Homepage Blank Arkansas Aid Li Tagy Form
Outline

The Arkansas Aid Li Tagy form is an essential document for businesses seeking to obtain a title agency license in Arkansas. This form requires detailed information about the business entity, including its name, formation date, and contact details. Applicants must disclose affiliations with financial institutions and provide the names and Social Security Numbers of all licensed title agents associated with the business. Additionally, the form mandates background checks, where applicants must report any criminal convictions, administrative proceedings, or financial judgments against the business or its key personnel. This ensures that the Arkansas Insurance Department can assess the integrity and reliability of the applicants. The form also includes a certification section, where the undersigned attests to the truthfulness of the information provided and acknowledges compliance with relevant laws and regulations. Completing the Arkansas Aid Li Tagy form accurately is crucial for a smooth licensing process, as it lays the groundwork for the business's operations within the state’s insurance framework.

Sample - Arkansas Aid Li Tagy Form

FORM AID-LI-TAGY (9/07)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
1200 WEST 3
RD
STREET
LITTLE ROCK, AR 72201
PHONE: 501-371-2750
FAX: 501-683-2604
TITLE AGENCY
(Please Print or Type)
Business Entity Name
Incorporation/Formation
Date
FEIN
-
If assigned, National Producer Number (NP#) If applicable, NASD Firm Central Registration Depository (CRD) Number
List any other assumed, fictitious, alias or trade names under which you are doing
business or intend to do business.
State of Domicile Country of Domicile
Is the business entity affiliated with a financial institution/bank? Yes No
Business Address City State Zip Code Foreign Country
Phone Number
( ) -
Fax Number
( ) -
Business Web Site Address Business E-Mail Address
Mailing Address P.O. Box City State Zip Code Foreign Country
Designated/Responsible Licensed Title Agent
Identify all Licensed Title Agents:
Name SSN - -
Name
SSN - -
Name
SSN - -
Name
SSN - -
Owners, Partners, Officers and Directors
Identify all owners with 10% interest or voting interest, partners, officers and directors of the business entity:
Name
Title SSN/FEIN - - Owner: Yes / No
Name
Title SSN/FEIN - - Owner: Yes / No
Name
Title SSN/FEIN - - Owner: Yes / No
Name
Title SSN/FEIN - - Owner: Yes / No
Name
Title SSN/FEIN - - Owner: Yes / No
Name
Title SSN/FEIN - - Owner: Yes / No
Name
Title SSN/FEIN - - Owner: Yes / No
Name
Title SSN/FEIN - - Owner: Yes / No
(State Use)
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Form AID-LI-TAGY(9/07)
Page 2
Jurisdiction and Type of License/Registration Requested –
Next to each jurisdiction, check the legal business type, license/registration type(s) and line(s) of authority for which you are applying.
Legal Business Type:
C – Corporation P – Partnership LLC – Limited Liability Company LLP – Limited Liability Partnership
Background Information
Please read the following very carefully and answer every question. All copies of documents must be certified. All written statements
submitted by the Applicant must include an original signature.
1. Has the business entity or any owner, partner, officer or director ever been convicted of, or is the business entity or any owner, partner,
officer or director currently charged with, committing a crime, whether or not adjudication was withheld?
Yes ___ No___
“Crime” includes a misdemeanor , felony or a military offense. You may exclude misdemeanor traffic citations and juvenile offenses.
“Convicted” includes, but is not limited to, having been found guilty by verdict of a judge or jury, having entered a plea of guilty or nolo
contendre, or having been given probation, a suspended sentence or a fine.
If you answer yes, you must attach to this application:
a) a written statement explaining the circumstances of each incident,
b) a certified copy of the charging document, and
c) a certified copy of the official document which demonstrates the resolution of the charges or any final judgment
2. Has the business entity or any owner, partner, officer or director ever been involved in an administrative proceeding regarding any
professional or occupational license?
Yes ___ No___
“Involved” means having a license censured, suspended, revoked, canceled, terminated; or, being assessed a fine, a cease and
desist order, a prohibition order, a compliance order, placed on probation or surrendering a license to resolve an administrative
action. “Involved” also means being named as a party to an administrative or arbitration proceeding, which is related to a
professional or occupational license. “Involved” also means having a license application denied or the act of withdrawing an
application to avoid a denial. You may EXCLUDE terminations due solely to noncompliance with continuing education
requirements or failure to pay a renewal fee.
If you answer yes, you must attach to this application:
a) a written statement identifying the type of license and explaining the circumstances of each incident,
b) a certified copy of the Notice of Hearing or other document that states the charges and allegations, and
c) a certified copy of the official document which demonstrates the resolution of the charges or any final judgment.
3. Has any demand been made or judgment rendered against the business entity or any owner, partner, officer or director for overdue
monies by an insurer, insured or producer, or have you ever been subject to a bankruptcy proceeding?
Yes ___ No___
