A. Fill out this section completely. Do not use whiteout to correct mistakes. If necessary, line-through any mistakes.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-a.gif)
B. Write ‘N/A’ or ‘Self Employed’ for business address, if none.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-b.gif)
C. IMPORTANT: Include a legible photocopy of your valid Driver’s License or state identification card, front and back. Your home address must match your Driver’s License. If you have registered a change of address online, please note. If you need to update your address, visit http://cyberdriveillinois.com/.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-c.gif)
D. Provide an email address (for correspondence from the state).
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-d.gif)
E. Provide at least one phone number.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-e.gif)
F. Print your county of residence, not business.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-f.gif)
G. Print your name exactly as you want it to appear on your commission certificate.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-g.gif)
H. In the presence of a Notary, sign the notarial oath. Signature must match printed name.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-h.gif)
J. Sign your name here, as shown on your Driver’s License, as you are the Principal/Notary Public Applicant.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-j.gif)
K. Leave this blank. The Bond Number will be completed by our office.
![](/Image%20Library/NNA/knowledge%20center/state%20applications/illinois-instructions-k.gif)