§431:4-409  Application for authority;declaration required.  (a)  When applying for a certificate of authority,the original subscribers and the proposed attorney shall fulfill therequirements of section 431:3-212, and execute and file with the commissioner adeclaration setting forth:

(1)  The name of the insurer, in compliance withsection 431:3-202(b) and section 431:4-104(d)(1);

(2)  The location of the insurer's principal office,which shall be the same as that of the attorney;

(3)  The classes of insurance proposed to betransacted;

(4)  The names and addresses of the originalsubscribers;

(5)  The designation and appointment of the proposedattorney and a copy of the power of attorney;

(6)  The names and addresses of the officers anddirectors of the attorney if a corporation, or of its members if a partnership;

(7)  The powers of the subscribers' advisory committeeand the names and terms of office of the members thereof;

(8)  That all moneys paid to the reciprocal, afterdeducting therefrom any sum payable to the attorney, shall be held by theattorney-in-fact in the name of the reciprocal insurer for the purposesspecified in the subscribers' agreement;

(9)  A copy of the subscribers' agreement;

(10)  A statement that each of the original subscribershas in good faith applied for insurance of the class proposed to be transacted,and that the insurer has received from each such subscriber the full premium orpremium deposit required for the policy applied for, for a term of not lessthan twelve months at the rate theretofore filed with and approved by thecommissioner;

(11)  A statement of the financial condition of theinsurer, and a schedule of its assets; and

(12)  A copy of each policy, endorsement, andapplication form it then proposes to issue or use.

(b)  Such declaration shall be acknowledged byeach subscriber and by the attorney before any officer authorized to takeacknowledgements of deeds. [L 1987, c 347, pt of §2]