If you answer yes, submit a statement summarizing the details of the indebtedness and arrangements for repayment.
4. Has the business entity or any owner, partner, officer or director ever been notified by any jurisdiction to which you are applying of any
delinquent tax obligation that is not the subject of a repayment agreement?
Yes ___ No___
If you answer yes, identify the jurisdiction(s): _______________________________________
5. Is the business entity or any owner, partner, officer or director a party to, or ever been found liable in any lawsuit or arbitration proceeding
involving allegations of fraud, misappropriation or conversion of funds, misrepresentation or breach of fiduciary duty?
Yes ___ No___
If you answer yes, you must attach to this application:
a) a written statement summarizing the details of each incident,
b) a certified copy of the Petition, Complaint or other document that commenced the lawsuit or arbitration, and
c) a certified copy of the official document which demonstrates the resolution of the charges or any final judgment.
6. Has the business entity or any owner, partner, officer or director ever had an insurance agency contract or any other business relationship
with an insurance company terminated for any alleged misconduct?
Yes ___ No___
If you answer yes, you must attach to this application:
a) a written statement summarizing the details of each incident and explaining why you feel this incident should not prevent you
from receiving an insurance license, and
b) certified copies of all relevant documents.
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Form AID-LI-TAGY(9/07)
Page 3
Applicants Certification and Attestation
The undersigned owner, partner, officer or director of the business entity hereby certifies, under penalty of perjury, that:
1. All of the information submitted in this application and attachments is true and complete and I am aware that submitting false information or omitting pertinent or
material information in connection with this application is grounds for license or registration revocation and may subject me and the business entity to civil or
criminal penalties.
2. Where required by law, the business entity hereby designates the Commissioner, Director or Superintendent of Insurance, or an appropriate representative in each
jurisdiction for which this application is made to be its agent for service of process regarding all insurance matters in the respective jurisdiction and agree that
service upon the Commissioner or Director of that jurisdiction is of the same legal force and validity as personal service upon the business entity.
3. The business entity grants permission to the Commissioner or Director of Insurance in each jurisdiction for which this application is made to verify any
information supplied with any federal, state or local government agency, current or former employer or insurance company.
4. Every owner, partner, officer or director of the business entity either a) does not have a current child-support obligation, or b) has a child-support obligation and is
currently in compliance with that obligation.
5. I authorize the jurisdictions to give any information they may have concerning me to any federal, state or municipal agency, or any other organization and I
release the jurisdictions and any person acting on their behalf from any and all liability of whatever nature by reason of furnishing such information.
6. I acknowledge that I understand and comply with the insurance laws and regulations of the jurisdictions to which I am applying for licensure/registration.
7. If required, I have received a Certificate of Good Standing from the jurisdiction's Secretary of State in which I am applying.
8. For Non-Resident License Applications, I certify that I am licensed and in good standing in my home state/resident state for the lines of authority requested from
the non-resident state.
Attachments
Must be signed by an officer, director, principal
or partner of the business entity:
Month Day Year
____________________________________________
Signature
_________________________________________________
Typed or Printed Name
_________________________________________________
Title
_________________________________________________
Social Security Number
_________________________________________________
Address
_________________________________________________
City State Zip
29

Form Information

Fact Name Description
Form Title The form is officially titled "AID-LI-TAGY" and is used for title agency applications in Arkansas.
Governing Law This form is governed by the Arkansas Insurance Code, which outlines the requirements for licensing title agencies.
Submission Date The form's version is dated September 2007 (9/07), indicating when the current format was established.
Contact Information The Arkansas Insurance Department License Division can be reached at 501-371-2750 for inquiries related to the form.
Business Information Applicants must provide detailed business information, including the entity's name, address, and contact details.
Affiliation Disclosure The form requires disclosure of any affiliation with a financial institution or bank, which is crucial for regulatory compliance.
Background Checks Applicants must answer questions related to criminal convictions, administrative proceedings, and financial obligations.
Certification Requirement Each application must be certified by an owner, partner, officer, or director, affirming the truthfulness of the information provided.
Attachments Needed Specific documents must accompany the application, including statements and certified copies for any affirmative responses to background questions.

