Fillable INITIAL REGISTRATION STATEMENT OF PREPAID LEGAL SERVICES PLAN (North Carolina State Bar)

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INITIAL REGISTRATION STATEMENT OF PREPAID LEGAL SERVICES PLAN (North Carolina State Bar)

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INITIAL REGISTRATION STATEMENT OF
PREPAID LEGAL SERVICES PLAN
Pursuant to N.C. Gen. Stat. § 84-23.1(b) and 27 N.C. Admin. Code Chapter 1,
Subchapter E, § .0304 of the North Carolina State Bar Regulations for
Organizations Practicing Law, all organizations offering prepaid legal services shall
register the plans with the North Carolina State Bar on forms provided by the State
Bar. Each plan shall be registered prior to its implementation or operation in North
Carolina.
The owner or sponsor of the prepaid plan must complete this form and file it
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
P.O. Box 25908
Raleigh, NC 27611
Please provide complete responses to each of the following items; no items
may be left blank. If more space is needed to respond to an item, attach additional
documents to this statement. Note that, for registration to be granted, a response is
required for each item.
1. Name of Plan: _____________________________
a. Owner or Sponsor of Plan
i. (Name) ______________________________________
ii. (Title) _______________________________________
2. Principal place of business for plan:
Address:
Address 2:
City:
State:
Zip code:
Telephone
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Initial Registration Form Rev Aug 2018
2
Number:
3. Principal address for plan in North Carolina:
Address:
Address 2:
City:
State:
Zip code:
Telephone
Number:
4. Contact information for plan representative to whom communications with
the State Bar will be directed:
Name:
Address:
Address 2:
City:
State:
Zip code:
Telephone
Number:
5. Please identify all persons or entities with ownership interest in the plan and
the extent of their interests.
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Initial Registration Form Rev Aug 2018
3
6. Attach to the report the following:
a. All terms and conditions of the plan;
b. All services provided under the plan and a schedule of benefits and
schedule of fees;
c. All plan documents;
d. All plan marketing and advertising materials;
e. All plan contracts with the plan’s customers;
f. All plan contracts with plan attorneys;
g. A list of the names, addresses, bar numbers, and telephone numbers of
all North Carolina licensed attorneys who have agreed to participate in
the plan (this list should be alphabetized by attorney last name); and
7. Please answer fully the following questions regarding whether the plan is a
prepaid legal services plan as defined by 27 N.C.A.C. Subchapter 1E, Rule
.0303. Attach additional sheets of paper if necessary to answer this section.
a. Does the plan, in exchange for any valuable consideration, offer to
provide or arrange the provision of specified legal services that are
paid for in advance of any immediate need for the specified legal
service (“covered services”)? Yes No
b. If the answer to question “a” is “yes”, list each covered service below.
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Initial Registration Form Rev Aug 2018
4
c. Does the plan provide specified legal services at fees that are less than
what a non-member of the plan would normally pay? Yes No
d. If the answer to question “c” is “yes”, list the discounted legal services
below.
e. Are the legal services offered by the plan provided by North Carolina
licensed lawyers who are not employees, directors, or owners of the
plan? Yes No
8. DECLARATION:
I have read the foregoing form and examined the attachments in their
entirety. All statements and attachments are true and correct to the best of my
knowledge. A non-refundable initial registration fee in the amount of $100.00,
made payable to the North Carolina State Bar, is enclosed.
Page 5 of 6
Initial Registration Form Rev Aug 2018
5
I have read and understand the rules applicable to prepaid legal services
plans as adopted by the State Bar Council and I agree to comply with those rules
and ensure compliance on behalf of my prepaid plan. I have also read and
understand the law on unauthorized practice as set out in N.C. Gen. Stat. § 84-2.1,
4, and 5. I understand that this plan cannot operate in any capacity until it is
registered with the North Carolina State Bar.
I understand that registration of the plan does not constitute approval by the
State Bar. I agree that if the plan represents in any communication that it is
registered with the State Bar it also shall include a clear and conspicuous
statement within the advertisement or communication that registration with the
North Carolina State Bar does not constitute approval of the plan by the State Bar.
I understand that the plan is responsible for assuring its compliance with all
pertinent laws, including the prohibition on the unauthorized practice of law in N.C.
Gen. Stat. § 84-2.1-10.
I will file with the State Bar any amendments to the plan no later than 30
days after the adoption of the amendments but prior to any implementation of the
amendments. I understand that the amendments to the plan must be submitted in
the same manner as the initial registration and may not be implemented until the
amended plan is registered by the North Carolina State Bar in accordance with
27 N.C. Admin. Code Chapter 1, Subchapter E, § .0305 of the North Carolina State
Bar Regulations for Organizations Practicing Law.
I will file with the Secretary of the North Carolina State Bar a registration
renewal form on or before the deadline of each year after the plan’s initial
registration.
Date Signature of Plan Owner or Sponsor
__________________________________
Typed name of Plan Owner or Sponsor
Title
Address
( )
click to sign
signature
click to edit
Page 6 of 6
Initial Registration Form Rev Aug 2018
6
Telephone Number
( )
Fax Number
Amended May 2014
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INITIAL REGISTRATION STATEMENT OF PREPAID LEGAL SERVICES PLAN (North Carolina State Bar)

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Completed 20 July 2020

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