Forms and instructions for purchasing groups pursuant to public act 214 of 198

Issued and entered March 30, 1990 by Dhiraj N. Shah, Acting Commissioner of Insurance

The attached forms, together with the $25 registration fee, must be submitted to the Michigan Insurance Bureau by all purchasing groups wishing to do business in Michigan. These forms have been promulgated pursuant to the Risk Retention Act, Public Act 214 of 1989. The forms include:

1. PURCHASING GROUP, APPLICATION FOR REGISTRATION

2. PURCHASING GROUP, APPOINTMENT OF ATTORNEY TO ACCEPT SERVICE

3. REGISTRATION FEE CARD{Footnote 1}

{Footnote 1} Not reproduced herein.

BACKGROUND

The Risk Retention Act regulates, to the extent allowed by the federal law, risk retention and purchasing groups in Michigan. The act provides that purchasing groups may only purchase insurance for their Michigan risks from admitted insurers, eligible surplus lines insurers or risk retention groups.

FORMS WITH INSTRUCTIONS --
For Registration of Purchasing Groups

NOTICE: These forms must be complete when submitted to the Insurance Bureau. Incomplete forms will be returned to the originator. Instructions for completing forms:

1. A check for $25 payable to "State of Michigan" to cover the registration fee should accompany the application, clipped (not stapled) to the appropriate Registration Fee Card.

2. Complete the purchasing group application for registration.

a. Item 12: The "Line Code" is a number that identifies the line of insurance. Select the number which most closely corresponds to the line purchased. If one cannot be found, indicate "other commercial liability."

Types of Commercial Liability Insurance	Line Code
Medical Malpractice	110
Comprehensive General	174
Director's & Officer's	175
Environmental Impairment & Pollution	176
Errors & Omissions	177
Legal Liability	178
Liquor Liability	173
Municipal Liability	172
Products & Completed Operations	171
Professional Liability	179
Other Commercial Liability	170

b. Item 13: The "Agent Code" indicates the type of insurance placement. That is, whether the purchase is through a resident agent, a surplus lines agent or by direct placement. For the response to item 13, determine the Agent Code and the respective name and address information as follows:

Type of Placement Code	Agent Code	Name and Address
Direct Placement	0	Person in Group making arrangements
Resident Agent	1	Name and address of agent
Surplus Lines Agent	2	Name and address of agent

3. Complete the "Appointment of Attorney to Accept Service."

4. If a purchasing group is incorporated in Michigan, please also submit a copy of the group's articles of incorporation and all amendments as filed with Michigan's Corporation and Securities Bureau.

5. Purchasing groups must provide notification to the Bureau of their intent to continue operations by February 1st of each year and of changes in registration information within 10 days of changes.

PREMIUM AND SINGLE BUSINESS TAX PAYMENT
RESPONSIBILITY

The State of Michigan requires the payment of premium, retaliatory and/or single business taxes on all insurance transactions. The appropriate tax forms and instructions will be sent to registrants when they are notified that they are registered.

The entity responsible for paying premium taxes shall be determined as follows:

Questions regarding the forms should be addressed to the Company Admissions Division of the Insurance Bureau at the address below or call: 517/373-6854. All groups will be notified as to whether they are registered or not.

Completed forms and questions regarding their completion should be submitted in writing to:

Company Admissions Division
Insurance Bureau
Post Office Box 30210
Lansing, MI 48909-771