044-6 Wyo. Code R. § 6-2
These Rules and Regulations may be amended at any regular meeting of the Board by a regular vote, provided a copy of the proposed amendment shall have been given to each member of the Board at least ten days prior to the date of the meeting at which they are to be considered, or without such notice at any regular meeting where there is a full attendance of the members of the Board, and with the unanimous vote of the Board.
The above Rules and Regulations were adopted by unanimous vote of the Board on the 9th day of Oct, 1961.
Board M Board Member Board Member Board Member
Board Member
APPLICATION FOR INSURANCE EXAMINATION AND LICENSE
to the BOARD OF INSURANCE AGENT'S EXAMINERS AND INSURANCE COMMISSIONER
of the STATE OF WYOMING
NOTICE: A fee of $10.00 must accompany this application as required by the Wyoming Statutes. Checks and Money
Orders must be made payable to: "State Board Of Insurance Agent's Examiners." Mail applications and checks to: "STATE BOARD OF INSURANCE AGENT'S EXAMINERS
STATE OFFICE BUILDING, CHEYENNE, WYOMING"
For the purpose of securing a license as an Insurance Agent in the State of Wyoming, I submit the following statement and answers to questions contained herein. NOTICE: Application must be filled out in applicant's own handwriting.
1. Full Name of Applicant __________________________________________________________________
First Middle Last
2. Marital Status ................ Age ------- How long Resident in Wyoming? --------------
3.Resident Address ---------------------------------------
--------------- How long? .................... --
Street
Town
4. Business Address ---------------------------------------
--------------- How long? ........................
Street
Town
5. Previous Residence ---------------------------------
------------------- How long? ........................
Town
State
6. State occupation during post five years next preceding the date of this application, giving various employment in chronological order including present employment and name of present employer and his address; if engaged in business for yourself, give address during that time.
OCCUPATION AND/OR PAST FIVE EMPLOYER'S NAME & ADDRESS & NATURE
POSITION HELD YEARS OF BUSINESS, OR THAT OF YOURSELF
FROM TO
FROM TO
FROM TO
FROM TO
FROM I TO
7. Will you devote all of your efforts to acting as on insurance agent? ------------
---------------------If answer is, "NO," what percentage of time will be devoted to insurance? -------------------------What will be nature of other
work? ----------------------------------------
8.Hove you had insurance experience or training? State extent
9. Do you now or hove you ever represented any insurance company?
Name companies: --------------------------------------
--------------------------------------List states where you have
held licenses:
10. Do you now hold an active or current Resident Agent's license from any other State? - ---------------
11. Has any request for insurance license been refused, or has a license been suspended or revoked? ------If so, relate circumstances: ------------------------
---------------------------------------------
---------------------------------------------
---------------------------------------------
--
Insurance Department? Name of State
Form No. 200 -1-
12. Does any insurance company, general or branch insurance agent claim any indebtedness under an agency
contract or otherwise and, if so, the name of the claimant, the nature of the claim and the applicant's
defense thereto: ------------------------------------------
---------------------------------------------------
13.Do you understand that it is illegal to rebate, twist policies, misrepresent policy conditions or the standing of your own or other companies? ----------
14. Do you understand that is unlawful to hold a license for the principal purpose of effecting insurance upon your own property or life of those of your employer? ---------
15. Do you, the applicant, understand that you are not to solicit any application for insurance until your Wyoming Agent's license is in your possession? ---------NOTICE: If you have resided in the State for less than one year, give names of three persons with whom you
are acquainted for references:
----------------------------------------------------
Name
Address
-------------------------- -------------------------Name
Address
----------------------------------------------------
Name
Address
I - ------------------ hereby certify that I hove carefully reviewed this application and hove
answered said questions to the best of my knowledge and ability and the answers are true.