Detailed Guide for Filling Out Arkansas Aid Li Tagy

Filling out the Arkansas Aid Li Tagy form is a crucial step for businesses seeking to operate within the state. It's essential to ensure that all sections are completed accurately to avoid delays in processing. Below are the steps to guide you through the completion of the form.

  1. Business Entity Name: Clearly print or type the name of your business entity at the top of the form.
  2. Incorporation/Formation: Indicate the type of incorporation or formation of your business.
  3. FEIN Date: Provide the date of your Federal Employer Identification Number (FEIN).
  4. National Producer Number: If applicable, enter your assigned National Producer Number (NP#).
  5. CRD Number: If applicable, include your NASD Firm Central Registration Depository (CRD) Number.
  6. Assumed Names: List any other names under which you are doing or intend to do business.
  7. State of Domicile: Specify the state where your business is domiciled.
  8. Country of Domicile: Indicate the country where your business is domiciled.
  9. Affiliation with Financial Institution: Answer whether your business is affiliated with a financial institution or bank by checking 'Yes' or 'No.'
  10. Business Address: Fill in your business address, including city, state, and zip code.
  11. Foreign Country: If applicable, provide the foreign country associated with your business.
  12. Contact Information: Enter your phone number, fax number, business website, and email address.
  13. Mailing Address: If different from your business address, provide your mailing address, including P.O. Box, city, state, and zip code.
  14. Designated Licensed Title Agent: Identify the responsible licensed title agent for your business.
  15. Licensed Title Agents: List all licensed title agents along with their Social Security Numbers (SSN).
  16. Owners, Partners, Officers, and Directors: Provide details for all owners with a 10% or greater interest, partners, officers, and directors, including their titles and SSNs.
  17. Jurisdiction and License Type: Check the appropriate boxes for the legal business type and license/registration type you are applying for.
  18. Background Information: Carefully answer all background questions regarding criminal history, administrative proceedings, financial obligations, tax obligations, lawsuits, and insurance relationships.
  19. Certification and Attestation: Ensure that the certification section is signed by an authorized individual, affirming the truthfulness of the information provided.

Once you have completed the form, review it thoroughly to confirm that all information is accurate and complete. Attach any required documents as specified in the instructions. After ensuring everything is in order, submit the form to the Arkansas Insurance Department for processing. This step is vital to ensure compliance and facilitate your business operations in Arkansas.

Obtain Answers on Arkansas Aid Li Tagy

  1. What is the purpose of the Arkansas Aid Li Tagy form?

    The Arkansas Aid Li Tagy form is used to apply for a title agency license in the state of Arkansas. This form collects essential information about the business entity, its owners, and any affiliated licensed title agents. It ensures compliance with state regulations governing the title insurance industry.

  2. Who needs to fill out this form?

    Any business entity seeking to operate as a title agency in Arkansas must complete this form. This includes corporations, partnerships, limited liability companies, and limited liability partnerships. Individuals involved in the business, such as owners and licensed title agents, must also provide their information.

  3. What information is required on the form?

    The form requires various details, including:

    • Business entity name and type
    • Federal Employer Identification Number (FEIN)
    • National Producer Number (if applicable)
    • Business address and contact information
    • Details about owners, partners, officers, and directors
    • Background information regarding any legal issues
  4. What background information must be disclosed?

    Applicants must disclose any past criminal convictions, administrative proceedings related to professional licenses, overdue debts, tax obligations, lawsuits involving fraud or misconduct, and any termination of business relationships with insurance companies. Each disclosure requires additional documentation.

  5. What happens if I provide false information?

    Providing false information or omitting important details can lead to serious consequences. This includes potential revocation of your license or registration and possible civil or criminal penalties. It is crucial to ensure that all information is accurate and complete.

