Get Ny Oc-409

The NY OC-409 is an initial application form required to take the license representative exam to appear on behalf of claimants or represent carriers and/or self-insurers. This guide will help you through each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to fill out the NY OC-409 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the appropriate application type under the section labeled 'Application is made under' by checking one of the four provided options: Section 24-a with fee, Section 50 (3-b), Section 24-a without fee, or Section 50 (3-d).
3. In the first field, enter your name (first, middle, last). If you have been known by another name, indicate 'Yes' and provide the other name.
4. Provide your home address, including street, city, and state. If you have lived at your current address for less than three years, list your previous addresses as well.
5. Fill in your home telephone number and your telephone number during normal business hours.
6. Input your Social Security number in the designated field.
7. Indicate your citizenship status by selecting 'United States of America' or 'Other'. If you are a naturalized citizen, provide the date and place of naturalization. If you are a permanent resident alien, state your registration number and date.
8. Confirm that you are over 18 years of age by selecting 'Yes' or 'No'.
9. Answer questions regarding any other licenses, certificates, or attorney admissions, providing details if applicable.
10. Disclose any history of revocation or disciplinary action against any licenses you hold by answering the relevant questions.
11. Indicate whether you have ever been convicted of a crime or if there are any pending criminal charges, providing details if applicable.
12. List five character references, ensuring they have known you for at least five years, and specify the fields in which they know you (business, social, family life, etc.).
13. Once you have completed all fields, review your entries for accuracy. You can then save your changes, download a copy of the form, print it, or share it as needed.

Complete your NY OC-409 application online today to ensure timely processing.