11 N.C. Admin. Code 13 .0301 - FORMS
The following forms are provided by the division and are used by insurance premium finance companies for purposes as specified herein:
(1) Application for Insurance Premium Finance License. The form entitled
"Application for Insurance Premium Finance License" shall include general interrogatories concerning the
company's structure, employees' past business experience, address and proposed method of operation of the
applicant as well as all other pertinent information.
(2) Premium
Finance License Renewal Form. A "Premium Finance Renewal Application" shall include the name and address of
the premium finance company, date of cancellation of the license if the application is not received by the
Division, the amount of the proper license fee, a statement of any changes in the structure of the applicant
since its last application, a computation of the bond amount specified in
G.S.
58-35-15 and
11 NCAC 13
.0302, instructions for the completion and return of the application and other
pertinent information.
(3) Premium Finance Surety Bond Form. The
surety bond described in G.S
58-35-15 shall be executed on a form supplied by the Commissioner and shall
be executed in accordance with the laws of North Carolina governing surety bonds. The surety bond form shall
include the name of the premium finance company [corporation - use corporate name exactly as shown on the
articles of incorporation; unincorporated - use name(s), trading as (T/A) the name of the premium finance
company], name of the surety, amount of the bond, terms of cancellation of the bond and other pertinent
information.
(4) Premium Finance Company Personnel Form. Each
stockholder owning ten percent or more of the applicant's outstanding stock and each partner, director,
officer, office manager or field representative employed by the applicant shall complete form DOI-5PF
entitled "Personal Questionnaire." Form DOI-5PF will be furnished by the Commissioner and shall contain the
name of the premium finance company, the name and address of the individual completing the form, the
position(s) held by the individual, past business experience of the individual, the name and address of three
people not related to the individual who can attest to the individual's reputation for honesty and fair
dealings and other pertinent information. All "Personal Questionnaires" shall be attached to the applicant's
"Application for Insurance Premium Finance License."
(5) Request
by Insured for Separate Contracts Form. Each insured who expressly requests separate premium finance
contracts authorized by 11 NCAC
13 .0325 shall complete form DOI-6PF entitled "Request by Insured for
Separate Contracts."
Notes
Eff. February 1, 1976;
Readopted Eff. January 1, 1978;
Amended Eff. April 8, 2002; May 1, 1989;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
Eff. February 1, 1976;
Readopted Eff. January 1, 1978;
Amended Eff. April 8, 2002; May 1, 1989.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.