in the amount aforesaid, said Bond to assure the faithful performance of the
Principal’s obligation to its subscribers and/or sponsoring clients in the State of Arkansas wile this Bond is in effect.
NOW THEREFORE, the condition of the obligation is such that if the above bounden Principal shall well and truly
comply with the laws of the State of Arkansas pertaining to Third Party Administrators by the full accounting and
due payment, to the person entitled thereto, of any funds coming into the possession of the Administrator, then this
obligation shall be null and void; otherwise to remain in full force and effect.
PROVIDED, this bond may be cancelled by the Surety by filing thirty (30) days written cancellation notice by
Registered Mail with the Insurance Commissioner, State of Arkansas, Little Rock, Arkansas, and with the
Administrator/Principal.
IN WITNESS WHEREOF, the Principal has hereunto set his hand and the Surety has caused its corporate name to
be hereunto signed, and its corporate seal attached by its duly authorized Attorney-in-fact the day and year first
above written.
_______________________________
Principal
BY _____________________________
Title
______________________________
Surety
BY_____________________________
Attorney-in-fact
Countersigned:
FORM AID-LI-TPA-BOND (5/20)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
1 COMMERCE WAY, SUITE 104
LITTLE ROCK, AR 72202
PHONE: 501-371-2750
FAX: 501-683-2604
THIRD PARTY ADMINISTRATOR BOND
Bond No.________________
KNOW ALL MEN BY THESE PRESENTS:
That we, ________________________________________________ of ________________________________, as
Principal, and ____________________________________________of _________________________________,
being duly qualified to transact business in the state of Arkansas as Surety, are held and firmly bound unto the State
of Arkansas, in the full and just sum of Twenty-Five Thousand Dollars ($25,000) lawful money of the United States
for payment of which sum, will and truly be made, we hereby bind ourselves, our and each of our heirs, executors
and administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITIONS OF THIS OBLIGATION IS SUCH THAT:
WHEREAS, the above bounden principal has taken all necessary legal steps as required by the Insurance
Commissioner of the State of Arkansas to qualify as a Third Party Administrator and doing and performing such
other acts as may be necessary to comply with all requirements of the Arkansas
Insurance Code, as amended,
including the maintenance of this Bond, in the amount aforesaid, said Bond to assure the faithful performance of the
Principal’s obligation to its subscribers and/or sponsoring clients in the State of Arkansas wile this Bond is in effect.
NOW THEREFORE, the condition of the obligation is such that if the above bounden Principal shall well and truly
comply with the laws of the State of Arkansas pertaining to Third Party Administrators by the full accounting and
due payment, to the person entitled thereto, of any funds coming into the possession of the Administrator, then this
obligation shall be null and void; otherwise to remain in full force and effect.
PROVIDED, this bond may be cancelled by the Surety by filing thirty (30) days written cancellation notice by
Registered Mail with the Insurance Commissioner, State of Arkansas, Little Rock, Arkansas, and with the
Administrator/Principal.
IN WITNESS WHEREOF, the Principal has hereunto set his hand and the Surety has caused its corporate name to
be hereunto signed, and its corporate seal attached by its duly authorized Attorney-in-fact the day and year first
above written.
_______________________________
Principal
BY _____________________________
Title
______________________________
Surety
BY_____________________________
Attorney-in-fact
Countersigned: