Test Audit Module N

This field is for validation purposes and should be left unchanged.

SpotID

Auditor Name

Date Assigned

Auditor Email

Contact Details

Brokerage Name(Required)

Brokerage License Number(Required)

Does your firm have a Principal Broker?(Required)

Principal Broker Name(Required)

First Last

Your Name(Required)

First Last

Your Email(Required)

Your Phone(Required)

Audit Information

1. Are the majority of shareholders in your firm RIBO licensees?(Required)

2. Who are your shareholders?(Required)

3. Please attach your current shareholder structure of your firm.(Required)

Drop files here or

Max. file size: 256 MB.

4. Provide a complete list of all entities or individuals from which your firm receives commissions, fees, or any other form of compensation.(Required)

5. What is the primary purpose of your firm as a non-active entity?(Required)

6. Does your firm distribute or pay funds, commissions, or any other compensation to an entity or person other than payments to yourself?(Required)

Please List all entities or persons that receive commissions or any other compensation(Required)

7. Does your firm have any retail business?(Required)

8. Does your firm have any other business other than that of an insurance broker?(Required)

Please list the other businesses of your firm.(Required)

Have you received a secondary business exemption for this business?(Required)

9. Does your firm have a trust account?(Required)

10. Please confirm if your firm provides the following (Select all that apply):(Required)

Advertise

Holding trust funds

Hold insurance contracts

Receive payments directly from insured

11. How many full-time employees does your firm employ?(Required)

12. Does your firm employ RIBO licensees or other non-active firms?(Required)

Please list all the RIBO licensees and/or non-active firms that are employed by your firm.(Required)

13. Does your firm have an E&O policy in place?(Required)

Is your firm an additional named insured on the active firm’s E&O Policy?(Required)

14. Is your firm used to operate a branch location on behalf of an active firm?(Required)

15. Does your firm have registered tradename(s)?(Required)

Please list all registered tradenames for the non-active firm and indicate which, if any, is substantially similar to the active firm.(Required)

Test Audit Module N

Contact Details

Audit Information

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