The Arkansas Aid Li Tagy form, formally known as Form AID-LI-TAGY, is a critical document issued by the Arkansas Insurance Department License Division for business entities requiring title agency licensing. It serves as a comprehensive application that facilitates the collection of crucial business, personal, and regulatory information from entities operating within the state's insurance sector. Interested parties are encouraged to thoroughly review and complete the form to ensure compliance with Arkansas' regulatory requirements.
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In the realm of professional licensing and business operations within Arkansas, the Arkansas Aid Li Tagy form emerges as a pivotal document, underscored by its exhaustive detail and stringent requirements. Originating from the Arkansas Insurance Department License Division, this form serves as a comprehensive application for title agencies seeking licensure or registration within the state. With sections meticulously outlining the necessity for business entity information, including but not limited to business names, incorporation details, and affiliations with financial institutions, it encapsulates a broad spectrum of operational aspects. Moreover, it extends into the personal territory of owners, partners, officers, and directors, demanding disclosures on past legal and financial discrepancies that could influence their eligibility. The form also encompasses a section dedicated to the jurisdiction and type of license or registration sought, further emphasizing its role as a gateway for businesses to enter the Arkansas market legitimately. Through a series of attestations and certifications, applicants are compelled to affirm the accuracy of their submissions, acknowledging the legal ramifications of falsehoods. This myriad of requirements illustrates the form's critical function in vetting the integrity and reliability of title agencies, ensuring that only those fully compliant and of reputable standing can navigate the market. The Arkansas Aid Li Tagy form, therefore, stands not merely as a bureaucratic hurdle but as a testament to the state's commitment to consumer protection and ethical business practices.
FORM AID-LI-TAGY (9/07)
ARKANSAS INSURANCE DEPARTMENT
LICENSE DIVISION
1200 WEST 3RD STREET
LITTLE ROCK, AR 72201
PHONE: 501-371-2750
FAX: 501-683-2604
TITLE AGENCY
(Please Print or Type)
1
Business Entity Name
2 Incorporation/Formation
3 FEIN
Date
-
4
If assigned, National Producer Number (NP#)
5 If applicable, NASD Firm Central Registration Depository (CRD) Number
6List any other assumed, fictitious, alias or trade names under which you are doing business or intend to do business.
7State of Domicile
8Country of Domicile
9 Is the business entity affiliated with a financial institution/bank?
Yes
No
10Business Address
11City
12State
13Zip Code
14Foreign Country
15
Phone Number
16 Fax Number
17 Business Web Site Address
18 Business E-Mail Address
(
)
19
Mailing Address
20
P.O. Box
21 City
22 State 23 Zip Code
24Foreign Country
Designated/Responsible Licensed Title Agent
25Identify all Licensed Title Agents:
Name
SSN
Owners, Partners, Officers and Directors
26Identify all owners with 10% interest or voting interest, partners, officers and directors of the business entity:
Title
SSN/FEIN
Owner: Yes / No
(State Use)
Form AID-LI-TAGY(9/07)
Page 2
Jurisdiction and Type of License/Registration Requested –
27Next 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
28Please 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,
Yes ___
No___
officer or director currently charged with, committing a crime, whether or not adjudication was withheld?
“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)
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?
“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.
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?
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?
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?
a written statement summarizing the details of each incident,
a certified copy of the Petition, Complaint or other document that commenced the lawsuit or arbitration, and
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?
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.
Page 3
Applicants Certification and Attestation
29The 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 DayYear
____________________________________________
Signature
_________________________________________________
Typed or Printed Name
Social Security Number
Address
City
State
Zip
Filling out the Arkansas Aid Li Tagy form is a critical step for any business entity seeking to register or renew its license with the Arkansas Insurance Department. This document requires detailed information about your business, including its legal status, ownership, and compliance history. By providing accurate and complete information, you can ensure a smoother process. Here are the steps you need to follow:
After completing the form, review it to ensure all information is accurate and no section has been overlooked. Attach any required documents as specified in the instructions. Then, send the completed form and attachments to the Arkansas Insurance Department via the provided mail or fax numbers. Filling out this form accurately is crucial for the timely processing of your application or renewal. Should you have questions during this process, consider reaching out to the Arkansas Insurance Department directly for assistance.
What is the FORM AID-LI-TAGY used for?
This form is utilized by business entities to apply for insurance licensure or registration with the Arkansas Insurance Department. It includes sections for business information, background questions, and certifications vital for the licensing process.
Who needs to fill out the FORM AID-LI-TAGY?
Any title agency or business entity seeking to offer insurance services and requires licensure or registration from the Arkansas Insurance Department must complete this form.
What are the key sections of the FORM AID-LI-TAGY?
The form comprises several sections including the business entity name, contact information, identification of owners, partners, officers, and directors with a significant interest in the business, background information checks, and a certification and attestation section to be signed by an authorized individual.
Is it required to disclose any criminal background on the FORM AID-LI-TAGY?
Yes, the form requires disclosure of any criminal history for the business entity or any of its owners, partners, officers, or directors. This includes details of convictions or current charges, excluding minor traffic citations and juvenile offenses.
What happens if any section of the FORM AID-LI-TAGY is left blank?
All sections of the form need to be completed. Omitting information or submitting false information can lead to the revocation of the license or registration and may subject the individual and the business entity to civil or criminal penalties.
How are disputes involving financial issues disclosed on the form?
Any judgments, overdue monies, or bankruptcy proceedings involving the business entity or associated individuals must be disclosed, along with a statement summarizing the details and repayment arrangements if applicable.
Are there any requirements for disclosing past license revocations or sanctions?
