4. ERRORS & OMISSIONS INSURANCE: (E&O insurance must have an eective date on or before the date you submit
your application)
Rice Insurance Services Company (Commission group policy - attach copies of separate RISC certicates of
coverage - 1 for the DB and 1 for the corporation) - OR
Independent Coverage (attach completed, signed Certication of E&O Coverage form(s) (REE-141 and/or REE-142)
showing coverage for both the DB and the corporation)
REQUIRED ATTACHMENTS
____ $50licensefee(checkorcreditcardauthorizationform) ............................................................................................................
____ ListofOcersandDirectors(names,titlesandaddressesofallocersanddirectorsofthecorporation).. ..............................
____ CorporateRegistration(attachale-stampedcopyofeithertheArticles of Incorporation or Certicate of
Authority(ifaforeigncorporation)issuedbytheIdahoSecretaryofState).................................................................................
____ DBARegistration(ifapplicable,attachale-stampedcopyoftheCerticate of Assumed Business Name issued
bytheIdahoSecretaryofState)...................................................................................................................................................
____ Corporate Resolution stating that the proposed DB has full authority to act on behalf of the company, has been
namedtheDesignatedBroker,andisadirectororocerforthiscorporation .............................................................................
____ TrustAccountNoticationForm(REE-088)whetheryouwillholdentrustedfundsornot............................................................
____ E&OInsuranceCerticationofCoverageformforboththeDBandthecorporation(part4)........................................................
____ BrokerLicenseApplicationforproposedDB(ifnotalreadylicensedasanIdahobroker)...........................................................
____ IhavecompletedtheBCOOorBrokerageManagementcoursewithintheprevious3years(inactivetoactiveDB
orABtoDBapplicantsonly).........................................................................................................................................................
ProposedDesignatedBroker(signature)
NOTARY IS REQUIRED
State of )
)ss.
County of )
I, , a notary public, do hereby certify that on this day
of , 20 ,
personallyappearedbeforemewho,beingbymerstdulysworn,declaredthathe/sheistheproposeddesignatedbrokerandanocer
of the corporation, that he/she signed the foregoing document on behalf of
the corporation, and that the statements therein contained are true.
___________________________________________________
Notary Public
notary seal
__________________________________________________
My Commission Expires
NOTICE: Because of rising costs associated with issuing a refund, it is the policy of IREC to refund overpayments of under $25 only if requested in writing
within 30 days of IREC receipt of the overpayment. Overpayments of $25 or more will be automatically refunded. There is a $20 fee assessed for each
check returned to IREC for insucient funds.
IREC use
ONLY
REE-058-26 Rev. 07/2020 Page 2 of 2