SECTION .0300 ‑ INSURANCE PREMIUM FINANCE COMPANIES
11 NCAC 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."
History Note: Authority G.S. 58-2-40; 58-35-5(b);
Eff. February 1, 1976;
Readopted Eff. January 1, 1978;
Amended Eff. April 8, 2002; May 1, 1989.