To receive an acknowledgment letter from the Commissioner recognizing your status as an advisory organization, please submit the following by email to kdoi.rf@ks.gov:

• A copy of the advisory organization’s:
• constitution, articles of agreement or association
• certificate of incorporation;
• bylaws, rules and regulations governing its activities;
• A list of the advisory organizations’ members;
• The name and address of a resident of this state upon whom notices or orders of the commissioner or process issued at the Commissioner's direction may be served, with its written agreement to accept such notices or service. (A sample agreement is provided).

By submitting this application for recognition as an advisory organization, the undersigned, on behalf of the applicant, represents and agrees that:

• The information provided with this application is accurate and complete.
• The person submitting the application has authority to submit such information.
• The advisory organization agrees that the Commissioner may examine such advisory organization.
• The advisory organization will not commit an act or practice which is unfair or unreasonable or otherwise inconsistent with this act or the insurance laws of Kansas.

Entity Name:
Mailing Address:
Phone Number:
Administrative Contact Email address:
Submitter's Name:
Submitter's Email Address:
Kansas Irrevocable Consent to Service of Process
Applicant Company Name:
Previous Name:
Business entity type (corporation,partnership, LLC,etc):
Home Address:
City, State, Zip:
FEIN:

The undersigned, , a(n) organized under the laws of , and regulated under the laws of , for purposes of complying with the laws of Kansas relating to the conduct of regulated business within Kansas, pursuant to a resolution adopted by its board of directors or other governing body, hereby irrevocably appoints: , and their successors identified herein, or where applicable appoints the required agent so designated herein as its agent in Kansas upon whom may be served any notice, process or pleading as required by law as reflected herein in any action or proceeding against it in Kansas; and does hereby consent that any lawful action or proceeding against it may be commenced in any court of competent jurisdiction and proper venue within Kansas; and agrees that any lawful process against it which is served under this appointment shall be of the same legal force and validity as if served on the entity directly.
  This appointment shall be binding upon any successor to the above named entity that acquires the entity’s assets or assumes its liabilities by merger, consolidation or otherwise; and shall be binding as long as there is a contract in force or liability of the entity outstanding in Kansas. The entity hereby waives all claims of error by reason of such service.
Applicant Company Officers’ Certification and Attestation
One of the two Officers (listed below) of the Applicant Company must carefully read the following carefully and sign:
1. I acknowledge that I am authorized to execute and am executing this document on behalf of the Applicant Company.
2. I hereby certify under penalty of perjury under the laws of the applicable jurisdictions that all of the forgoing is true and correct, executed at (county) (state).
Date: 11/21/2024 Signature of President:
Full Legal Name of President:
Date: 11/21/2024 Signature of Secretary
Full Legal Name of Secretary:
By typing your name above, you are signing this electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.

Service of Process Agent

Name of Entity:
Phone Number: Fax Number:
Email Address:
Mailing Address:
Street Address: