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Naic biographical affidavit form 11

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Applicant Company Name NAIC No* FEIN BIOGRAPHICAL AFFIDAVIT To the extent permitted by law this affidavit will be kept confidential by the state insurance regulatory authority. Print or Type Full name address and telephone number of the present or proposed entity under which this biographical statement is being required Do Not Use Group Names. In connection with the above-named entity I herewith make representations and supply information about myself as hereinafter set forth. Attach addendum o ...

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What is NAIC form a?

(Form A) Page 1. Statement Regarding the Acquisition of Control of or Merger with a. Domestic Insurer.

What is a biographical affidavit?

The NAIC Biographical Affidavit is used to evaluate the suitability of the Affiant in connection with an applicant's pending or future application(s) for licensure or a permit to organize with a department of insurance in one or more states.

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