Application for limited lines producer license

Sec. 18. (a) A vendor shall apply for a limited lines producer license required by this chapter by filing a sworn application for the license with the commissioner on forms prescribed and furnished by the commissioner. (b) An application filed under subsection (a) must include the following information: (1) Except as provided in subdivision (2), the name, residence address, and other information required by the commissioner for an employee or officer of the vendor who is designated by the vendor as the individual who is responsible for the vendor's compliance with this chapter. (2) If the vendor derives more than fifty percent (50%) of the vendor's revenue from the sale of portable electronics insurance, the name, residence address, and other information required by the commissioner for each officer, director, and shareholder of record that has beneficial ownership of at least ten percent (10%) of any class of securities registered by the vendor under federal securities law. (3) The physical address of the vendor's home office.