(a) Lists the applicant’s name, residence and business address, previous experience transacting insurance, present occupation and occupation during the previous year and the names of the applicant’s employers for the previous five years;

(b) Lists the street address of the applicant’s principal place of business and of all other locations in which the applicant will engage in business as an insurance consultant;

(c) Lists any assumed business name under which the applicant intends to engage in business as an insurance consultant;

(d) Specifies the portion of the applicant’s time that the applicant will devote to engaging in business as an insurance consultant;

(e) Discloses whether the applicant:

(A) Is under indictment for, or has previously been convicted of, a crime;

(B) Is or was subject to a judgment for fraud;

(C) Owes a debt to any insurer or insurance producer, together with the nature and details of the indebtedness; and

(D) Has had any occupational or professional license the applicant holds or held in this or another state suspended or revoked or has had a renewal of the license denied;

(f) Includes the applicant’s fingerprints, unless the applicant submitted the applicant’s fingerprints to another state as part of a successful application for a license to engage in business as an insurance consultant in the other state;

(g) Identifies the class or classes of insurance that the applicant intends to transact in this state; and

(h) Includes any other information the director requires by rule.

(2) An applicant that is a business entity, in addition to providing the information specified in subsection (1) of this section in an application for a license to engage in business as an insurance consultant, shall:

(a) List the names and addresses of each director, member and officer, and any person that owns, directly or indirectly, more than 10 percent of any class of equity security of the business entity; and

(b) Designate each individual who is responsible for ensuring that the business entity complies with the Insurance Code and all administrative rules that regulate insurance in this state and who will otherwise exercise the powers that the license confers on the licensee.

(3) The applicant shall pay to the Director of the Department of Consumer and Business Services as part of an application under this section a fee in an amount that the director specifies by rule. Unless the director by rule specifies otherwise, the fee is not refundable. [2019 c.151 §12]