Form AID-LI-ARF-TI-AGY-R "Arkansas Replacement Renewal Form for Title Agencies" - Arkansas

What Is Form AID-LI-ARF-TI-AGY-R?

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-ARF-TI-AGY-R by clicking the link below or browse more documents and templates provided by the Arkansas Insurance Department.

ADVERTISEMENT
ADVERTISEMENT

Download Form AID-LI-ARF-TI-AGY-R "Arkansas Replacement Renewal Form for Title Agencies" - Arkansas

Download PDF

Fill PDF online

Rate (4.8 / 5) 27 votes
Form AID-LI-ARF-TI-AGY-R (5/20)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
1 Commerce Way, Suite 104
Little Rock AR 72202
Phone 501-371-2750
Fax: 501-683-2604
Website:https://insurance.arkansas.gov/pages/industry-regulation/licensing/
ARKANSAS REPLACMENT RENEWAL FORM
FOR
TITLE AGENCIES
Licensee’s Federal Tax ID # or License # _________________________________________________________________
Name of Title Agency: ________________________________________________________________________________
Current Mailing Address: _____________________________________________________________________________
Current Business Address: ____________________________________________________________________________
Current Phone Number: ______________________________________________________________________________
Current Fax Number: ________________________________________________________________________________
E-mail Address: _____________________________________________________________________________________
THESE QUESTIONS MUST BE ANSWERED:
If you answer yes, you must attach to this renewal notice (a) a
written statement explaining the circumstance of each incident, (b) a copy of any legal notice and (c) a copy of the official
documentation showing the resolution or final judgment.
1.
Has the business owner, partner or title agent been convicted of or currently charged with a crime (whether or not
adjudication was withheld) since the last renewal of this license?
Yes ____ No____
2.
Has the business, owner, officer, partner or title agency or any business in which you are were an owner, partner, officer or
director been involved in an administrative proceeding regarding any professional or occupational license since the last
renewal of this license? Yes ____ No _____
3.
Has any demand been made or judgment rendered against the business, owner, partner, officer or title agent or overdue
monies by an insurer, insured or agent since you last renewed this license? Yes____ No____
4.
Has the business, owner, partner, officer or agent been subject to a bankruptcy proceeding since you last renewed this license?
Yes____ No_____
5.
Have you changed your mailing address and filed to notify the Department? Yes____ No_____
I hereby certify that, under penalty of perjury, all of the information submitted in this application and attachments is true and
complete. I am aware that submitting false information or omitting pertinent or material information in connection with this
renewal application is grounds for license revocation or denial of license renewal and may subject me to civil or criminal penalties.
Signature: ______________________________________________________________
Printed Name: ___________________________________________________________
Date Signed: ________________________________________
Fees: Title Agency Renewal Fee $250.00
If late the Title Agency will be subject to a late fee of $100.00 in addition to the renewal fee.
Form AID-LI-ARF-TI-AGY-R (5/20)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
1 Commerce Way, Suite 104
Little Rock AR 72202
Phone 501-371-2750
Fax: 501-683-2604
Website:https://insurance.arkansas.gov/pages/industry-regulation/licensing/
ARKANSAS REPLACMENT RENEWAL FORM
FOR
TITLE AGENCIES
Licensee’s Federal Tax ID # or License # _________________________________________________________________
Name of Title Agency: ________________________________________________________________________________
Current Mailing Address: _____________________________________________________________________________
Current Business Address: ____________________________________________________________________________
Current Phone Number: ______________________________________________________________________________
Current Fax Number: ________________________________________________________________________________
E-mail Address: _____________________________________________________________________________________
THESE QUESTIONS MUST BE ANSWERED:
If you answer yes, you must attach to this renewal notice (a) a
written statement explaining the circumstance of each incident, (b) a copy of any legal notice and (c) a copy of the official
documentation showing the resolution or final judgment.
1.
Has the business owner, partner or title agent been convicted of or currently charged with a crime (whether or not
adjudication was withheld) since the last renewal of this license?
Yes ____ No____
2.
Has the business, owner, officer, partner or title agency or any business in which you are were an owner, partner, officer or
director been involved in an administrative proceeding regarding any professional or occupational license since the last
renewal of this license? Yes ____ No _____
3.
Has any demand been made or judgment rendered against the business, owner, partner, officer or title agent or overdue
monies by an insurer, insured or agent since you last renewed this license? Yes____ No____
4.
Has the business, owner, partner, officer or agent been subject to a bankruptcy proceeding since you last renewed this license?
Yes____ No_____
5.
Have you changed your mailing address and filed to notify the Department? Yes____ No_____
I hereby certify that, under penalty of perjury, all of the information submitted in this application and attachments is true and
complete. I am aware that submitting false information or omitting pertinent or material information in connection with this
renewal application is grounds for license revocation or denial of license renewal and may subject me to civil or criminal penalties.
Signature: ______________________________________________________________
Printed Name: ___________________________________________________________
Date Signed: ________________________________________
Fees: Title Agency Renewal Fee $250.00
If late the Title Agency will be subject to a late fee of $100.00 in addition to the renewal fee.