Form Ar-20 - Annual Registration Of Title Insurance Agents (Pursuant To Section 16 Of The Title Insurance Act)

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Form AR-20 (DFI – 12/14/2013)

STATE OF ILLINOIS

DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

DIVISION OF FINANCIAL INSTITUTIONS

TITLE INSURANCE SECTION

TITLE INSURANCE ACT

ANNUAL REGISTRATION OF TITLE INSURANCE AGENTS

(Pursuant to Section 16 of the Title Insurance Act)

FILING YEAR - 2013

Date Annual Registration Submitted_________________________________________________

TITLE INSURANCE COMPANY:_________________________________________________________________

ADDRESS:____________________________________________________________________________________

CITY, STATE, ZIP CODE:_______________________________________________________________________

PHONE NUMBER INCLUDING AREA CODE:______________________________________________________

SIGNATURE & TITLE OF PERSON COMPLETING REPORT:_________________________________________

**TOTAL NUMBER OF POLICIES ISSUED BY ALL AGENTS, REGISTERED OR CANCELLED, IN CALENDAR YEAR 2013:____________

(** This figure should include all policies issued by agents during the year. Any agents that were cancelled during the year must be listed, showing their policy

volume and direct premiums written. List these cancelled agents separately from the agents that are being registered for this year. A transaction where a mortgagee’s

policy is issued simultaneously with an owner’s policy by the same title insurance company is considered 2 (two) title policies issued.)

TOTAL DIRECT PREMIUMS WRITTEN FOR ALL POLICIES BY ALL AGENTS IN CALENDAR YEAR 2013:_________________________________________________

AMOUNT OF REGISTRATION FEE ENCLOSED WITH THIS ANNUAL REGISTRATION:__________________________________________________________________

With respect to each and every title insurance agent to be registered by title insurance company, the filing of this Annual Registration of Title Insurance Agents constitutes a

representation by the title insurance company that:

1) If agent is an individual person, such person maintains the same name as registered under and agent was alive on December 1, 2013; and

2) If agent is an Illinois attorney, agent’s license to practice law in Illinois is in good standing and has not been suspended as of December 1, 2013 and attorney has not been

disbarred as of December 1, 2013; and

3) If agent is a corporation, partnership, limited liability company or any variation of any of them, the entity is properly registered with the Illinois Secretary of State, is authorized

to do business in Illinois and the entity has not been voluntarily or involuntarily dissolved; and

4) All contact information shown for all agents is correct and current and that each agent maintains its operation at the address listed for it; and

5) Title Insurance Company will periodically remind agent of the requirement that changes in information are to be promptly reported to DFI and Title Insurance Company.