Please be advised that it will be necessary for the Company to submit the following items for the demutualization to be recorded:

• Application
• Amendment fee - The fees are retaliatory and non-refundable, please pay the amendment fee listed for the company’s State of Domicile. Make check payable to: Treasurer, State of New Hampshire
• Certificate of approval from state of domicile
• Certificate of compliance from state of domicile
• Return the company’s current New Hampshire Certificate of Authority (original)

Please submit all documents to the New Hampshire Insurance Department Financial Examination and Analysis Division.

If you have any questions, please contact Diane Beaudoin

 Adobe Acrobat Reader format. You can download a free reader from Adobe.