Certificate of Authority Section IV - Item #17
Special Power of Attorney to Appoint Agents
A notarized Special Power of Attorney to Appoint and Certify Agents form must be filed in duplicate. It must be signed by officers who have authority to execute such powers.
Only one insurer may be named in a single power. If a person is to be appointed for several insurers comprising a group, separate powers must be filed by each insurer authorizing such person.
More than one person may be named in a single power. However, only natural persons should be named. Do not name corporations or partnerships. For example, do not name the "Blank Agency, Incorporated." Instead, name "John Doe and James Roe" of said agency.
A power must authorize a person to appoint agents for an insurer and must not limit authority to an underwriting department of the insurer.
Do not alter the Power of Attorney form. This is a universal form. If the person named is not to be permitted to appoint and certify life agents (including disability only agents), please restrict his or her authority within your own organization and do not alter the form's language.
Appointments of attorneys-in-fact are effective on the dates filed, as shown by the date received stamp of this department thereon. For the purpose of being able to send you an acknowledgment, these forms must be filed in duplicate. The duplicate copy will be date-stamped and returned to you and will constitute an acknowledgment of filing.
The Certificate of Authority of an interinsurance exchange is issued to its attorney-in-fact. A Power should be executed in the name of the attorney-in-fact as attorney for the exchange. (For example: "Blank Corporation, Attorney-in-Fact for Blank Insurance Company, an Interinsurance Exchange").
In the case of an alien insurer, the document may be executed by the United States Manager before a notary. No seal is required.
Note: The instructions set forth herein apply only to the Special Power of Attorney to Appoint and Certify Agents and have no reference to other Power of Attorney forms. There is no fee required for filing.