Application For Real Estate Broker'S Reciprocal License Form (Page 2 of 2) in pdf

(b) Indicted?

_____ Yes _____ No

(e) Imprisoned?

_____ Yes _____ No

(f) Placed on Probation?

_____ Yes _____ No

criminal offense?

_____ Yes _____ No

IF YES TO ANY OF THE ABOVE, GIVE COMPLETE EXPLANATION ON ADDITIONAL SHEET AND ATTACH TO APPLICATION

11. IF YOU ARE NOT A RESIDENT OF THE STATE OF ALABAMA, you must agree to and sign the following:

I, as a nonresident applicant for a real estate license and as a licensee, agree that the Alabama Real Estate Commission shall have jurisdiction over me in

any and all of my real estate related activities the same as if I were an Alabama resident licensee. I agree to be subject to investigations and disciplinary actions the

same as Alabama resident licensees. Further, I agree that civil actions may be commenced against me in any court of competent jurisdiction in any county of the State

of Alabama.

I hereby appoint the Executive Director or the Assistant Executive Director of the Alabama Real Estate Commission as my agent upon whom all disciplinary,

judicial, or other process or legal notices may be served. I agree that any service upon my agent shall be the same as service upon me and that certified copies of this

appointment shall be deemed sufficient evidence and shall be admitted into evidence with the same force and effect as the original might be admitted. I agree that any

lawful process against me which is served upon my agent shall be of the same legal force and validity as if personally served upon me and that this appointment shall

continue in effect for as long as I have any liability remaining in the State of Alabama. I understand that my agent shall, within a reasonable time after service upon him

or her, mail a copy of the service by certified mail, return receipt requested, to me at my last known business address.

I agree that I am bound by all the provisions of the Alabama Real Estate License Law the same as if I were a resident of the State of Alabama.

Legal Signature of Applicant _______________________________________________________

CHECK ONE OPTION:

Issue license to:

_____________ Active Status

_____________ Inactive Status

• If license will be issued to inactive status, do not complete the following section. Proceed to Affidavit.

• If license is to be issued to active status, please check the following: Errors and Omissions Insurance applied for through

Alabama State Group Policy

Optional E&O Coverage

Covered by Group Contract in home state

MUST

ALABAMA BROKER, OR RECIPROCAL BROKER APPLICANT, UNDER WHOM YOU WISH TO BE LICENSED

COMPLETE THE

FOLLOWING:

“In my opinion this applicant is honest, trustworthy and of good reputation, and I hereby accept responsibility of any actions of this licensee under the provisions of the

Alabama Real Estate License Law.”

1. Alabama Company Name (as appears on license) OR Name of company to be registered in Alabama (company not required to be physically located in Alabama):

NOTE: If opening a corporation, partnership or branch office, obtain an application from the Real Estate Commission and submit with this application along

with appropriate fees and proof of E & O Insurance. This does not apply if opening a sole proprietorship since no separate company license is

required.

______________________________________________________________________________________________________________________________________

2. Alabama Registration Number (PLEASE STATE ACCURATELY) _______________________________________________________________________________

(If registering a new company, number will be assigned)

3. Company Address (Physical location) ______________________________________________________________________________________________________

City: _______________________________________________________

State __________________________________ Zip: ________________________

4. Mailing Address: _______________________________________________________________________________________________________________________

__________________________________________________________________________________________________________

E-mail Address:

6. Company Telephone Number _____________________________________________________________________________________________________________

7.Alabama Qualifying Broker’ s Signature _________________________________________________ and Social Security Number ___________________________

FOR QUALIFYING BROKERS ONLY:

I understand and agree that if my place of business is in Alabama, I may not have any Alabama licensees under me, unless I am in a position to

actually supervise them on a full-time basis as required by law. Simply put, my licensees and I must be in the same place

Sworn to and Subscribed before me this ____________ day of ____________________, 19 ___________.

______________________________________________________________________________________

Notary Public

AFFIDAVIT

INSTRUCTIONS: This affidavit must be completed, signed, notarized and returned as a part of your application for either a reciprocal broker or salesperson license

whether active or inactive.

STATE OF __________________________________________________________________________________________________________________________

CITY OF ____________________________________________________________________________________________________________________________

COUNTY OF _________________________________________________________________________________________________________________________

NAME OF APPLICANT ________________________________________________________________________________________________________________,

being duly sworn, deposes and says I am the applicant named above and, I have read the application with the answers noted thereon. The answers are true to my

knowledge, except as to any matter stated to be upon information and belief, and as to such matter I believe it to be true, and I personally signed this affidavit. I further

verify that I knowingly and willingly signed the release statement contained on the first page of this application form. I give permission to the staff of the commission to

have access to such education, employment, law enforcement, and other records as are necessary to verify or contradict the information I have provided.

I have read and I understand the Alabama Real Estate License Law and Alabama Real Estate Commission Rules. I will comply with their provisions, including:

Meeting continuing education requirements at license renewal time by submitting proof of completion of Alabama approved courses or supplying a copy of my

active license in another state.

Complying with errors and omissions insurance requirements at license renewal time by purchasing the state group coverage, or by supplying an optional coverage

certificate under Rule 790-X-2-.22, or by furnishing a copy of my current, active license in my home state under Rule 790-X-2-.23, if my home state has its own

group errors and omissions contract.

Complying with all requirements for license renewal because my license expires on the date shown on my license certificate.

Complying with requirements for change of business or home address.

Complying with license change (transfer) procedures.

Complying with RECAD.

I understand this list does not include all the provisions and requirements of the law and rules as they apply to me, but these are most commonly missed by reciprocal

licensees.

(Signed) ____________________________________________________

Sworn to and subscribed before me

Legal Signature of Applicant

this ____________ day of ____________________, 19 __________.

(day)

(month)

(year)

_______________________________________________________

Notary Public