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The affidavit must be completed and signed by a member of your firm who has

The affidavit must be completed and signed by a member of your firm who has 2026

The affidavit must be completed and signed by a member of your firm who has Preview on Page 1

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The document provides detailed instructions for completing the Affidavit of Intended Use for insurance agencies. It outlines the requirements for certification, necessary information to include, and the process for notarization and submission to iiX for approval. The affidavit must be signed by an authorized member of the firm and includes declarations regarding the confidentiality and proper use of driver record information.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the Legal Business Name and D/B/A Name if applicable. Ensure all fields are completed accurately to prevent processing delays.
In the Ownership section, list all individuals involved in the management of your business. If necessary, attach an additional list.
Complete the Licensing Information section by providing your insurance certificate numbers and their respective states along with expiration dates.
Initial each of the eight declaration statements to affirm your understanding and compliance, then sign and date the form in front of a Notary.
Finally, ensure that you mail the completed and notarized affidavit to iiX at the specified address for processing.

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