ROA's Entry

Enter the information for a Reporting of Action and attach the document(s).

Indicator Definition
1 Category of Action - Select one category from the dropdown list. For definitions, refer to the ROA User Definition Guidance section located above the form.
2 Date of Action - Date of Adjudication or the "date of final disposition of the matter" for administrative (and civil) actions, and the "date of initial pretrial hearing" for criminal actions per NAIC Producer Licensing Model Act, Section 17.
Enter the date of action in mm-dd-yyyy format.
Note: The correct format is very important here: any other date format will return an error.
3 Producer's information for regulators - Provide an explanation surrounding the circumstances for the action being taken against the license.
4 - Information about the respective field.
5 Document description by producer - List or describe the document(s) submitted.
6 New Document - Select if you are going to upload a document from your computer or from a flash drive connected to your computer.
7 Existing Documents - Select if you want to attach to this ROA a file previously uploaded to the Attachments Warehouse. All of your documents in the Attachment Warehouse will display, including the files uploaded through the BQSD application.
8 Browse - Click to select a file from your computer.
9 Attach Document - Click to attach the selected document.

Provide all required information, select a file, and click .

Note: File formats accepted: doc, docx, gif, jpg, jpeg, jpe, pdf.

The attached files will display:

Note: Attach all documents you want to submit for this ROA by clicking .

Once all documents are attached, click to proceed.

Note: The Reporting of Actions and document file(s) will not be saved if the payment is not made during this session. A session expires for non use (30 minutes without activity), or ends when you log out, the browser is closed, or the system errors out.


Missing field information: