FEE $10.00  

STATE OF UTAH
DEPARTMENT OF INSURANCE

REGISTERED AGENT AND REGISTERED OFFICE

 

Pursuant to Section 31A-14-204(1), Utah Insurance Code, all foreign insurers must provide the name and address of a registered agent for purposes of service of process.  Companies can register  with and designate the State insurance commissioner and its agent solely for the purpose of receiving service of legal documents of process.

 _________________________________________________________________________

            (Name of Insurance Company)

If electing to have State Insurance Commissioner Merwin U. Stewart as registered agent please sign below:

_______________________________________________

 

If electing to use some other entity please fill out information below:

Address of Registered Agent & Registered Office:

_______________________________

_______________________________

_______________________________

Telephone Number of Registered Agent:______________________

 

Address of the Utah Insurance Department
3110 State Office Building
Salt Lake City UT 84114
Phone (801) 538-3800
FAX    (801) 538-3829

Mail this form to attention   Kris Redmond

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