.04 Biographical Affidavit and Disclosure Authorization Format.

A. Form. Each biographical affidavit required by this chapter shall be submitted to the Commissioner and the approved independent third party in a legible format, in the most recent form made available by the NAIC.

B. Contents. The biographical affidavit requires an affiant to provide information, including the affiant’s employment history, education, personal information, and character.

C. Date. Biographical affidavits must be certified by the affiant, notarized, and dated no earlier than 1 year prior to the date of submission of the application or statement, or management change.

D. NAIC Disclosure and Authorization Concerning Background Form.

(1) Consent to Release Information. By completing the NAIC “Disclosure and Authorization Concerning Background” form, the affiant consents to:

(a) The release of the information in the biographical affidavit to the approved independent third party;

(b) The background investigation conducted by the approved independent third party; and

(c) The approved independent third party’s release of the results of its background report to the Commissioner.

(2) An affiant may revoke the authorization at any time by delivering a written revocation to the applicant.

(3) The applicant shall, upon an affiant’s action pursuant to §D(2) of this regulation, forward such revocation promptly to any approved independent third party that either prepared or is preparing a background report under the “NAIC Disclosure and Authorization Concerning Background” form.