INSTRUCTIONS: CONNECTICUT APPLICATION FOR INDIVIDUAL FRATERNAL LICENSE AGENT/APPOINTMENT

To apply for a Connecticut individual fraternal agent license or appointment, use the form discussed in this article. This document can be obtained from the website maintained by the government of Connecticut.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 1: Enter your Social Security number in box 1. Leave boxes 2 and 3 blank.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 2: Enter your last name, first name, middle name and date of birth in boxes 4 through 7.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 3: Enter your residential street address, P.O. box number, city, state and zip code in boxes 8 through 12.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 4: Enter your home phone number, gender and indicate your citizenship status with a check mark in boxes 13 through 15.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 5: Enter the business name in box 16.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 6: Enter the business street address, P.O. box number, city, state and zip code in boxes 17 through 21.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 7: Enter the business phone number, fax number, email address and web site address in boxes 22 through 25.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 8: Enter the applicant's mailing address, P.O. box number, city, state and zip code in boxes 26 through 30.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 9: Enter the assumed business name, trade name, or "doing business as" (DBA) name in box 31.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 10: Enter your present occupation and employer on line 31a.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 11: On line 32a, enter the lines of authority being applied for. Indicate with a check mark whether you are seeking a new license, a reinstatement or an amendment.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 12: Answer all questions about your background on the first, second and third pages.

Connecticut Application For Individual Fraternal License Agent/Appointment Step 13: Both the applicant and the fraternal benefit society should sign the third page and provide all certifying information requested.