Forms
| Action | Form Name |
|---|---|
| Change Name Correct SSN or FEIN Trade Name Notification Clearance Letter (moving out of Virginia) |
Form 5001 |
| Individual License Cancellation Request Form | Individual Cancellation |
| Agency License Cancellation Request Form | Agency Cancellation |
| Request for List of Resident Agents for Continuing Education Mailings | Guidelines and Form |
| Lines of Authority - Full Lines | Form Name |
| Life & Annuities Variable Contract Health Personal Lines Property & Casualty Title Title Instructor Certification and Affidavit of Course Completion |
Form 3001 (initial) Certification and Affidavit |
| Lines of Authority - Limited Lines | Form Name |
| Limited Lines Credit Limited Lines Life & Health Limited Lines Property & Casualty Motor Vehicle Rental Contract |
Form 3001 (initial) |
| Lines of Authority - Temporary | Form Name |
| Temporary Life & Health Temporary Life & Health (Debit Only) Temporary Property & Casualty |
Form 3001 (initial) |
| Lines of Authority - Non-Standard | Form Name |
| Consultant (Life & Health) Consultant (Property & Casualty) Public Adjuster Viatical Settlement Broker |
Form 3001 (initial) Form 3001REN (renewal) |
| Surplus Lines Broker | Form 3001 (initial) Form 3001REN (renewal) SLB-2 |
| Lines of Authority - Business Entity (Agency) | Form Name |
| Life & Annuities Variable Contracts Health Property & Casualty Title Limited Property & Casualty – Portable Electronic Insurance Limited Property & Casualty – Travel Insurance Limited Property & Casualty – Self Storage Insurance |
Form 4052 (initial) |
| Lines of Authority - Non-Standard Business Entity (Agency) | Form Name |
| Consultant (Life & Health) Consultant (Property & Casualty) Public Adjuster Viatical Settlement Broker |
Form 4052 (initial) Form 4052REN (renewal) |
| Surplus Lines Broker | Form 4052 (initial) Form 4052REN (renewal) SLB-2 |
| License Type - Reinsurance Intermediary | Form Name |
| Initial Application | RI-app |
| Renewal Application | RI-renew |
| Appointment | Form Name |
| Appointment Form | Form 4151 |
| Appointment Cancellation Form | Form 4921 |
| Non-Licensed 1033 Consent Waiver Form | Form Name |
| Non-Licensed 1033 Consent Waiver Form | Form 1033 |
| RESA Forms | Form Name |
| Title Settlement Agent and Agency Financial Responsibility Certification Form | TSA Form |
| Title Settlement Agent Surety Bond | TSA Surety Bond |
| Waiver of Blanket Fidelity Bond or Employee Dishonesty Insurance Policy for Title Insurance Settlement Agents | TSA Waiver |
| Settlement Agent Official Registration Form - Individual | RESA Individual |
| Settlement Agent Registration Form - Corporation or Other Legal Entity | RESA Corp |
| Annuity Suitability | Form Name |
| Insurance Agent (Producer) Disclosure for Annuities | Form CN01 |
| Consumer Refusal to Provide Information | Form CN02 |
| Consumer Decision to Purchase an Annuity NOT Based on a Recommendation | Form CN03 |
| Unlicensed Ocean Marine Disclosure Form | Form Name |
| Unlicensed Ocean Marine Disclosure Form | Unlicensed Ocean Marine Disclosure Form |
| Annual Certification of Anti-Fraud Initiatives Form | Form Name |
| Annual Certification of Anti-Fraud Initiatives Form | Annual Certification of Anti-Fraud Initiatives Form |