APPOINTMENT OF AGENT TO ACCEPT
SERVICE OF PROCESS
(Name of Company),
appoints THE DULY ELECTED STATE AUDITOR AND COMMISSIONER OF INSURANCE OF
THE STATE OF MONTANA as its agent to receive service of legal process issued against it
in the State of Montana. The Company authorizes the Commissioner, or, in the
Commissioner’s absence, an employee of the Commissioner, to acknowledge service of
legal process on behalf of the Company in this state. The Company does consent and
agree that any lawful process against it that is served upon the Commissioner as
appointed agent shall have the same legal force and validity as if served upon the
Company. The Company waives all claim or right of error by reason of
acknowledgement of service. This appointment is irrevocable, binds the Company and
any successor in interest or to the assets or liabilities of the Company, and remains in
effect as long as there is in force in the State of Montana any contract made by the
Company or obligations arising from a contract. The Company is duly organized under
the laws of the State of Montana and has been admitted or is applying for authority to
transact insurance in the State of Montana.
IN WITNESS WHEREOF, the said Company has to these presents affixed its corporate
seal and caused the same to be subscribed and attested by its President and Secretary
at the City of , in the State of
_
_________, on the day of , 20 ____.
President
[SEAL]
Secretary
Below, please provide the name and address of the person to whom Service of Process is
to be forwarded:
atthew M. Rosendale, Sr.
Commissioner of Securities & Insurance
Phone: 406.444.2040
800.332.6148
Fax: 406.444.3497
