Form Aid Li Ac PDF Details

Navigating the intricate details of compliance with state regulations can often feel daunting for individuals and businesses involved in the insurance sector. One such administrative task that requires attention to detail is the updating of addresses with the Arkansas Insurance Department. The Aid Li Ac form serves a critical purpose in this process, ensuring that both individuals and agencies maintain up-to-date contact information with the department. This form, officially known as FORM AID-LI-AC, is instrumental for reporting changes in mailing, residence, and business addresses. Instructions provided with the form stress the importance of completeness and accuracy, specifying that all relevant sections should be filled unless inapplicable. Highlighting the form's user-friendly aspect, there is no associated fee for submitting a change of address, and the option to fax submissions adds a layer of convenience. However, the form strictly prohibits its use for name changes, requiring separate procedures for such updates. The directive that individuals and agencies must not be combined on a single form further underlines the importance of clear and distinct communication with regulatory bodies. As the form makes clear, specific requirements come into play when the change involves moving to a new state, underscoring the nuanced nature of compliance within the insurance industry. Thus, the Aid Li Ac form embodies both a straightforward administrative task and a critical compliance checkpoint for professionals in Arkansas's insurance domain.

QuestionAnswer
Form NameForm Aid Li Ac
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesarkansas insurance department change form aid li ac, ar doi address chagne form, Licensee, duplicated

Form Preview Example

FORM AID-LI-AC (5/06)

ARKANSAS INSURANCE DEPARTMENT

LICENSE DIVISION

1200 WEST 3RD STREET

LITTLE ROCK, AR 72201

PHONE: 501-371-2750

FAX: 501-683-2604

ADDRESS CHANGE FORM

INSTRUCTIONS: All areas of this form that relate to the individual or the agency must be completed. If information does not apply, then mark the section N/A. WE MUST HAVE A PHYSICAL ADDRESS FOR THE RESIDENCE. WE MUST HAVE A CURRENT E-MAIL ADDRESS. Use a separate form for each individual and for each agency -- do not combine an individual and an agency on the same form -- combinations will not be processed. This form must be printed in ink, typed or computer generated. The form must be legible or the change will not be made. There is no charge for a change of address and this form may be computer generated or duplicated. COMPLETED FORM MAY BE MAILED OR FAXED TO 501-683-2604. This form cannot be used for a name change for an individual or a business entity.

INDIVIDUAL:

Name

Social Security or License Number:

Current Mailing Address:

P.O. Box or Street NumberCityState Zip

Current Residence Address:

 

 

 

Street Number

City

State

Zip

 

 

 

 

(Must be a physical address, cannot use P.O. Box. In a small town, General Delivery is acceptable.)

 

Current Business Address:

 

 

 

 

 

 

 

 

Street Number

City

State

Zip

 

 

 

 

(Must have a physical address, you can also include P.O. Box.)

 

 

 

Current Home Phone:

Current Business Phone:

 

 

 

 

 

 

 

 

 

 

 

Current Fax:

 

Current E-Mail Address:

 

 

 

 

 

 

 

 

 

 

 

 

Please change the information on my record to reflect this current information. I understand if I change my state of residence, additional requirements will apply.

__________________________________________

 

Dated:

 

 

 

 

 

 

 

 

 

Signature of Licensee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BUSINESS ENTITY (AGENCY):

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

FEIN Number:

 

 

 

 

 

 

 

 

 

 

Current Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P.O. Box or Street Number

 

 

City

State

Zip

 

 

 

Current Physical Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Must be a physical address, cannot use P.O. Box) Street Number

 

 

City

State

Zip

 

 

 

Agency Contact Person

 

 

Agency Phone:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Fax:

 

 

E-mail of Contact Person:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please change the information on the agency record to reflect this current information. I understand that an agency name change or move to another state of domicile requires additional information.

__________________________________________ Dated:

Signature of Agency Contact Person

Department Use Only: Date Received by Department ________________________ Date Keyed _______________________

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