How to Submit Fingerprints for PEO

PEO-15 Fingerprint Instructions

Before You Begin

Submission

  • 1

    Fingerprinting Services and Cards

    Fingerprinting services and cards (FD-258) are available from your local law enforcement office (sheriff or police department).

  • 2

    Complete the Top Portion of the Fingerprint Card (Black Ink or Typed)

    Please fill out the top of the fingerprint card in accordance with the sample shown and read the back of the fingerprint card. Please compare your card to the sample. If your card is missing information, or has stray marks, your fingerprint card will be rejected. (see instructions below)

  • 3

    Get Fingerprinted

    Prints may be taken by any local law enforcement agency, including your local police department or sheriff’s office. If they cannot perform the fingerprinting, they should be able to refer you to another appropriate place. Positive proof of identification will be required such as a valid driver’s license. If a driver’s license is not available another acceptable type of picture identification (i.e., passport) will be required. Sign the card in the presence of a law enforcement officer. You may be charged a fee for the “rolling” of your fingerprints. You will need to contact your local law enforcement office for this information. The law enforcement official executing the fingerprinting will need to date and sign the fingerprint card in the appropriate boxes.

  • 4

    Authority for Release of Information

    Complete an Authority for Release of Information form (Form 01-132-15) for each controlling person. (Do not mail directly to the SBI)

  • 5

    Submission

    Once all of the fingerprints are obtained and forms completed for all controlling persons, the documents and processing fee are to be submitted to the address below.  The fingerprint filing shall include the following items:

    Mail these items to the following address (Do not mail directly to the SBI):

    North Carolina Department of Insurance
    Financial Analysis & Receivership Division
    Special Entities Section-PEO Unit
    1203 Mail Service Center
    Raleigh, NC 27699-1203
     

    Should you have any questions, please contact Christine Williams at 919-807-6612 or via e-mail at christine.williams@ncdoi.gov.

Instructions for Completing Fingerprint Card

If you need fingerprints for:

Agent Services - Resident Fingerprint Requirements

Manufacturing Buildings - MBD Licensing Fingerprints

Please only follow these instructions for PEOs.

Each fingerprint card for a PEO must contain the information exactly as shown below in bold (print or typed):

OCA:INSUR0002
Employer and Address:
N.C. Department of Insurance
1203 Mail Service Center Raleigh, NC 27699-1203
Attn: Jeff Trendel
Reason Fingerprinted: DOI Applicants, State and Federal N.C.G.S. 58-89A-60(d)
ORI: NCBCI0000 SBI Raleigh, NC

Complete other blocks as indicated:

  • NAM - Complete last name, first name, and middle name of individual being fingerprinted.
  • DOB - List date of birth numerically - month, day, and year. Example: May 31, 1948 should be shown as 05 31 48.
  • SEX - Male (M), Female (F)
  • RACE -White (W), Black (B), Hispanic (H), American Indian or Alaskan Native (I), Asian or Pacific Islander (A), Other (O)
  • HGT - Height in feet and inches using all numbers. Example: 6’ 01”= 601
  • WGT - Weight in pounds using all numbers. Example: 135lbs. = 135
  • EYES - List eye color - Black (BLK), Blue (BLU), Brown(BRO), Gray (GRY), Green (GRN), Hazel (HAZ)
  • HAIR - List hair color - Black (BLK), Blonde or Strawberry(BLN), Brown(BRO), Gray or partially gray (GRY), Sandy(SDY), Red or Auburn(RED), Bald or partially balding (BAL)
  • POB - Indicate city and state where the individual was born. Abbreviate State.
  • SOC - Social Security Number of individual.
  • SIGNATURE - Legible signature of person being fingerprinted must appear in this space.
  • CURRENT RESIDENCE - Complete number, street, city, state, and zip.
  • DATE - Indicate date fingerprints were taken.
  • Signature of person taking the fingerprints.
  • Fingerprints.

Questions

If you have any questions please contact Christine Williams at 919-807-6612 (Christine.Williams@ncdoi.gov).