Please be advised that there are no provisions in the New Hampshire Statutes that provide for automatic transfer in the event of a merger. Pursuant to New Hampshire Law RSA 405:14-a, if a company undergoes a substantial change in financial or managerial control a new license is required. To assure that there will be no interruption of service to policyholders, it will be necessary for the Company to submit the following items:

• Application Form
• Application Fee * (company must pay application fee listed and the Certificate of Authority fee listed), (NH RSA 400-A:29). Fee is non-refundable. Please submit payment for the company’s state of domicile. Make check payable to "Treasurer, State of New Hampshire." *All fees are retaliatory.
• Pro forma consolidated balance sheet prior to and subsequent to the merger of the company.
• Form E – If the change of control of an insurer licensed in New Hampshire results in the merger or affiliation with one or more New Hampshire licensed insurers that were not previously affiliated, Form E is required. Otherwise, send a statement that there is no such affiliation.
• Copies of the State Approvals.
• Current New Hampshire Certificate of Authority (original).
• Business plan for surviving entity.

Mail the above items to the New Hampshire Insurance Department Financial Examination and Analysis Division.

If you have any questions, please contact Diane Cygan .

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