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Appraisal Management Company Registration Application

Entity Information

Checkbox/Radio Group

If the applicant is a corporation or an LLC, a Certificate of Good Standing or Registration from the Department of Consumer and Regulatory Affairs (DCRA) is required to transact business in the District of Columbia. For additional information on filing with DCRA, contact that office at (202) 442-4400 or at dcra.dc.gov.

Physical Address

Full Address

Mailing Address: (If different than above)

Authorized Controlling Person

Full Name

Date of Birth

Date Picker

Since you were licensed, have you legally changed your name?

Full Address

Do you have a different mailing address?

Mailing Address

Foreign Registration

Is this company currently or has it previously been registered in any other state as an appraisal management company?

Owners

Does

Name(s) of any individual or business entity that owns ten percent (10%) or more of the appraisal management company. Each owner that owns ten percent (10%) or more is required to fill out Attachment A below

Attachment A

Each owner (individual or entity) that has a ten percent (10%) or more ownership interest in the appraisal management company must fill out this attachment and submit to the Department of Insurance, Securities, and Banking as part of the AMC application.

5Registered Agent for Service of Process in District of Columbia

5Agent Full Address

5Agent Full Address

5Agent Full Address

5Agent Full Address

5Agent Full Address

5Agent Full Address

5Agent Full Address

5Registered Agent for Service of Process in District of Columbia

5Agent Full Address

5Registered Agent for Service of Process in District of Columbia

5Agent Full Address

5Registered Agent for Service of Process in District of Columbia

5Registered Agent for Service of Process in District of Columbia

5Registered Agent for Service of Process in District of Columbia

5Registered Agent for Service of Process in District of Columbia

Registered Agent for Service of Process in District of Columbia

Agent Full Address

Registered Agent for Service of Process in District of Columbia

Agent Full Address

Registered Agent for Service of Process in District of Columbia

Agent Full Address