Section Saf-C 4506.01 - Application Form(a) Each applicant for a permit or certificate pursuant to RSA 376 shall furnish the following on form DSAD 5: (1) Name, address, and telephone number;(2) Whether the applicant is a natural person, partnership or corporation;(3) If a partnership, the names of all partners;(4) If owned in part or controlled by out-of-state interests, the name, address, and type of business of each;(5) If a corporation, the date and state of incorporation;(6) A copy of the certificate of registration issued by the secretary of state pursuant to the provisions of RSA 349:1;(7) Whether authority is sought as a common or contract carrier;(8) Whether authority is sought to transport passengers, household goods or property;(9) If seeking regular route common carrier authority, a description of the routes to be served, listing the terminal and the intermediate points to be served, including highway route numbers and street names, if possible;(10) If seeking irregular route common or contract carrier authority, a detailed description of the territory proposed to be served and the exact nature of the operation;(11) A full description of any commodities to be handled, if applicable;(12) A schedule of all proposed fares and charges;(13) A statement of assets and liabilities as of the date of the application, unless the applicant is a certificate or permit holder;(14) A clear and concise statement of why the service covered by the application is currently or shall be required by the future public convenience and necessity or the public interest;(15) The names of all motor carriers, known to the applicant, with whose service the operations described are or will be directly competitive;(16) A statement of the experience of the applicant or officers of the applicant company, and any other facts relevant to the ability of the applicant to properly perform the service covered by the application, including but not limited to: a. Any special license held; andb. Any special equipment to be employed;(17) Any other facts relevant to the ability of the applicant to properly perform the service covered by the application;(18) A certificate of insurance; and(19) The signature of the applicant under penalty of unsworn falsification pursuant to RSA 641:3.N.H. Admin. Code § Saf-C 4506.01
#5853, eff 6-23-94; ss by #7239, eff 6-23-00, EXPIRED: 6-23-08
New. #9378, eff 1-30-09
Amended by Volume XXXVII Number 32, Filed August 10, 2017, Proposed by #12357, Effective 8/2/2017, Expires 8/2/2027.