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OFFICE OF THE ATTORNEY GENERAL CONSUMER PROTECTION DIVISION (Maryland Attorney General)

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1
OFFICE OF THE ATTORNEY GENERAL
CONSUMER PROTECTION DIVISION
200 ST. PAUL PLACE, 16 FLOOR
th
BALTIMORE, MD 21202
Maryland Vehicle Protection Product Warrantor Registration Application and Checklist
1. Name of Business
Trade Name
Number and Street
City , State, Zip
Telephone E-mail
2. Contact /Administrator
Name
Number and Street
City , State, Zip
Telephone E-mail
3. Resident Agent (Please No P.O. Box Address)
Name
Number and Street
City , State, Zip
Telephone E-mail
4. Officer who is directly responsible for the Vehicle Protection Product Business
Name
Title
Number and Street
City , State, Zip
Telephone E-mail
5. The Vehicle Protection Product Warrantor has met the Financial Accountability
requirement of § 14-4A-07 of the Commercial Law Article by:
A.____ Maintaining a net worth of at least $50,000,000.00. I have attached:
i. ______ a copy of the most recent form 10-K or 20-F that you or your parent
company have filed with the United States Securities and Exchange
Commission;
or
ii. _____ the audited financial statement of the business demonstrating a net
worth of $50,000,000.00.
B.____ Maintaining a Warranty Liability Reimbursement Insurance Policy (please
attach a copy of the policy.)
2
6. If an insurance policy is used, please provide the following information
Name of Insurer
Contact
Number and Street
City , State, Zip
Telephone
E-mail
Policy number
Amount of Coverage
CERTIFICATION OF CORPORATE OFFICER, LLC MEMBER
LIMITED LIABILITY PARTNER, OR GENERAL PARTNER
• I certify that I have read and will abide by §14-4A- 01 through §14- 4A-14 of the
Commercial Law Article of the Annotated Code of Maryland, the Vehicle Protection
Products Act.
• I agree to keep accurate accounts, books, and records and make these and all records
maintained under the Act available to the Division upon request including: 1.) A copy of
each Vehicle Protection Product Warranty, 2.) The names and addresses of each Warranty
Holder, and 3.) The date, amount, and description of each receipt, claim, and expenditure.
I also agree to keep said accounts, books, and records for at least 2 years following the
expiration of the Vehicle Protection Product Warranty. If the business is discontinued, I
will maintain accounts, books, and records until I can prove to the Division the discharge
of all obligations to any warranty holder in the state.
• I understand that I am responsible to renew the registration annually and shall file any
updates within (30) days of any change.
I hereby certify under penalties of perjury that the information contained in this application is true
and correct.
Signature___________________________________________ Date:_________________
Name (Printed)______________________________________
Title:____________________________________________
Submit by Email
Print Form
3
Application Checklist - Please use this list to assist you in submitting all required information.
____ Vehicle Protection Product Registration Application
____ Certificate of Good Standing Status
A copy of your Certificate of Good Standing showing that your company is authorized to conduct
business in Maryland must be submitted for a Corporation or Limited Liability Company that
provides Vehicle Protection Product Warranties in Maryland. This Certificate may be obtained
from the Maryland Department of Assessments and Taxation or requested via the Internet at
www.dat.state.md.us
____ Financial Security Documents
The Financial Security Requirements Described in Section 4 of the Act is satisfied upon proof of
insurance under a Warranty Reimbursement Insurance Policy or financial records that
demonstrate the net worth of the business or stockholder equity at or above $50,000,000. Please
indicate from the choices below which items you are submitting to satisfy this requirement.
____ Warranty Reimbursement Insurance Policy - If the Warranty Reimbursement
Insurance Policy option is used, the applicant must attach a copy of the policy
issued by an insurer authorized to do business in the state of Maryland. The policy
must contain the statutorily required language provided in Attachment A.
____ $50,000,000 Business Net Worth or Stockholder Equity - If the $50,000,000 net
worth option is used one of the following items must be attached:
____ A copy of the most recent form 10-K or form 20-F filed by the Warrantor or
the Warrantor’s parent company* with the United States Securities and
Exchange Commission.
____ A copy of the Warrantor’s or the Warrantor’s parent company’s* audited
financial statement compiled within the last year that shows a net worth or
stockholders’ equity of not less than $50,000,000.
*If the parent corporation’s form 10-K, 20-F or audited financial statements are used, the
parent company must have on file with the Division a guarantee relating to the warranties
issued by the Warrantor in the state of Maryland. A board resolution must be attached to
the application acknowledging the guarantee and its continued existence for the year to
which the application pertains.
____ Consumer Warranties
A sample copy of each type of warranty offered must be included. Each warranty must contain
the statutorily required language provided in Attachment B.
____ Fees
A check or money order in the amount of $500.00 must be attached to the application for
the total amount due. Please make checks payable to the Office of the Attorney General.
Please mail to address on page 1 of this form.
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OFFICE OF THE ATTORNEY GENERAL CONSUMER PROTECTION DIVISION (Maryland Attorney General)

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Completed 14 August 2020

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