<p> SERFF Advisory Board Candidate Application Package</p><p>The SERFF Advisory Board Application consists of three parts:</p><p>1) Part I – Acknowledgement of Responsibilities/Signature (Page 1) 2) Part II – The Application (Pages 2 and 3) 3) Part III – A Professional Biography (Supplement)</p><p>Acknowledgement of Responsibilities/Signature – Part I</p><p>The SERFF Advisory Board (SAB) member responsibilities are described in the SERFF Advisory Board Operating Procedures adopted by the NAIC membership on 8/25/13. (http://www.serff.com/documents/contact_serff_board_psc_listing.pdf) </p><p>The SAB meets at NAIC National Meetings which occur three times per year. (Registration for the National Meeting is not required to attend the SAB meeting as a Board member.) </p><p>Applicants should be aware that the NAIC does not fund the travel to any SERFF Advisory Board meetings at this time.</p><p>Please review the SERFF Advisory Board Operating Procedures and sign below, indicating your acknowledgement of SAB member responsibilities and your intent to apply for a SERFF Advisory Board position.</p><p>______Signature</p><p>© 2016 National Association of Insurance Commissioners 1 | P a g e Application – Part 2</p><p>Date</p><p>Name First Name MI Last Name</p><p>Employer Name</p><p>Your Title</p><p>Address</p><p>Phone</p><p>Email</p><p>Type of business or organization</p><p>Board Member Position Applying For:</p><p>Industry Consumer Representative</p><p>Please list other professional boards and committees that you serve on, or have served on. Organization Role/Title Dates of Service</p><p>Education/Training/Certificates:</p><p>© 2016 National Association of Insurance Commissioners 2 | P a g e What is your area of expertise in the insurance industry?</p><p>How do you feel the SERFF Advisory Board would benefit from your involvement on the Board?</p><p>Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of the SERFF Advisory Board.</p><p>Please tell us anything else you’d like to share.</p><p>Professional Biography</p><p>Separately, please provide a bio describing your professional career.</p><p>Thank you very much for applying.</p><p>© 2016 National Association of Insurance Commissioners 3 | P a g e</p>