Fillable AMENDMENTS TO PREPAID LEGAL SERVICES PLAN Pursuant to (North Carolina State Bar)

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AMENDMENTS TO PREPAID LEGAL SERVICES PLAN Pursuant to (North Carolina State Bar)

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Page 1 of 2
AMENDMENTS TO PREPAID LEGAL SERVICES PLAN
Pursuant to 27 N.C.A.C. 1E, § .0306, amendments to prepaid legal services plans and other
documents required to be filed upon registration of the plan shall be filed in the office of the North
Carolina State Bar no later than 30 days after the adoption of such amendments. Please note
that, pursuant to Rule .0306, amendments “may not be implemented until” they are
accepted by the North Carolina State Bar. Furthermore, pursuant to the requirement of Rule
.0306 that amendments be completed “in the same manner as the initial registration,” the
declaration on page 2 must be completed by the plan owner or sponsor. This form should be filed
with the Secretary of the North Carolina State Bar at the following address:
Secretary of the North Carolina State Bar
c/o Savannah B. Perry, Deputy Counsel
North Carolina State Bar
PO Box 25908
Raleigh, NC 27611
Current Plan Name: __________________________________
Current Plan Number: __________________________________
Current Date: __________________________________
Please provide complete responses to only the items listed below that you would like to amend.
There is no need to complete items that you do not wish to change. If more space is needed to
respond to an item, you may attach additional documents to this form. Regardless of how many
items are changed, the plan owner or sponsor must complete and sign the declaration
on page 2.
1. New Name of Legal Services Plan: _________________________________
2. New Name of Plan Sponsor: _________________________________
3. New Name of Registered Agent or Entity Owning Plan in North Carolina:
_____________________________________________________________________________________
4. New Name of Plan Administrator: _________________________________
5. Names, addresses, and telephone numbers of all new attorneys responsible for furnishing
legal services in the plan:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
6. This amendment form includes attachments detailing the following information:
□New terms of the legal services plan
□New schedule of benefits
□New subscription charges
□New participating attorney agreement
Page 2 of 2
7.
New Address of Plan: _________________________________
8. New Telephone Number of Plan: _________________________________
9. New Address of Registered Agent of Plan or Entity Owning Plan in North Carolina:
_____________________________________________________________________________
10. New Telephone Number of Registered Agent of Plan or Entity Owning Plan in North
Carolina: _________________________________
11. New Address of Plan Administrator: _________________________________
12. New Telephone Number of Plan Administrator: _________________________________
13. New person to be contacted by the North Carolina State Bar:
_________________________________
14. New address of person to be contacted by the North Carolina State Bar:
____________________________________________________________________________________
15. New telephone number of person to be contacted by the North Carolina State Bar:
_________________________________
16. For any other amendments not listed above, please attach any documents or information
explaining, in detail, the changes you desire to make and check the box below to indicate that
such attachments are included.
□ I would like to make an amendment not listed above and have attached documents to that
end.
17. Declaration
I have read the foregoing form and examined the attachments. All statements and attachments
are true and correct to the best of my knowledge. I understand that the amendments to this plan
may not be implemented until the amended plan is registered with the North Carolina State Bar
in accordance with 27 N.C.A.C. 1E, §§ .0305 and .0306 of the North Carolina State Bar
Regulations for Organizations Practicing Law.
____________________ ________________________________________
Date Signature of Plan Owner or Sponsor
________________________________________
Type or Print Name of Plan Owner or Sponsor
________________________________________
Title
________________________________________
Address
________________________________________
Phone Number
Amended 9/2018
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AMENDMENTS TO PREPAID LEGAL SERVICES PLAN Pursuant to (North Carolina State Bar)

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Completed 20 July 2020

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