Application for the NAIC International Fellows Program

To participate in the NAIC Fellows program, every prospective Fellow must complete the application below, as well as attach an updated curriculum vitae (CV) with a photo.

Your responses to this application will not be saved before submission. Please ensure that you have all the information necessary before beginning the application.

The applicant also confirms their command of English is sufficiently advanced to read technical publications and to carry out and understand conversations on technical matters.

1. General Information
 
Applicant's Name (Given name, Surname):
Regulatory Organization:
Title:
Address:
E-Mail:
Telephone:
Fax:


2. Higher Education
 
Name of Institution(s) Attended (include dates):
1:
2:
3:
 
Degree(s) Received:
 
Educational Area of Concentration /Specialization:
1:
2:
3:


3. English Language Proficiency
 
Check One:

   Excellent 
   Very Good 
   Good 

Have you taken any English language proficiency exams or taken courses in English? If so which ones and what were your scores?


4. Employment History
 
Current Title:
Date Assumed Current Position:

 
List of Current Principal Duties & Responsibilities:


4a. Prior Positions Held Within This or Other Organizations
 
Title:
Date Assumed Position:
 
Title:
Date Assumed Position:
 
Title:
Date Assumed Position:


5. Explain Goals/Objectives in pursuing an NAIC Fellows
1:
2:
3:
4:


5a. Please rank only your ten most relevant areas of interest (1-most relevant, 10-least relevant)
  
Financial Regulation:
  On-Site Financial Exams
      Life
      Health
      Property/Casualty
  Desk Audits/Other
      Life
      Health
      Property/Casualty
  
Market Regulation:
  Market Conduct Exams
      Life
      Health
      Property/Casualty
  Market Analysis
  
Product Regulation:
  Forms
      Life
      Health
      Property/Casualty
  Rates
      Life
      Health
      Property/Casualty
  
Other Areas of Regulation:
  Reinsurance
  Investment Analysis
  Insurer Licensing
  Producer Licensing
  Actuarial Activities
  Fraud Prevention Activities
  Consumer Complaints
  Disaster Preparedness/Response


6. Commissioner or other supervisor who endorses your application so that we may verify their permission:
 
Name/Title:
Email:


7. Please detail upon which areas you would like to focus and list specific goals and objectives for participating in this program.


8. Please provide the name, phone number and e-mail address of the individual(s) we should contact for you in the event of an emergency situation.


9. Please provide the name of your medical insurance company and your policy number for reference in the event of a medical situation. If you are unable to provide specified information at this time, you will be required to do so via e-mail before entering the program.


By submitting this application electronically, the applicant certifies:
  -That they are an employee in good standing of the Insurance Regulatory Organization noted below and plans to continue to work with
    this organization for at least three years.
  -That they will follow the hours as defined by their host jurisdiction's Department of Insurance and comply with all rules and
    regulations in place.
  -That they will actively participate in the program and that they understand failure to do so may lead to their removal from the program.
 
  Please check this box to certify that you have your supervisor's permission to participate in the NAIC International Fellows Program.
Please provide the above mentioned supervisor's name, phone number and e-mail address so that we may verify their permission.


Attach CV and photo:
 
Attach current CV:
Attach photo: