Form PF "Application for Premium Finance Company" - Missouri

What Is Form PF?

This is a legal form that was released by the Missouri Department of Commerce and Insurance - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2015;
  • The latest edition provided by the Missouri Department of Commerce and Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PF by clicking the link below or browse more documents and templates provided by the Missouri Department of Commerce and Insurance.

ADVERTISEMENT
ADVERTISEMENT

Download Form PF "Application for Premium Finance Company" - Missouri

1446 times
Rate (4.3 / 5) 101 votes
DIVISION OF FINANCE
Telephone 573-751-3242
Harry S Truman State Office Building
Mailing Address:
Sixth Floor
P. O. Box 716
301 West High Street
Jefferson City, Missouri 65102-0716
Jefferson City, Missouri 65101
C
364 - P
F
C
HAPTER
REMIUM
INANCE
OMPANY
L
A
P
ICENSING
PPLICATION
ACKET
(Licensing Year July 1 through June 30)
________________________________________________________________
Instructions:
1. The enclosed application must be completed in its entirety.
2. Application must be signed before a notary public.
3. The licensing fee of $500 made payable to the "Division of Finance" must be
submitted with your completed application.
4. Should your company move to a new location, you must notify our office
immediately and surrender your original license for amendment.
5. If you have any further questions regarding the filing of this application, please
call our office at 573-751-3463.
___________________________________________________________________________________
DIVISION OF FINANCE
Telephone 573-751-3242
Harry S Truman State Office Building
Mailing Address:
Sixth Floor
P. O. Box 716
301 West High Street
Jefferson City, Missouri 65102-0716
Jefferson City, Missouri 65101
C
364 - P
F
C
HAPTER
REMIUM
INANCE
OMPANY
L
A
P
ICENSING
PPLICATION
ACKET
(Licensing Year July 1 through June 30)
________________________________________________________________
Instructions:
1. The enclosed application must be completed in its entirety.
2. Application must be signed before a notary public.
3. The licensing fee of $500 made payable to the "Division of Finance" must be
submitted with your completed application.
4. Should your company move to a new location, you must notify our office
immediately and surrender your original license for amendment.
5. If you have any further questions regarding the filing of this application, please
call our office at 573-751-3463.
___________________________________________________________________________________
NEW LICENSED LOCATION
Instructions: Please complete this form and submit, along with the $500.00 licensing fee, to the Division of Finance, 301
West High Street, Harry S. Truman State Office Bldg., Room 630, P.O. Box 716, Jefferson City, MO 65102. PLEASE
NOTE: THE LICENSING FEE APPLIES TO EACH LOCATION TRANSACTING BUSINESS. Should you have
any questions, please contact the Consumer Credit Licensing Section at 573-751-3463.
MISSOURI DIVISION OF FINANCE
OFFICE USE ONLY --
PF - _____________
Rec#________
Application for
Premium Finance Company
Check No.
Amount: $
Date:
Initials:
License Year: July 1 – June 30
Information for Licensed Location:
Company Name: ____________________________________________________________________________
Address: __________________________________________________________________________________
City: __________________________________ State: ______________________ Zip: ________________
Telephone: ________________ Fax: _________________ County (MO only): ______________________
Internet address: ___________________________________________________________________________
Hours of Operation:
Name:
Mailing Address:
Licensing Contact for
Renewal Applications:
City/State/Zip:
Telephone: (
)
Email:
Name:
Contact Person to
Mailing Address:
Receive Examination
City/State/Zip:
Reports
Telephone: (
)
Email:
Name:
Contact Person for
Mailing Address:
Office and Consumer
City/State/Zip:
Inquiries/Complaints:
Telephone: (
)
Email:
Name:
Information Regarding
Preparer of Application:
Telephone: (
)
Email:
Mailing Instructions for
Mail to Licensed Location
Mail to Licensing Contact above
this License Certificate
Other (please specify): ________________________________________________
PF - 07/15
- Page 1 of 2 -
Name
Street Address:
Company Home Office
Information
Mailing Address:
(if applicable)
City/State/Zip:
Telephone: (
)
Fax: (
)
If applicant is: Individual, complete Section I. Partnership, Corporation, or LLC complete Section II
Name:
Phone Number: (
)
I. INDIVIDUAL
