Form 12 Uniform Consent To Service Of Process (Page 4 of 4) in pdf

Form 12 Uniform Consent To Service Of Process Page 4

Resolution Authorizing Appointment of Attorney

BE IT RESOLVED by the Board of Directors or other governing body of

_____________________________________________________________________________________________,

(Applicant Company Name)

this ________ day of _______ , 20 _____ , that the President or Secretary of said entity be and are hereby authorized by

the Board of Directors and directed to sign and execute the Uniform Consent to Service of Process to give irrevocable

consent that actions may be commenced against said entity in the proper court of any jurisdiction in the state(s) of

_____________________________________________________________________________________________

in which the action shall arise, or in which plaintiff may reside, by service of process in the state(s) indicated above and

irrevocably appoints the officer(s) of the state(s) and their successors in such offices or appoints the agent(s) so designated in

the Uniform Consent to Service of Process and stipulate and agree that such service of process shall be taken and held in all

courts to be as valid and binding as if due service had been made upon said entity according to the laws of said state.

CERTIFICATION:

I, _________________________________________________________________________ , Secretary of

_____________________________________________________________________________________________,

(Applicant Company Name)

state that this is a true and accurate copy of the resolution adopted effective the ____ day of ____________ , 20 _____ by

the Board of Directors or governing board at a meeting held on the _____________ day of ____________ , 20 _____ or

by written consent dated _____ day of ____________________, 20 ___.

Date_______________________

________________________________

Secretary

Revised 11/21/15

2000, 2005-2016 National Association of Insurance Commissioners 4

FORM 12

Form 12 Uniform Consent To Service Of Process Page 4