Being a Title Insurance Producer duly licensed by the New Jersey Department of Insurance, does hereby make application for Agency Membership in the New Jersey Land Title Association (NJLTA) and agrees to comply with all provisions of the Association's Constitution, By-Laws and Code of Ethics.
In support of our request, we submit the following information;
Full Name of Company & Producer License Number
Name of applicant
Signature
Business Address
City
State
County
Phone
Fax
Name the authorized officer of your company to whom official correspondence should be directed
First Name
Middle Initial
Last Name
Names and title of owners and officers of application who have a 5% or more interest in the Agency and License number
List below all Title Companies for which the applicant is an agent.
Year in which the applicant was first licensed as a title insurance agent/producer by the Department of Insurance?
What other states besides New Jersey is the applicant licensed as a title insurance agent/producer?
Is applicant a member of the American Land Title Association (ALTA)? Yes No
Is applicant licensed to engage in any other class of insurance other than title insurance? Yes No
Please list below all licensed title producers employed by the applicant, set forth herin.
A minimum of three references are required. ONE must be an ACTIVE MEMBER (Title Insurance Company) which applicant is agent for, and TWO must be AGENCY MEMBERS in good standing with the NJLTA.
1) Name of Title Company: Name of Personal Reference:
2) Name of Title Agent Member: Name of Personal Reference:
3) Name of Title Agent Member: Name of Personal Reference:
Send application to: Edward C. Eastman, Jr. Executive Director, New Jersey Land Title Association, Monmouth Executive Center, 100 Willowbrook Rd, Building 1, Freehold, NJ 07728 along with membership dues for the current year made payable to: NJLTA, Agency Section, in the amount of $250.00
Membership is subject to approval by the Agency Section Membership Committee and the Board of Governors of the NJLTA.
Does hereby make application for Affiliate Membership in the New Jersey Land Title Association (NJLTA) and agrees to comply with all provisions of the Association's Constitution, By-Laws and Code of Ethics.
Type of business the applicant is engaged in, and its relationship to the title industry.
Type of Business Entity: Corporation Partnership Sole Proprietorship Individual
Names and titles of owners and officers of applicant.
Is applicant licensed to engage in any other class of insurance including title insurance? Yes No
Please briefly explain why you are interested in becoming an Affiliate member of the New Jersey Land Title Association.
A minimum of two references are required, both of which must be an active or agency member in good standing with the New Jersey Land Title Association.
1.
2.
3.
Send application to New Jersey Land Title Association:
Attention: Edward C. Eastman, Jr. Executive Director, Monmouth Executive Center, 100 Willowbrook Rd, Building 1, Freehold, New Jersey 07728 along with an application of $100.00 made payable to NJLTA
