Get New Hampshire Purchasing Group Registration Form

Filling out the New Hampshire Purchasing Group Registration Form online is a straightforward process designed to ensure that purchasing groups can register efficiently. This guide will provide clear and detailed instructions for each section of the form, assisting users of all experience levels in completing it effectively.

Follow the steps to successfully complete the registration form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editing tool.
2. Enter the exact name of the Purchasing Group in the first field. Ensure that it matches the legal name as registered.
3. Select the form of organization or incorporation from the provided options, such as corporation, LLC, or partnership.
4. Specify the State where the Purchasing Group is domiciled. This should reflect the primary location of your group.
5. List any other names under which the Purchasing Group operates, if applicable, to ensure clarity and transparency in operations.
6. Provide the complete physical address of the Purchasing Group, ensuring to include street, city, state, and zip code.
7. Fill out the contact details for the principal staff person or officer knowledgeable about the group's insurance program. Include name, address, and phone number.
8. If applicable, list the administrator of the purchasing group along with their contact details, noting the principal account executive responsible for the insurance.
9. Identify the principal agent or broker involved in the liability insurance process, if none exist, indicate this appropriately.
10. List the names, addresses, and occupations of principal officers and directors of the Purchasing Group. If more space is needed, attach additional pages.
11. Describe the business or activities that define the members of the Purchasing Group. This should demonstrate their related exposure to liability.
12. Confirm that the Purchasing Group's purpose includes purchasing liability insurance specifically for its members.
13. State that the liability insurance will only cover similar or related liability exposure as outlined previously.
14. Detail the lines and classifications of liability insurance the Purchasing Group intends to purchase.
15. List the insurance companies from which the Purchasing Group plans to purchase insurance and include required identifiers like state and FEIN.
16. Complete information about the licensed agent or broker through whom purchases will be made, especially if using surplus lines insurance.
17. If transacting insurance business through direct offerings, list all relevant individuals involved, excluding licensed agents by admitted insurers.
18. Answer questions regarding any legal or professional issues faced by individuals transacting business on behalf of the Purchasing Group, including arrest or license status inquiries.
19. Verify the statements are true, and have the President or Chief Executive Officer and Secretary sign the form. Ensure the notary's information is filled accurately.
20. After completing the form, save your changes, download a copy for your records, print it if necessary, or share it online as required.

Start completing the New Hampshire Purchasing Group Registration Form online today!