Yes, the form asks if the business entity or any associated individuals have been involved in administrative proceedings regarding any professional or occupational license, including censures, suspensions, cancellations, terminations, fines, or probation. Details of these incidents must be attached.
What documentation is required if the business entity or any associated individuals have been involved in lawsuits?
Allegations of fraud, misappropriation, misrepresentation, or breach of fiduciary duty necessitate the attachment of a summary of each incident, plus certified copies of the initial legal complaint and the final judgment or resolution documents.
How does the CART process work with respect to FORM AID-LI-TAGY submissions?
The "Consent to Service of Process" section implies that the business entity consents to having the Commissioner, Director, or Superintendent of Insurance, or their representative, serve as their agent for legal matters in the jurisdiction where the application is made. This ensures there is a legally recognized method for handling legal and regulatory communications related to the license or registration.
When filling out the Arkansas Aid Li Tagy form, individuals often encounter several pitfalls that can complicate or delay the submission process. Understanding these mistakes is crucial for ensuring accurate and timely processing of the application. Here are five common errors:
Addressing these common mistakes before submitting the Arkansas Aid Li Tagy form can significantly streamline the application process, ensuring a smoother interaction with the Arkansas Insurance Department. It is also advisable to review the application multiple times and possibly seek professional assistance to avoid these pitfalls. McKenzie
When completing the Arkansas Aid Li Tagy form, entities and individuals might need to integrate additional forms and documents to ensure thorough and accurate processing. These supplementary documents vary based on specific circumstances and requirements set forth by the Arkansas Insurance Department. Below is a list of documents that are often used alongside the Arkansas Aid Li Tagy form.
Together, these documents provide a comprehensive overview of a business’s legal, financial, and operational fitness, complementing the information on the Arkansas Aid Li Tagy form. Proper documentation ensures a smoother review process, helping the Arkansas Insurance Department assess qualifications for licensure accurately.
The Arkansas Aid Li Tagy form, used by the Arkansas Insurance Department, shares similarities with various other documents required in the process of registering or licensing a business entity in various fields. One such document is the Business Entity Application form required for registering a new corporation or LLC with a state's Secretary of State. Both forms collect foundational information about the business, including the name, type of business entity, and contact information, ensuring that the entity is legally recognized and can operate within the state.
Another document similar to the Arkansas Aid Li Tagy form is the Uniform Application for Broker-Dealer Registration (Form BD), which is used by securities broker-dealers to register with state securities regulators, the SEC, and self-regulatory organizations. Like the Arkansas form, Form BD requires detailed information about the business's structure, background, and affiliations, aiming to ensure compliance with financial and securities regulations.
The Professional Licensing Application forms, used across various states for professions such as real estate, medicine, law, and accounting, also share a resemblance. These forms, while specific to their respective profession, gather information on the entity's or individual's qualifications, legal standing, and business operations, similar to the detailed and structured information requested in the Arkansas form.
The IRS SS-4 Form, Application for Employer Identification Number (EIN), also parallels the Arkansas Aid Li Tagy form in its fundamental purpose of identifying a business entity. While the SS-4 is specific to tax identification, both forms require information about the entity's formation, ownership, and operational context, facilitating regulatory oversight.
The NAIC Uniform Application for Individual Producer License/Registration is geared towards individuals in the insurance industry seeking to obtain or renew a license. Similar to the Aid Li Tagy form, it collects personal and professional information, including background checks and business affiliations, ensuring the applicant meets the industry's ethical and professional standards.
The National Futures Association (NFA) Membership Application for firms is another comparable document, required for firms engaging in futures trading to become members of the NFA. It demands extensive details about the business's operations, principals, and regulatory compliance, akin to the scrutiny seen in the Arkansan insurance document.
State-specific Charitable Solicitation Registration forms, required for non-profits and others soliciting donations, parallel the Arkansas form in their need for detailed information on the organization's background, operation, and financial handling. This ensures transparency and compliance with state laws designed to protect donors and public interests.
The FINRA Form U4, used for registering individuals with regulatory authorities and firms in the securities industry, shares the intent of ensuring those operating in sensitive financial positions are appropriately vetted and qualified. Both this and the Arkansas form delve into personal and professional backgrounds to protect public and investor interests.
A Commercial Driver’s License (CDL) Application form, required for individuals to operate large or specialized vehicles for commercial purposes, similarly requires detailed information on the applicant's identity, qualifications, and legal compliance. Like the Arkansas Aid Li Tagy form, it ensures individuals or entities meet specific regulatory standards before granting permission to operate.
Lastly, the Patent and Trademark Office (PTO) Application forms, though focused on intellectual property, necessitate detailed disclosure about the inventor or business entity, the invention, and its commercial application, ensuring a thorough review process before granting legal protections, reflecting the comprehensive nature of the Arkansas form's business and operational disclosures.
When filling out the Arkansas Aid Li Tagy form, it's essential to approach the task with care and attention to detail. Here's a guide to help ensure you complete the form accurately and effectively:
By following these dos and don'ts, you'll help ensure that your application is complete, accurate, and processed without unnecessary delays.
When it comes to understanding the Arkansas Aid Li Tagy form, several misconceptions can lead to confusion. These forms are essential for businesses in the insurance sector in Arkansas and provide vital information to the Arkansas Insurance Department. Misinterpretations can result in mistakes that delay the licensing process or compliance issues that could have been easily avoided. Here are five common misconceptions about the Arkansas Aid Li Tagy form:
Correcting these misconceptions ensures businesses in the insurance sector can navigate the licensing process more efficiently and maintain good standing in Arkansas. It's imperative for entities to thoroughly review and understand the requirements outlined in the Aid Li Tagy form to avoid common pitfalls and foster a compliant business environment.
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