Form DFS-H2-1544TERM "Appointment Termination Form" - Florida

Form DFS-H2-1544TERM or the "Appointment Termination Form" is a form issued by the Florida Department of Financial Services.

The form was last revised in April 1, 2011 and is available for digital filing. Download an up-to-date Form DFS-H2-1544TERM in PDF-format down below or look it up on the Florida Department of Financial Services Forms website.

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Download Form DFS-H2-1544TERM "Appointment Termination Form" - Florida

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DEPARTMENT OF FINANCIAL SERVICES
Division of Agent & Agency Services - Bureau of Licensing
200 East Gaines Street, Larson Building Room 419
Tallahassee, FL 32399-0319
Department of Financial Services
Name and Address of Appointing Entity
Return to:
Bureau of Licensing
200 E Gaines Street
Company Code
Tallahassee FL 32399-0319
Temporary Limited Surety Agent (T2-35), Limited Surety Agent (2-34),
Professional Bail Bond Agent (2-37) and Managing General Agents
For Bail Bond Business (0-60)
TERMINATION
Appointment
Form
Print or Type
Part I
Section
Section
Section
Section
Section
1
2
3
4
5
Type &
License Number
Last Name, First Name and Middle Initial
County
Class of
Effective Date of
Code
Insurance
Termination
/
/
PART II (to be completed by appointing company representative)
R
:
E
:
EASON
XPLANATION
L
R
___________________________________________________
ICENSEE
EQUEST
D
(
)
ECEASED
ATTACH PROOF
N
R
C
___________________________________________________
O LONGER
EPRESENTS
OMPANY
A
V
F
S
LLEGED
IOLATION OF THE
LORIDA
TATUTES
___________________________________________________
___________________________________________________
This form must be signed by an official of the appointing entity. This signature verifies that appropriate notice of termination has been
given to the appointee pursuant to §648.39, Florida Statutes. Otherwise, this form must be signed by the appointee if he or she is
requesting termination of the appointment themselves.
Signature of Appointing Official, or Agent (self termination)
Print/Type Name of Appointing Official or Agent (self termination)
10/9/12
Title
Date
Business Phone
License # (if applicable)
DFS-H2-1544
69B-221.155 F.A.C.
TERM
Revised 04/11
DEPARTMENT OF FINANCIAL SERVICES
Division of Agent & Agency Services - Bureau of Licensing
200 East Gaines Street, Larson Building Room 419
Tallahassee, FL 32399-0319
Department of Financial Services
Name and Address of Appointing Entity
Return to:
Bureau of Licensing
200 E Gaines Street
Company Code
Tallahassee FL 32399-0319
Temporary Limited Surety Agent (T2-35), Limited Surety Agent (2-34),
Professional Bail Bond Agent (2-37) and Managing General Agents
For Bail Bond Business (0-60)
TERMINATION
Appointment
Form
Print or Type
Part I
Section
Section
Section
Section
Section
1
2
3
4
5
Type &
License Number
Last Name, First Name and Middle Initial
County
Class of
Effective Date of
Code
Insurance
Termination
/
/
PART II (to be completed by appointing company representative)
R
:
E
:
EASON
XPLANATION
L
R
___________________________________________________
ICENSEE
EQUEST
D
(
)
ECEASED
ATTACH PROOF
N
R
C
___________________________________________________
O LONGER
EPRESENTS
OMPANY
A
V
F
S
LLEGED
IOLATION OF THE
LORIDA
TATUTES
___________________________________________________
___________________________________________________
This form must be signed by an official of the appointing entity. This signature verifies that appropriate notice of termination has been
given to the appointee pursuant to §648.39, Florida Statutes. Otherwise, this form must be signed by the appointee if he or she is
requesting termination of the appointment themselves.
Signature of Appointing Official, or Agent (self termination)
Print/Type Name of Appointing Official or Agent (self termination)
10/9/12
Title
Date
Business Phone
License # (if applicable)
DFS-H2-1544
69B-221.155 F.A.C.
TERM
Revised 04/11
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