In order to issue a Certificate of Compliance the Department will need the following information:
| |
Name of Third Party Administrator (TPA) |
| |
Home Address of the TPA |
| |
Date of Formation |
| |
Domestic State |
| |
Number of Certificates needed |
| |
Name of the person requesting the Certificate |
| |
Phone number or e-mail of requestor in case the Department needs to contact you |
| |
Address or e-mail where the Certificate(s) should be sent (If Certificate is e-mailed, there will not be a raised Seal) |
| |
Do you want the Certificate mailed, e-mailed or both? |
There is no fee for a Certificate(s) of Compliance.
The request can be sent in by e-mail to Tim.Stroud@dobi.nj.gov or requested by phone at 609-940-7452.
|
