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CA Department of Insurance

Certificate of Authority Section IV - Item #7 and Item #8

Affidavit Instructions

As part of the application process, it will be necessary for the applicant to ensure completion of both the Individual Affidavit(s) and the Organizational Affidavit. Submit the original and two (2) copies.

The Individual Affidavit(s) must be completed by all of the following individuals:

  • The applicant's officers, directors and key management personnel;
  • Individuals having a 10 percent or more beneficial ownership of the applicant (direct or indirect including attribution);
  • Applicant's ultimate controlling parent; and
  • Individuals having a 10 percent or more beneficial ownership of the applicant's ultimate controlling parent.

For insurers, "key management personnel" includes all persons responsible for oversight of any of the following functions:

  • Actuarial
  • Claims
  • Finance
  • Investments
  • Rating
  • Reinsurance
  • Risk Management
  • Sales and Marketing
  • Underwriting

For underwritten title companies, "key management personnel" includes all of the following:

  • Chief Escrow Officer
  • Chief Title Officer
  • County Manager
  • Subdivision Manager
  • Title Plant Manager

The Organizational Affidavit must be completed by an executive officer of the applicant's organization.

The affidavits must be typed and all questions must be answered. Do not leave any spaces blank. If additional space is required, attach an addendum, numbering the response to the corresponding question. Please be sure to submit your originals.

Back to Section IV: Guidelines & Sample Language

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