------------------------Signature of applicant
Signed and sworn before me this --- day of ------- A. D., 1 9--
S Notary Public in and for the County of ------- State of ------
E My commission expires -------------
A
------------------ ------
Signature of Notary Public
We have investigated the character and background of the applicant and are satisfied that he is trustworthy and qualified to act as our agent and to hold himself out in good faith to the general public as an insurance agent, and that we desire the applicant be licensed as an insurance agent to represent us in the State of Wyoming.
------------------------Company
By - ------------------------Authorized Signature
Dated at ------------ State of ----------- this --- day of -------- 19 --
It shall be the duty of the Commissioner to with-hold any license applied for or revoke any license issued to any agent or agency, when he is satisfied that the principal use of such license is to effect insurance upon the property or liability of such agent or agency, to evade the enforcement of the anti-rebate low, or that such applicant has not complied with or is not complying with all legal requirements relating to agent (Sec. 26-66 - 26-67, Wyoming Compiled Statutes, 1957)
Your attention is directed to the fact that a fee of $10.00 will be charged for each sitting for the insurance agents examination.
The examination will be divided into the following sections. Please check the section or sections in which
you desire to be examined:
CLASSIFICATION ESTIMATED TIME FOR EACH SECTION
LIFE Section
1.( ) Life &Annuities 30 min.
2. ( ) Accident & Health 30 min. GENERAL INSURANCE
3. ( ) Automobile Physical Damage 30 min.
Comprehensive (Fire, Theft, Combined Additional Coverage) Collision
Towing and Road Service
4. ( ) Automobile Liability 30 min.
5. ( ) Fire & Allied Lines 30 min.
6. ( ) General Casualty 30 min.
7. ( ). Surety 30 min.
8. ( ) Title 30 min.
9. ( ) Livestock & Crop Hail 30 min. 10. ( ) Aviation-------------I---------- 30 ---------
--
THIS SPACE IS TO BE USED BY THE BOARD OF INSURANCE AGENTS EXAMINERS
APPLICANT'S NAME ---------------------------------
---------
First
Middle
Last
ADDRESS ---------------------------------------------
---
Street
Town
You are hereby advised that the examination to test your qualifications for a license to sell insurance in the
State of Wyoming will be held at -------------- on the --- day of -------- 1 9--
at -------------
You are hereby requested to report to ------------------------------
----at the specified address and time set forth in the above.
You will be notified of the results of the examination within a reasonable period of time. STATE BOARD OF INSURANCE AGENTS EXAMINERS
Secretary-Treasurer
-N
D -910ONAN
VICK PRESIDENT
ARCHIE W. SHAFER
SECRETARY-TREASURER
ATTILIO W. BEDONT. CLU PRESIDENT
STATE BOARD OF INSURANCE AGENT'S EXAMINERS P. 0. BOX 1112, CHEYENNE
PROCTOR'S REPORT (Applicant's Name)
THOMAS HORN. JR. BOARD MEMBER
H. MAX HURSH BOARD MEMBER
was afforded the following examinations on
(Date)
at (Place)
(Check those given)
= 1 . Life and Annuities. =5. Fire and Allied Lines.
= 2. Accident and Health. =6. General Casualty.
=3. Automobile Physical Damage. = 7. Surety.
=4. Liability (automobile) . =8. Title.
=9. Livestock and Crop Hail . 10.Aviation
The following instructions were given to applicant and were followed by him:
1. Place correct answers in appropriate place on Answer paper.
2. Only the papers given to you by proctor are to be on your table or desk.
3. You are not to refer to any notes during examination and no notes are to be made during examination.
4. You are not to receive help from anyone else during examination, and there is to be no talking during the examination.
5. The proctor is not allowed to explain or interpret the examination questions. Do the best you can with them. All applicants have the same problems.
6. You must not leave the room until the examination is finished and the questions and answers returned to the proctor.
7. AlI material must be returned to the proctor and by the proctor to the Board.
COMMENTS: (Note anything pertinent. If applicant failed to appear, so note)
044-6 Wyo. Code R. § 6-2