  6. Is there a fee associated with submitting this form?

    The form itself does not specify a fee, but there may be associated costs for licensing and registration. It is advisable to check with the Arkansas Insurance Department for any applicable fees when submitting your application.

  7. How do I submit the form?

    Once completed, the form can be submitted to the Arkansas Insurance Department. You can send it via mail, fax, or potentially through an online portal if available. Ensure that all required signatures and attachments are included before submission.

  8. How can I contact the Arkansas Insurance Department for questions?

    You can reach the Arkansas Insurance Department's License Division by phone at 501-371-2750 or by fax at 501-683-2604. For further assistance, consider visiting their official website for more resources and information.

Common mistakes

When completing the Arkansas Aid Li Tagy form, individuals often make several common mistakes that can lead to delays or rejections of their applications. One frequent error is failing to provide the correct Business Entity Name. This name must match the official documents of the business. If there are discrepancies, it can create confusion and cause the application to be returned for correction.

Another mistake involves the National Producer Number (NP#). Applicants sometimes overlook this section or provide an incorrect number. If applicable, this number is crucial for processing the application efficiently. Omitting it can result in unnecessary delays.

Inaccuracies in the Social Security Number (SSN) or Federal Employer Identification Number (FEIN) are also common pitfalls. Providing incorrect numbers can lead to complications in verifying the identity of the business and its owners. It is essential to double-check these numbers before submission.

Additionally, some applicants neglect to answer all questions, particularly those related to criminal history or administrative proceedings. Leaving these sections blank can raise red flags. It is important to answer each question thoroughly and truthfully, as incomplete responses may lead to a denial of the application.

Another frequent issue arises with the attachments. Some individuals fail to include necessary documents, such as certified copies of legal documents or written statements required for certain questions. Ensuring that all required attachments are included is vital for a complete application.

Lastly, the signature section is often overlooked. The form must be signed by an authorized individual within the business entity. Failing to provide a signature or including an unauthorized signature can invalidate the application. It is important to ensure that the correct person signs the document to avoid complications.

Documents used along the form

The Arkansas Aid Li Tagy form is an essential document for businesses seeking to obtain a title agency license in Arkansas. However, it is often accompanied by various other forms and documents that help to provide a comprehensive view of the business entity's qualifications and background. Below is a list of related forms and documents that are commonly used alongside the Arkansas Aid Li Tagy form, along with brief descriptions of each.

  • Certificate of Good Standing: This document verifies that a business entity is legally registered and compliant with state regulations. It is often required to demonstrate that the entity is in good standing with the Secretary of State.
  • Business Plan: A detailed outline of the business's objectives, strategies, and financial projections. This document helps to illustrate the entity's viability and operational plans to the licensing authority.
  • Background Check Authorization Form: This form grants permission for the licensing authority to conduct background checks on the owners, partners, and key officers of the business. It is crucial for assessing the integrity and reliability of the individuals involved.
  • Financial Statements: These documents provide an overview of the business's financial health, including balance sheets, income statements, and cash flow statements. They are important for evaluating the financial stability of the entity.
  • Proof of Insurance: A certificate or document that demonstrates the business has obtained the necessary insurance coverage as required by state law. This protects both the business and its clients from potential liabilities.
  • Licensing Application for Other States: If the business operates in multiple states, it may need to submit applications for licensing in those jurisdictions as well. This documentation ensures compliance with varying state regulations.
  • Partnership or Operating Agreement: This document outlines the internal governance of the business, detailing the roles and responsibilities of partners or members. It is essential for clarifying how the business will operate and make decisions.

Each of these documents plays a vital role in the licensing process, providing necessary information that supports the application for a title agency license in Arkansas. Ensuring that all required documents are completed accurately and submitted in a timely manner can significantly enhance the likelihood of a successful application.

