Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 75 - THIRD PARTY ADMINISTRATORS › Section 836-075-0000 - Third Party Administrators; License Application; Required Information

Current through Register Vol. 63, No. 7, July 1, 2024
An applicant for a third party administrator license shall
				provide the following electronically in accordance with directions set forth on
				the Division of Financial Regulation website of the Department of Consumer and
				Business Services at dfr.oregon.gov:
(1) Information relating to the
			 organizational form of the applicant as follows:
(a) The name under which the applicant will
			 transact business as a third party administrator;
(b) The principal place of business at which
			 the applicant will transact business as a third party administrator, including
			 the street and mailing addresses and telephone number;
(c) The organizational form of the applicant
			 (corporation, partnership, sole proprietorship);
(d) All assumed business names and other
			 names under which the applicant will transact business as a third party
			 administrator;
(e) Whether the
			 applicant has ever had a judgment entered against the applicant for fraud, and
			 whether any insurer, insurance producer or other person claims the applicant to
			 be indebted to it, together with the details of any such
			 indebtedness;
(f) Whether any
			 license of the applicant to act in any occupational or professional capacity
			 has ever been refused, revoked or suspended in this or any other state, and
			 whether the applicant has otherwise ever been the subject of a complaint to a
			 professional licensing board or agency. If the applicant's answer is
			 affirmative in any respect, the applicant must also provide the name and
			 address of the licensing board or agency, the date of the complaint or the
			 action taken against the license, a description of the nature of the complaint
			 or the reason for the action taken against the license, and, with regard to a
			 complaint, a description of the licensing board or agency's disposition of the
			 complaint;
(g) Whether the
			 applicant has ever filed for bankruptcy or been adjudged a bankrupt;
(h) All states and provinces of Canada in
			 which the applicant currently holds a license or certificate of authority to
			 transact business as a third party administrator, or has held such a license or
			 certificate within ten years prior to the date of the application;
(i) The names, addresses, official positions
			 and professional qualifications of the individuals who are responsible for the
			 conduct of affairs of the administrator, including all members of the board of
			 directors, board of trustees, executive committee or other governing board or
			 committee; the principal officers in the case of a corporation or the partners
			 or members in the case of a partnership or association; shareholders holding
			 directly or indirectly ten percent or more of the voting securities of the
			 administrator; and any other person who exercises control or influence over the
			 affairs of the administrator;
(j)
			 The name and telephone number of a contact person who is knowledgeable about
			 preparation of the annual financial statements or reports required under
			 section (4) of this rule.