Notice to Applicant: Federal Law - VIOLENT CRIME CONTROL AND LAW ENFORCEMENT ACT OF 1994, 18 U.S.C SECTION 1033 prohibits certain activities by or affecting persons engaged, or proposing to become engaged, in the business of insurance:
(e)(1)(A) Any individual who has been convicted of any criminal felony involving dishonesty or breach of trust, or has been convicted of an offense under this section, and who willfully engages in the business of insurance whose activities affect interstate commerce or participates in such business shall be fined as provided in this title or imprisoned not more than 5 years, or both.
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(B) Any individual who is engaged in the business of insurance whose activities affect interstate commerce and who willfully permits the participation described in subparagraph (A) shall be fined as a provided in this title or imprisoned not more than 5 years or both.
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(e)(2) A person described in paragraph (1)(A) may engage in the business of insurance or participation in such business if such person has the written consent of any regulatory official authorized to regulate
the insurer, which consent specifically refers to 18 U.S.C Sections 1033 and 1034.
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You must answer every question on the application. If a question does not apply, indicate N/A in the space provided for the answer. Your answers are not limited to the space provided on the Application. Attach additional pages as needed. First Financial Surety Services, will not process incomplete applications. Additional information may be requested.