APPOINTMENT OF AGENT TO ACCEPT
SERVICE OF PROCESS
(Name of Risk
Retention Group … hereinafter “Group”), duly organized under the laws of the State of
Montana appoints THE DULY ELECTED STATE AUDITOR AND COMMISSIONER OF
INSURANCE OF THE STATE OF MONTANA to be its lawful agent to receive service of legal
process issued against it in the State of Montana. The Group authorizes the Commissioner,
or, in the Commissioner’s absence, an employee of the Commissioner, to acknowledge
service of legal process on behalf of the Group in this state. The Group consents and
agrees 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 Group
and hereby waives all claim or right of error by reason of such acknowledgement of service.
This authority may be withdrawn only upon a written notice of revocation and in any case
shall continue in effect so long as any liability arising out of this appointment remains
outstanding in the State Montana and binds the assets or liabilities of the Group or any
successor in interest. This instrument is executed pursuant to, and shall be construed to
constitute full compliance with, Title 33, Chapters 11 and 28 of the Montana Code
Annotated.
IN WITNESS WHEREOF, the said Group 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 / Attorney-in-fact
[SEAL]
Secretary / Attorney-in-fact
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
