North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 13 - AGENT SERVICES DIVISION - NON-INSURANCE ENTITIES › Section .0300 - INSURANCE PREMIUM FINANCE COMPANIES › Section 13 .0301 - FORMS

Current through Register Vol. 39, No. 2, July 15, 2024
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;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. June 25,
				  2016.