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FINGERPRINTING PROCEDURE FOR OFFICERS/DIRECTORS OF INSURANCE COMPANIES

In accordance with this Department’s standard procedure, fingerprinting is required for all officers/directors of insurance companies in connection with the customary background investigations conducted by our Consumer Assistance Unit.

Officers/directors who have any address in New York State must be electronically fingerprinted.  Paper fingerprint cards will not be accepted from an officer/director with any address in New York.  The New York State Division of Criminal Justice Services (DCJS) has a contractual agreement with ID requiring a criminal background check.  Once fingerprints are taken, they are electronically transmitted to the NYS Division of Criminal Justice Services (DCJS) by IDEMIA for a record search.  DCJS, in turn, electronically transmits the fingerprints to the FBI for a further record search.  Please refer to the next page for information about scheduling an appointment through IdentoGO by IDEMIA for Live Scan digital fingerprinting.  When NAIC biographical affidavits for officers/directors are submitted to this Department, the receipts issued by IDEMIA as verification of having been electronically fingerprinted must be attached.

Officers/directors who do not have any address in New York State and are unable to go to a IDEMIA electronic fingerprinting location in New York are required to submit paper fingerprint cards to this Department along with NAIC biographical affidavits.  Paper fingerprint cards are electronically transmitted to DCJS and the FBI for record searches, as mentioned above.  To facilitate this “cardscan” submission, officers/directors MUST PRE-ENROLL WITH IDEMIA on their website. After such registration (during which the fingerprint processing fee is also paid), the pre-enrollment confirmation page which is furnished MUST be completed, printed, signed and the form with the original signatures (no photo copies) must be attached to the paper fingerprint cards and submitted to this Department along with the required NAIC biographical affidavit.  Please refer to the next page for more detailed information.

For any questions concerning this information, please contact Officer and Director Processing at (518) 474-4837.

Officer and Director Processing
Consumer Assistance Unit

Fingerprinting Services Information Form

ELECTRONIC FINGERPRINTING - Applicants who have any address in New York State MUST be electronically fingerprinted.  Paper fingerprint cards will not be accepted from an officer/director with any address in New York.   Visit www.Identogo.com or call (877) 472-6915 to schedule an appointment.  The applicant will be required to provide all the information indicated below and furnish the listed forms of identification as well as a $99.00 fingerprint processing fee at the time of the appointment.  The receipt issued by IDEMIA as verification of having been electronically fingerprinted must be attached to the applicant’s biographical affidavit and mailed to the address indicated at the bottom of this page.

CARDSCAN – Applicants who do not have any address in New York State and are unable to go to a IDEMIA electronic fingerprinting location in New York (for a list of locations go to www.Identogo.com) MUST submit fingerprint cards.  Applicants MUST pre-enroll for this cardscan submission with IDEMIA by logging into their system at https://uenroll.identogo.com and selecting the option to “Submit a Fingerprint Card by Mail” (payment of the $99.00 fingerprint fee will be required during the online transaction).  After pre-enrollment, the applicant must print out, complete and sign the pre-enrollment confirmation page, which includes a barcode printed on the top right of the page.  This pre-enrollment confirmation page MUST be completed, printed, signed and the form with the original signatures (no photo copies) must be attached to the paper fingerprint cards (two) and biographical affidavit and mailed to the address indicated at the bottom of this page.  NOTE:  Only FBI Form FD-258 fingerprint cards may be used; any other type of fingerprint card will not be accepted and will be returned.


ORI:  NY921270Z

Contributor Agency: NEW YORK STATE DEPT. OF FINANCIAL SERVICES
One Commerce Plaza, Albany, NY 12257

The following information will be required by IDEMIA:

Job or License Type:  SERVICE CODE 1544Q5 (PRINC, EXEC, DIR INS CO)

New Submission OR Resubmission
Name of Applicant/Alias/Maiden Name(s)
Street Address/City/State/Zip/State & Country of Birth/Country of Citizenship/Social Security Number
Date of Birth/Age/Sex/Race/Ethnicity/Height/Weight/Skin Tone/Eye Color/Hair Color

Accepted Forms of Identification Section (Electronic Fingerprinting):
Applicant MUST present two (2) forms of ID, at least one of which must have a photo (see Column A): 

Column A – Valid Photo Identification:

U.S. Passport (unexpired or expired)
Permanent Resident Card
Alien Registration Receipt Card
Unexpired Foreign Passport
Driver’s License or Photo ID Card
(issued by U.S. State orTerritory)
School or College ID Card (with photo)
Unexpired Employment Authorization
with photo (Form I-766, I-688, I688A or B)
Photo ID Card issued by federal, state, or local govt.

Column B – Valid Supplementary Identification:

Voter registration card
U.S. Military card or draft card
Military dependent’s ID card
Coast Guard Merchant Mariner Card
Native American Tribal Document
(issued by U.S. State or Territory)
Canadian Driver’s License
U.S. Social Security Card
Original or certified copy of a Birth Certificate issued
by authorized U.S. agency with official seal
Certification of Birth Abroad (issued by U.S. Department
of State)
U.S. Citizen Id Card (Form l-197)

MAILING ADDRESS:

New York State Department of Financial Services – Insurance Division 
Life, Health or Property Bureau*
One State Street
New York, NY 10004

* Indicate the appropriate bureau by the type of company for which the biographical affidavit is being submitted.

Updated 10/11/2018

Department of Financial Services

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