Residence Address:
Business Address:
Name:
Phone Number: (
)
II. PARTNERSHIP,
ASSOCIATION OR
Principal Business Address:
CORPORATION
Names, Titles of
Business Address
Residence Address
Partners/Officers
Date of
Principal Office in Missouri (if applicable):
Incorporation:
STATE OF _____________________ )
)
COUNTY OF ___________________ )
The undersigned, first being duly sworn, states that (s)he is a(n) (officer) (principal) (partner) in the company above named and
that said company is financially capable of engaging in the business of insurance premium financing and that said company is authorized to
transact business in this state.
_____________________________________________________
Signature / Officer, Partner, Principal
Subscribed and sworn to before me this ______ day of ____________________, 2_____.
_____________________________________________________
Notary Public
My Commission expires: __________________________
- Page 2 of 2 -
PREMIUM FINANCE COMPANIES
Sec.
business of a premium finance company in this
364.100. Definitions.
state without first registering as a premium finance
364.105. Registration required - fee - forms.
company with the director.
364.110. Records to be maintained by company.
2. The annual registration fee shall be
364.115. Premium
finance
agreement,
five hundred dollars payable to the director as of
requirements, contents.
the first day of July of each year. The director may
364.120. Interest or discount, amount allowed,
establish a biennial licensing arrangement but in
computation - prepayment of obligation
no case shall the fees be payable for more than
- refund credit, calculation.
one year at a time.
364.125. Other charges allowed.
3. Registration shall be made on forms
364.130. Cancellation of finance contract under
prepared by the director and shall contain the
power of attorney - requirements,
following information:
procedure.
(1)
Name,
business
address
and
364.135. Return of unearned premiums on
telephone
number
of
the
premium
finance
cancellation of financed contract - time
company;
allowed.
(2) Name and business address of
364.140. Filing of agreement not required for
corporate officers and directors or principals or
validity against creditors.
partners;
364.145. Revenue deposited to state general
(3)
A
sworn
statement
by
an
revenue fund.
appropriate officer, principal or partner of the
364.150. Application of law.
premium finance company that:
364.160. Violation of law - misdemeanor.
(a) The premium finance company is
financially capable to engage in the business of
insurance premium financing; and
(b) If a corporation, that the corporation
364.100.
Definitions. - As used in
is authorized to transact business in this state;
sections 364.100 to 364.160, the following terms
(4) If any material change occurs in the
shall mean:
information contained in the registration form, a
(1) "Director", the director of the
revised statement shall be submitted to the
division of finance of the state of Missouri;
director accompanied by an additional fee of three
(2)
"Person",
an
individual,
hundred dollars.
partnership, association, business corporation,
(L. 1984 S.B. 686 § 2, A.L. 1986 H.B. 1195, A.L. 2003 S.B.
346, A.L. 2015 H.B. 587 merged with S.B. 345)
nonprofit corporation, common law trust, joint-
Effective 8-28-15 (H.B. 587)
stock company, or any other group of individuals,
*10-16-15 (S.B. 345), see § 21.250. S.B. 345 was vetoed July
however organized;
7, 2015. The veto was overridden September 16, 2015.
(3) "Premium finance agreement",
an agreement by which an insured or prospective
insured promises to pay to a premium finance
company the amount advanced or to be advanced
364.110. Records to be maintained
to an insurer or to an insurance agent or broker in
by company. - 1. A premium finance company
payment of premiums of an insurance contract
shall maintain records of its premium finance
together with interest or discount and a service
transactions.
charge, as authorized and limited by sections
2. A premium finance company shall
364.100 to 364.160;
preserve
its
records
of
premium
finance
(4) "Premium finance company", a
transactions, including cards used in a card
person engaged in the business of entering into
system, if any, for at least two years after making
premium
finance
agreements
or
acquiring
the final entry with respect to any premium finance
premium finance agreements from other premium
agreement.
The preservation of records in
finance companies.
photographic,
microfilm
or
microfiche
form
(L. 1984 S.B. 636 § 1)
constitutes compliance with this section.
(L. 1984 S.B. 686 § 3)
