Form FIS0846 "Consent to Service - Non-resident Reinsurance Intermediary Manager or Broker" - Michigan

What Is Form FIS0846?

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

Form Details:

  • Released on May 1, 2015;
  • The latest edition provided by the Michigan Department of Insurance and Financial Services;
  • 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 FIS0846 by clicking the link below or browse more documents and templates provided by the Michigan Department of Insurance and Financial Services.

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Download Form FIS0846 "Consent to Service - Non-resident Reinsurance Intermediary Manager or Broker" - Michigan

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FIS 0846 (5/15) Department of Insurance and Financial Services
Consent to Service – Non-Resident Reinsurance Intermediary Manager or Broker
Name of Reinsurance Intermediary Manager or Broker
(enter the same name – business or individual – that you requested your license be issued in)
A Reinsurance Intermediary Manager or Broker, incorporated and doing business under and by the virtue of the laws of
The State of
The Country of
has applied for registration as a Reinsurance Intermediary Manager or Broker to transact business in the state of Michigan.
Therefore, in compliance with the provisions of Section 500.1153(5) of the Michigan Insurance Code of 1956, as amended, this Reinsurance
Intermediary Manager or Broker does hereby make, constitute and appoint the Director of the Department of Insurance and Financial Services of the
State of Michigan, or deputies designated by the Director, as its true and lawful attorney in the state of Michigan, on whom all process of laws may
be served, in any action or proceeding under current or future laws and statutes of Michigan in which the Reinsurance Intermediary Manager or
Broker is a party. Further, we hereby stipulate and agree that any legal process affecting such Reinsurance Intermediary Manager or Broker, served
upon the Director, or designated deputy, shall have the same effect as if personally served upon the group and shall remain in force as long as any
liability shall remain within the state of Michigan. When process against or affecting the Reinsurance Intermediary Manager or Broker is served on
the Director, or designated deputy, a copy of such process shall be mailed to:
Name and Title of Contact Person
Address – Line 1
Address – Line 2
City
State
ZIP Code
Country
IN WITNESS WHEREOF, the group in accordance with a resolution of its board of directors duly passed, a certified copy of which is hereto
attached, has caused the same to be subscribed and signed in accordance with the bylaws of the company and the resolution of the board of
directors thereof, authorizing the same, at
The City of
in the State of
In the Country of
on the
day of
A.D. 20
Signature of President
Signature of Secretary
Attach certification from the board of directors approving the above consent to service.
PA 218 of 1956 as amended requires submission of this form by Non-Resident Reinsurance Intermediary Managers or Brokers applying for admission to Michigan. Failure to complete
and submit this form properly could result in denial of your application.
When complete, send with FIS 0845 Application for Reinsurance Intermediary Manager OR FIS 2274 Application for Reinsurance Intermediary Broker to:
DIFS Insurance Licensing
P.O. Box 30165
LANSING, MI 48909-7665
FIS 0846 (5/15) Department of Insurance and Financial Services
Consent to Service – Non-Resident Reinsurance Intermediary Manager or Broker
Name of Reinsurance Intermediary Manager or Broker
(enter the same name – business or individual – that you requested your license be issued in)
A Reinsurance Intermediary Manager or Broker, incorporated and doing business under and by the virtue of the laws of
The State of
The Country of
has applied for registration as a Reinsurance Intermediary Manager or Broker to transact business in the state of Michigan.
Therefore, in compliance with the provisions of Section 500.1153(5) of the Michigan Insurance Code of 1956, as amended, this Reinsurance
Intermediary Manager or Broker does hereby make, constitute and appoint the Director of the Department of Insurance and Financial Services of the
State of Michigan, or deputies designated by the Director, as its true and lawful attorney in the state of Michigan, on whom all process of laws may
be served, in any action or proceeding under current or future laws and statutes of Michigan in which the Reinsurance Intermediary Manager or
Broker is a party. Further, we hereby stipulate and agree that any legal process affecting such Reinsurance Intermediary Manager or Broker, served
upon the Director, or designated deputy, shall have the same effect as if personally served upon the group and shall remain in force as long as any
liability shall remain within the state of Michigan. When process against or affecting the Reinsurance Intermediary Manager or Broker is served on
the Director, or designated deputy, a copy of such process shall be mailed to:
Name and Title of Contact Person
Address – Line 1
Address – Line 2
City
State
ZIP Code
Country
IN WITNESS WHEREOF, the group in accordance with a resolution of its board of directors duly passed, a certified copy of which is hereto
attached, has caused the same to be subscribed and signed in accordance with the bylaws of the company and the resolution of the board of
directors thereof, authorizing the same, at
The City of
in the State of
In the Country of
on the
day of
A.D. 20
Signature of President
Signature of Secretary
Attach certification from the board of directors approving the above consent to service.
PA 218 of 1956 as amended requires submission of this form by Non-Resident Reinsurance Intermediary Managers or Brokers applying for admission to Michigan. Failure to complete
and submit this form properly could result in denial of your application.
When complete, send with FIS 0845 Application for Reinsurance Intermediary Manager OR FIS 2274 Application for Reinsurance Intermediary Broker to:
DIFS Insurance Licensing
P.O. Box 30165
LANSING, MI 48909-7665