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Form 1033-2026

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The document is a Short Form Application for Written Consent to engage in the business of insurance, as required by 18 U.S.C. § 1033 and 1034. It outlines the legal prohibitions against individuals with certain criminal convictions from participating in the insurance industry and details the application process for obtaining consent from regulatory officials. The applicant must provide personal information, disclose any criminal history, describe their current or proposed employment in insurance, and attach necessary documentation. The application emphasizes the importance of truthful disclosures and the potential consequences of false statements.

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Click ‘Get Form’ to open it in the editor.
Begin with Section I - Applicant Information. Fill in your full name, including any previous names if applicable. Ensure all fields are completed accurately.
Provide your home and mailing addresses, along with your contact numbers. Be sure to include your Social Security number and any other previously issued numbers.
Move to Section II - Criminal History. List any felonies you have been involved with, providing detailed descriptions as required. Attach additional pages if necessary.
In Section III - Present/Proposed Insurance Employment, specify your current or proposed employer's details and describe your job responsibilities thoroughly.
Finally, ensure you attach all required documents listed in Section IV before submitting the application for review.

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form 1033

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