Section .0400 - Description of Forms | Midpage

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North Carolina Administrative Code

§ 0400

Section .0400 - Description of Forms

.0401Application for Admission to Do Business in Nc .0402Power of Attorney for Service of Legal Process .0403Power of Attorney for Sale of Securities .0404Application for License: General .0405Application for License: Hospitals: Medical Service .0406Application for License: Dental Service Corporation .0407Applications for License: Fraternal Order .0408Affidavit: Education: Occupation: Business Experience .0409Insurance Company License .0410Deposit Bond Form .0411Fire and Casualty Annual Statement Blank .0412Completing Fire and Casualty Annual Statement Blank .0413Consolidated Annual Statement: Fire and Casualty Insurers .0414Fire and Casualty Quarterly Statement Blank .0415Life and Accident and Health Annual Statement Blank .0416Annual Statement Blank: Instructions .0417Life and Accident and Health Quarterly Statement Blank .0418Annual Statement Blank: Separate Account Business .0419Title Annual Statement Blank .0420Instructions for Completing Title Annual Statement Blank .0421Title Quarterly Statement Blank .0422Hospital: Medical and Dental Service or Indemnity Corp .0423Instructions/Annual Statement Blank: Hospital: Medical: Dental .0424Fraternal Annual Statement Blank .0425Instructions for Completing Fraternal Statement Blank .0426Fraternal Quarterly Statement Blank .0427Accident and Health Policy Experience Exhibit .0428Credit Life and Accident and Health Exhibit .0429Credit Life Insurance Statistical Report .0430Insurance Expense Exhibit .0431Stockholder Information Supplement .0432Town or County Farm Mutual Annual Statement Blank .0433Fire and/or Casualty Abstract .0434Life Abstract .0435Annual Gross Premium Tax Return: Retaliatory Tax Return .0436Statement of Installment Gross Premium Tax .0437Annual Additional Gross Premium Tax Return .0438Statement/Installment Additional Annual Gross Premium Tax .0439Nc Firemen's Relief Fund Tax Annual Return .0440Annual Franchise or Privilege Tax: Hosp and Medical Corp .0441Annual Franchise or Privilege Tax: Dental Service Corp .0442Nc Domestic Corporation Franchise and Income Tax Return .0443Automatic Extension of Time to File .0444Additional Extension of Time to File .0445Refund for Corporation Franchise and Income Taxes .0446Certification of Workmen's Compensation Loss Reserves .0447Workmen's Compensation Assessment Form .0448Form Hc: Insurer Holding Company Registration Statement .0449Sale of Variable Annuity Contracts in North Carolina .0450Annual Report of Escheat: Abandoned Property .0451Instructions for Completing the Annual Report .0452The Form a: Insider Trading of Equity Securities .0453Form B: Insider Trading of Equity Securities .0454Initial Statement of Beneficial Ownership of Securities .0455Statement of Changes in Beneficial Ownership of Securities .0456Revocation or Suspension of License: Foreign Insurance .0457Official Receipt of Securities .0458Check Sheet and Analysis of Application for Admission .0459Information Sheets: Admission of a Foreign Insurance .0460Taxes and Fees Applicable to Insurance Companies .0461Town or County Farm Mutual Examination Report Blank .0462Certificate of Compliance: Mutual Agreement .0463Power of Attorney: Sale of Deposited Securities .0464Certificate of Deposit .0465Certificate of Compliance: Accident and Health Advertising .0466Certificate of Retaliatory Provisions .0467Certificate of Good Standing .0468Certificate of Similarity: Report on Examination .0469Certificate of Similarity: Annual Statement .0470Certificate of Reserve Valuation .0471Certificate of Compliance: Insurance Laws .0472Stat Information: Life Ins Companies and Frat Orders .0473Stat Info/Fire and Cas/Reciprocals/Factory/Co Farm .0474Statistical Information: Accident and Health Business .0475Authorized Investments Pursuant to G.S. 58‑79(a).0476Investments Made Pursuant to G.S. 58‑79(a)(14).0477Authorized Investments Pursuant to G.S. 58‑79.1 .0478Corporate Resolution and Conflict of Interest .0479Contribution for Domestic Insurance Companies .0480Public Hearing on Plan of Exchange of Capital Stock .0481Public Hearing on Plan of Merger or Consolidation .0482Examiners' Expense and Days Worked Reports .0483Statement of Examination Charges .0484Form of Model Custodial Agreement .0485Form of Model Custodial and Fiscal Agency Agreement .0486Reconciliation: Statutory Capital and Stockholders Equity .0487Reconciliation: Statutory Net Gain and Net Income .0488Valuations of Securities Manual .0489Affidavit for Return of Deposit .0490Application for License: Health Maintenance Organization .0491Health Maintenance Organization: Annual Statement .0492Instructions for Completing Statement .0493Health Maintenance Organization: Quarterly Statement