Escrow Rate Filing Form - Arizona Department Of Financial Institutions
Download a blank fillable Escrow Rate Filing Form - Arizona Department Of Financial Institutions in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Escrow Rate Filing Form - Arizona Department Of Financial Institutions with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Arizona Department of Financial Institutions
ESCROW RATE FILING FORM
Please email a complete Manual and Schedule to financial@azdfi.gov for review. Please send either a Word or PDF
version of the rates. Rates that are mailed to the Department will not be approved. Rates that are incomplete will not be
approved.
Company / Agency Name
Contact Email
Address
City
State
Zip Code
Type of Filing
Effective Date
□
□
New Rate Schedule
Change of Existing Approved Rates
Information included with this filing
□
Cover letter including explanation of changes and justification
□
Justification – check items
□
□
Financial Analysis
Comparison of Rate of other Escrow Agencies
□
□
Statistics
Experience
□
Other
I,__________________________________________(Filer’s Name) , being duly sworn, make oath and declare that I have been
given authority by__________________________________________(Company Officer’s Name) to execute this filing on behalf
of__________________________________________________________(Company Name) , and agree to and represent the following:
That the information contained herein, including exhibits and other information filed attached hereto and made a part
hereof, are current, true, accurate, and complete under penalty of perjury, or un-sworn falsification to authorities, or similar
provisions as provided by law; that, the jurisdiction(s) to which the rate filing is being submitted may conduct any
investigation as to the legitimacy, accuracy and correctness in accordance with all applicable laws and regulations; that, if
the above named individual has made a falsehood of a material fact in either the rate filing or in any documentation
provided to support the foregoing rate filing, then the above named licensee may be subject to fines, fees, and penalties or
other measures accordance with all laws and regulations.
I hereby verify that I am the above named individual, and certify by my printed name below that I have read the conditions
stated above and agree to the language as stated.
Name of Filer
Date
FOR DEPARTMENT USE ONLY
□
Date Received
Approved
□
Withdrawn
□
Hearing
□
Analyst
Additional Information / Correspondence
Date
PROPOSED NEW ESCROW RATE OR CHANGE OF RATE FORM
Page 1 of 2
FE‐LC‐FM‐EA‐Escrow_Rate_Filing_Form‐032312ver1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Investment Adviser Fiscal Year End Report Form - Washington Department Of Financial Institutions
Legal
Investment Adviser Fiscal Year End Report Form - Washington Department Of Financial Institutions
Financial
Related Categories
Parent category: Legal