Section 431:4-409 - Application for authority; declaration required(a) When applying for a certificate of authority, the original subscribers and the proposed attorney shall fulfill the requirements of section 431:3-212, and execute and file with the commissioner a declaration setting forth: (1) The name of the insurer, in compliance with section 431:3-202(b) and section 431:4-104(d)(1);(2) The location of the insurer's principal office, which shall be the same as that of the attorney;(3) The classes of insurance proposed to be transacted;(4) The names and addresses of the original subscribers;(5) The designation and appointment of the proposed attorney and a copy of the power of attorney;(6) The names and addresses of the officers and directors of the attorney if a corporation, or of its members if a partnership;(7) The powers of the subscribers' advisory committee and the names and terms of office of the members thereof;(8) That all moneys paid to the reciprocal, after deducting therefrom any sum payable to the attorney, shall be held by the attorney-in-fact in the name of the reciprocal insurer for the purposes specified in the subscribers' agreement;(9) A copy of the subscribers' agreement;(10) A statement that each of the original subscribers has in good faith applied for insurance of the class proposed to be transacted, and that the insurer has received from each such subscriber the full premium or premium deposit required for the policy applied for, for a term of not less than twelve months at the rate theretofore filed with and approved by the commissioner;(11) A statement of the financial condition of the insurer, and a schedule of its assets; and(12) A copy of each policy, endorsement, and application form it then proposes to issue or use.(b) Such declaration shall be acknowledged by each subscriber and by the attorney before any officer authorized to take acknowledgements of deeds.