364.105. Registration required - fee
- forms. - 1. No person shall engage in the
364.115.
Premium
finance
Rev. 8/15
1
agreement,
requirements,
contents.
-
A
that, if the insurance premiums being financed are
premium finance agreement shall:
for other than personal, family or household
(1) Be dated and signed by or on
purposes, the parties to the premium finance
behalf of the insured, and the printed portion
agreement may agree to any rate of interest which
thereof shall be in at least eight point type;
shall be stated in the premium finance agreement.
(2) Contain the name and place of
The interest or discount permitted by this
business of the insurance agent or broker
subsection
anticipates
timely
repayment
in
negotiating the related insurance contract, the
consecutive monthly installments equal in amount
name and residence or place of business of the
for a period of one year. For repayment in greater
insured, the name and place of business of the
or lesser periods or in unequal, irregular, or other
premium finance company to which payments are
than monthly installments, the interest or discount
to be made, a brief description of the insurance
may be computed at an equivalent effective rate
contracts involved and the amount of premium;
having due regard for the timely payments of
and
installments.
(3) Set forth the following items, where
4. Notwithstanding the provisions of
applicable:
any premium finance agreement, any insured may
(a) The total amount of the premium;
prepay the obligation in full at any time and shall
(b) The amount of the down payment;
receive a refund credit. The amount of the refund
(c) The principal balance, meaning the
shall be calculated by the actuarial method of
difference between the amounts stated under
calculating refunds and no more interest shall be
paragraphs (a) and (b) of this subdivision;
retained by the lender than is actually earned.
(d) The amount of the interest or
(L. 1984 S.B. 686 § 5, A.L. 1986 H.B. 1207, A.L. 2002 S.B.
895)
discount;
(e) The balance payable by the
insured, meaning the sum of amounts stated
under paragraphs (c) and (d) of this subdivision;
364.125. Other charges allowed. - 1.
and
A premium finance agreement may provide for the
(f)
The
number
of
installments
payment by the insured of a delinquency charge
required,
the
amount
of
each
installment
of up to five percent of any installment which is in
expressed in dollars, and the due date or period
default for a period of five days or more. If the
thereof.
premium finance agreement is for personal, family
(L. 1984 S.B. 686 § 4)
or household purposes, the then maximum
delinquency charge shall be fifteen dollars. If the
default results in the cancellation of any insurance
contract listed in the agreement, the agreement
364.120.
Interest
or
discount,
may provide for the payment by the insured of a
amount allowed, computation - prepayment of
cancellation charge of fifteen dollars.
obligation - refund credit, calculation. - 1. A
2. A premium finance agreement may
premium finance company shall not charge,
provide for payment of collection costs and
contract for, receive, or collect any interest or
attorney's fees equal to twenty percent of the
discount charge other than as permitted by
outstanding indebtedness if the premium finance
sections 364.100 to 364.160.
agreement is referred for collection to a collection
2. The interest or discount is to be
agency
or
attorney
who
are
not
salaried
computed on the balance of the premiums due,
employees of the premium finance company.
after subtracting the down payment made by the
3. None of the charges referred to in
insured in accordance with the premium finance
this section shall be considered, directly or
agreement, from the effective date of the
indirectly, in determining whether a violation of the
insurance contract, for which the premiums are
usury laws has occurred under a premium finance
being advanced, to and including the date when
agreement.
the final installment of the premium finance
(L. 1984 S.B. 686 § 6)
agreement is payable.
3. The interest or discount shall be a
maximum of fifteen dollars per one hundred
dollars per year, which shall be computed as a
364.130.
Cancellation of finance
fifteen percent add-on interest rate, plus an
contract
under
power
of
attorney
-
additional service charge of ten dollars per
requirements, procedure. - 1. When a premium
premium finance agreement which need not be
finance agreement contains a power of attorney
refunded on cancellation or prepayment; except
clause enabling the premium finance company to
Rev. 8/15
2
Page of 6