Form 440-5343 "Attestation for Reduced Errors and Omissions Insurance Oregon Debt Buyer License" - Oregon

What Is Form 440-5343?

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

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the Oregon Department of Consumer and Business 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 printable version of Form 440-5343 by clicking the link below or browse more documents and templates provided by the Oregon Department of Consumer and Business Services.

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Download Form 440-5343 "Attestation for Reduced Errors and Omissions Insurance Oregon Debt Buyer License" - Oregon

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Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Room 410, Salem, Oregon 97301-388
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140 • Fax: 503-947-7862
http://dfr.oregon.gov
ATTESTATION FOR REDUCED ERRORS AND OMISSIONS INSURANCE
OREGON DEBT BUYER LICENSE
For debt buyers that collect less than $10,000,000 in annual receipts resulting from debt collection activities, this
form must be completed to document that the company qualifies for the reduced amount of required errors and
omission insurance of $500,000. Upload a completed copy of this form along with a copy of your errors and
omission insurance in the Errors and Omissions (Insurance Policy) section of the Document Uploads in the
Nationwide Multistate Licensing System (NMLS).
By signing this request for waiver, the company affirms that we collect less than $10,000,000 in annual receipts
resulting from debt collection activities. As a result, our company is eligible to provide an errors and omissions
policy of only $500,000 per OAR 441-820-0080. The company will notify the Division within 30 days if at any time
the company no longer meets the requirements.
The company attests that the person signing below is authorized to sign this document and bind the company. The
company further attests that the above statements are complete and true.
Company Name:
NMLS ID:
Signer’s Name:
Signer’s Title:
Signature:
Date:
440-5343 (10/17/COM)
Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Room 410, Salem, Oregon 97301-388
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140 • Fax: 503-947-7862
http://dfr.oregon.gov
ATTESTATION FOR REDUCED ERRORS AND OMISSIONS INSURANCE
OREGON DEBT BUYER LICENSE
For debt buyers that collect less than $10,000,000 in annual receipts resulting from debt collection activities, this
form must be completed to document that the company qualifies for the reduced amount of required errors and
omission insurance of $500,000. Upload a completed copy of this form along with a copy of your errors and
omission insurance in the Errors and Omissions (Insurance Policy) section of the Document Uploads in the
Nationwide Multistate Licensing System (NMLS).
By signing this request for waiver, the company affirms that we collect less than $10,000,000 in annual receipts
resulting from debt collection activities. As a result, our company is eligible to provide an errors and omissions
policy of only $500,000 per OAR 441-820-0080. The company will notify the Division within 30 days if at any time
the company no longer meets the requirements.
The company attests that the person signing below is authorized to sign this document and bind the company. The
company further attests that the above statements are complete and true.
Company Name:
NMLS ID:
Signer’s Name:
Signer’s Title:
Signature:
Date:
440-5343 (10/17/COM)