Similar forms

The Arkansas Aid Li Tagy form is an essential document for businesses seeking to obtain a title agency license. Similar forms exist in other contexts, serving various regulatory and compliance purposes. Here are four documents that share similarities with the Arkansas Aid Li Tagy form:

  • Business License Application: Like the Aid Li Tagy form, a business license application collects essential information about the business entity, including ownership details, business address, and nature of operations. Both forms require transparency regarding any legal or financial issues that may affect the business's ability to operate legally.
  • Insurance Agent License Application: This application is similar in that it gathers information about the applicant's qualifications, background, and any previous legal issues. Just as the Aid Li Tagy form does, the insurance agent license application emphasizes the importance of full disclosure regarding any past criminal or administrative proceedings.
  • Professional License Application (e.g., Medical, Legal): These applications require detailed information about the applicant's education, training, and professional history. Similar to the Aid Li Tagy form, they often include questions about any disciplinary actions or legal issues that could impact the applicant's professional standing.
  • Corporate Formation Documents: When forming a corporation, documents such as Articles of Incorporation require similar information about the business entity, including ownership structure and business purpose. Both types of documents aim to ensure compliance with state regulations and provide a clear picture of the entity's management and operations.

Dos and Don'ts

When filling out the Arkansas Aid Li Tagy form, it is important to follow specific guidelines to ensure accuracy and completeness. Below is a list of what you should and shouldn't do:

  • Do read the entire form carefully before starting. Understanding all requirements will help avoid mistakes.
  • Do provide accurate and complete information. Double-check all entries for accuracy.
  • Do attach all required documents. Ensure that they are certified where necessary.
  • Do sign the application. An unsigned form may be rejected.
  • Don't leave any required fields blank. Incomplete applications can lead to delays.
  • Don't use abbreviations or shorthand. Clarity is crucial for processing.
  • Don't submit false information. This can result in severe penalties, including license revocation.
  • Don't forget to keep a copy of the completed form for your records.

Misconceptions

  • Misconception 1: The form is only for large businesses.
  • This form is applicable to all types of business entities, regardless of size. Small businesses and startups can also use it to apply for the necessary licenses.

  • Misconception 2: Only the owner needs to fill out the form.
  • While the owner plays a significant role, the form requires information about all partners, officers, and directors. Their details are essential for a complete application.

  • Misconception 3: You can skip questions if you think they don't apply.
  • Every question on the form must be answered. If a question does not apply, it’s important to indicate that clearly. Omitting answers can delay the processing of the application.

  • Misconception 4: Previous criminal convictions automatically disqualify you.
  • While criminal history is considered, it does not always lead to disqualification. Each case is evaluated on its own merits, and applicants can provide context for any past issues.

  • Misconception 5: The form is only for insurance agencies.
  • This form is designed for various business entities seeking licenses related to title insurance. It is not limited to just insurance agencies but includes other types of businesses in the industry.

  • Misconception 6: You don’t need to provide supporting documents.
  • Supporting documents are often necessary, especially if there are any affirmative answers to certain questions. Providing these documents helps clarify the situation and supports the application.

  • Misconception 7: Once submitted, the application will be processed immediately.
  • The processing time can vary based on several factors, including the completeness of the application and the volume of applications being handled. Patience is key, as thorough reviews are essential for compliance.

Key takeaways

When it comes to filling out and utilizing the Arkansas Aid Li Tagy form, understanding the key components can make a significant difference in the application process. Here are some essential takeaways:

  • Accurate Information is Crucial: Every detail you provide must be correct. Inaccuracies can lead to delays or even denials of your application.
  • Signature Requirement: Ensure that the form is signed by an authorized individual within your organization. This adds authenticity to your application.
  • Document Attachments: Be prepared to attach necessary documents, especially if answering "yes" to certain background questions. This may include statements, legal documents, or certifications.
  • Know Your Business Type: Clearly identify your legal business type, whether it's a corporation, partnership, or limited liability company. This is vital for the licensing process.
  • Complete All Sections: Every section of the form must be filled out completely. Leaving blanks can lead to complications down the road.
  • Background Questions Matter: Take the background questions seriously. They are designed to assess your business's integrity and history.
  • Compliance with State Laws: Familiarize yourself with Arkansas insurance laws and regulations. This knowledge will help ensure your application aligns with state requirements.
  • Timely Submission: Submit your application promptly to avoid unnecessary delays. Check for any specific deadlines that may apply.

Being thorough and diligent while completing the Arkansas Aid Li Tagy form can pave the way for a smoother licensing experience. Each step you take now can save time and effort later.