Application For Certificate Of Authority Form Page 3

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3.) BUSINESS PLAN STATEMENT. Attach a separate sheet outlining the administrator’s Business Plan, including staffing levels
proposed for New Hampshire and nationwide.
4.) SUMMARY of INSURANCE POLICIES. Attach copies of binder pages from insurance carriers for Administrator’s:
“Errors & Omissions” Insurance
(carrier/limits/policy period)
“Directors & Officers” Insurance
(carrier/limits/policy period)
Any other pertinent coverage’s
(carrier/limits/policy period)
(12/15/95)
3

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