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STATE OF MAINE Bureau of Insurance 34 State House Station Augusta, ME 04333-0034 Overnight delivery:

STATE OF MAINE Bureau of Insurance 34 State House Station Augusta, ME 04333-0034 Overnight delivery:-2025

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The document is a Risk Retention Group Registration Application from the State of Maine Bureau of Insurance. It outlines the requirements and information needed for a Risk Retention Group to register, including details about its organization, membership, insurance activities, management, and compliance with state laws. The application also includes sections for providing contact information, financial statements, and designating a resident agent for service of process.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the License # in the designated field. This is crucial for Bureau use.
Fill in the Risk Retention Group Registration Application section. Start with the name as it appears on its Certificate of Authority, followed by the NAIC # and D.B.A. if applicable.
Provide your Federal ID#, principal place of business, and business mailing address, ensuring all details are accurate and complete.
Complete the sections regarding ownership and activities of the Risk Retention Group, checking appropriate boxes and providing descriptions where required.
List all officers and directors along with their SS#s and addresses. Attach additional pages if necessary.
Finally, review all entries for accuracy before submitting your completed form through our platform for a seamless process.

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