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Naic biographical affidavit

Naic form 11 2026

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The document is a Biographical Affidavit required for applicants seeking licensure or permits in the insurance industry. It collects personal and professional information about the affiant, including citizenship, occupation, education, employment history, licenses held, and any legal issues. The affidavit emphasizes confidentiality and includes sections for background checks and disclosures related to previous regulatory actions or criminal history. It also contains authorization for the company to obtain background reports.

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Click ‘Get Form’ to open NAIC Form 11 in the editor.
Begin by entering the Applicant Name (Company) and NAIC No. at the top of the form. Ensure all information is accurate.
Fill out the Biographical Affidavit section, providing your full name, address, and telephone number. Remember to print or type your responses.
Complete each question regarding citizenship, occupation, and business address. If any field requires additional information, attach a separate sheet as needed.
List your educational background and professional memberships in the designated sections. Be thorough to avoid delays in processing.
Detail your employment history for the past twenty years, ensuring you include all relevant positions held and their corresponding dates.
Review all entries for accuracy before signing and dating the affidavit at the bottom of the form.

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