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;
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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.

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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: