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.
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