Affiliated Business Arrangement Disclosure

Section 10-2-401(6), C.R.S. requires every title entity disclose the names of all affiliated business arrangements to which the agent or the agency is a party. To accomplish this, the Division of Insurance created the Affiliated Business Arrangement Disclosure Form, which must be completed and submitted with the license application.

The Division has issued Bulletin number 1.22, which outlines the disclosure requirements. Every individual must complete the disclosure when obtaining a new license, renewing an existing license or within thirty (30) days of any changes to the disclosed affiliated business arrangement information. The Responsible Producer of an agency must complete the disclosure on behalf of the licensed agency.

The completed form should be faxed to 303-869-0537 (no coversheet is necessary) or emailed to

If you have any questions concerning licensing please contact Pearson VUE at 1-800-275-8247.

Contact Information
Division of Insurance, Colorado Department of Regulatory Agencies
1560 Broadway, Suite 850
Denver, CO 80202