13 .0301 - FORMS

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."

(Authority G.S. 58-2-40; 58-35-5(b); 58-35-15(a); Eff. February 1, 1976; Readopted Eff. January 1, 1978; Amended Eff. April 8, 2002; May 1, 1989.)

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