Individual Affidavit {CDI-17}

CDI-017, INDIVIDUAL AFFIDAVIT, this form must be completed by all of the following individuals: • The applicant's officers, directors and key management personnel; • Individuals having a 10 percent or more beneficial ownership of the applicant (direct or indirect including attribution); • Applicant's ultimate controlling parent; and • Individuals having a 10 percent or more beneficial ownership of the applicant's ultimate controlling parent. For insurers, "key management personnel" includes all persons responsible for oversight of any of the following functions: • Actuarial • Claims • Finance • Investments • Rating • Reinsurance • Risk Management • Sales and Marketing • Underwriting. For underwritten title companies, "key management personnel" includes all of the following: • Chief Escrow Officer • Chief Title Officer • County Manager • Subdivision Manager • Title Plant Manager. www.FormsWorkflow.com