How do I complete the notary section?

An authorized officer signs and swears to the certification before a commissioned online notary, who completes the jurat and commission-expiration information.

Do I need to sign in front of a notary?

Yes. The certification includes a subscribed-and-sworn jurat, so the authorized officer must sign and swear to the statements before a notary.

Can I use an online notary for this application?

The form requires notarization, but it does not specify whether an online notarization is accepted. Confirm with the receiving agency or the Recorder of Deeds if unsure.

What supporting materials does the application request?

The form requests items such as officer or partner information, an errors and omissions policy declarations page, bond or letter-of-credit documentation, and proof of fiduciary accounts.

Office of the Lieutenant Governor, VI · St. Thomas

Original Application for Third Party Administrator

This four-page application is for an organization seeking a third-party administrator license from the U.S. Virgin Islands Office of the Commissioner of Insurance.

Detailed form~25 min to notarize

licensed online notary
~15 min average
Notarized PDF emailed

What you’ll need

Government-issued photo ID
Webcam-enabled device (laptop or phone)
This form, ready to upload as a PDF

Form previewView full PDF →

What this form is

The application collects information about the applicant’s organization, insurance activities, background, financial responsibility, and fiduciary accounts. An authorized officer or director completes the certification and swears that the application’s statements are true to the best of their knowledge and belief. The form also requests supporting documents, including officer or partner details and evidence of required coverage and accounts.

Who needs it

An organization applying for a third-party administrator license through the U.S. Virgin Islands Office of the Commissioner of Insurance needs this application.

Why it needs a notary

The certification includes a jurat stating “Subscribed and sworn to before me”; the applicant’s authorized officer signs and swears to the statements before the notary.

How to get this notarized

1
Download The Application
Get the Original Application for Third Party Administrator from the Office of the Commissioner of Insurance.
2
Complete The Application
Fill in the organization, licensing, background, financial responsibility, and fiduciary account sections, and gather requested attachments.
3
Book An Online Notary
Arrange an appointment with a commissioned online notary for the certification jurat.
4
Sign On Video
The authorized officer appears by video, signs the certification, and swears to its statements before the notary.
5
Submit To The Agency
Send the notarized application and required attachments to the Office of the Commissioner of Insurance.

Preview the form

The blank PDF straight from Office of the Lieutenant Governor. Look it over, then upload your filled copy to start the notary session.

Open in new tab

You’ll need ID and a webcam.

A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.