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Uniform Notification Form For Multi-Level Distribution Companies With A Montana Participant MLD-1 - Montana
| Uniform Notification Form For Multi-Level Distribution Companies With A Montana Participant Form. This is a Montana form and can be used in General Blue Sky Secretary Of State . |
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Form MLD-1 UNIFORM NOTIFICATION FORM FOR MULTI-LEVEL DISTRIBUTION COMPANIES WITH A MONTANA PARTICIPANT (An initial notification form must be accompanied by completed schedules A & B and a consent to service of process) This filing is: an initial notification an amendment 1. Company name: 2. Name under which business is conducted, if different: 3. If company or business name is being amended, give previous name: 4. Corporate address Do not use PO box: (City) (State) (Zip) 5. Mailing address (if different): (City) (State) (Zip) 6. Telephone number at this location: 7. e-mail address: 8. Web site URL: ( ) - 9. State of domicile: 10. State of In corporation: 11. Date of Incorp. Execution Both the undersigned and the above named multi-level distribution compan y represent that the information and statements contained herein, including attached schedules, exhibits and other information field herewith, are current, t rue, and complete. Both parties further represent that, to the extent that any information previously submitted is not amended, such information is currently accurate and complete. Date: Name of multi-level distribution company: By: (Signature) Type name and title: Note: The company is required by law to file an amendment with the State Auditors Office each time there is a material change to the information contained within this form. Orig. 9/99 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2Schedule A of Form MLD Name of Multi-Level Distribution Company: Date: 1. List below all individuals who have direct responsibility for the management of the Multi-Level Distribution Company . Also include each beneficial owner having the power to vote or dispose of 10% or more of a class of equity securities of the Company : Full legal name: Title : Date title acquired: SSN AND Date of Birth & State of Residence Mailing address: (city) (State) (Zip) Full legal name: Title : Date title acquired: SSN AND Date of Birth & State of Residence Mailing address: (city) (State) (Zip) Full legal name: Title : Date title acquired: SSN AND Date of Birth & State of Residence Mailing address: (city) (State) (Zip) Full legal name: Title : Date title acquired: SSN AND Date of Birth & State of Residence Mailing address: (city) (State) (Zip) Full legal name: Title : Date title acquired: SSN AND Date of Birth & State of Residence Mailing address: (city) (State) (Zip) Full legal name: Title : Date title acquired: SSN AND Date of Birth & State of Residence Mailing address: (city) (State) (Zip) Orig. 5/04 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3 Schedule B of Form MLD Name of Multi-Level Distribution Company: Date: 1. Provide a detailed description of the levels of distribution in the multi-level distribution company, the manner of compensating participants, and the compensation structure of the marketing plan. Attach a copy of all marketing material provided to new participants regarding applicants program. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 4 Orig. 9/99 UNIFORM CONSENT TO SERVICE OF PROCESS KNOW ALL PEOPLE BY THESE PRESENTS: That the undersigned__________________________________, organized under the laws of ____________________________________ for purposes of complying with the laws of the State of Montana relating to either the sale, distribution or supplying of goods or services through independent agents, contractors, or distributions at different levels of distribution through a multilevel distribution company, hereby irrevocably appoints the Montana State Auditor and successors in such office, its attorney in the State of Montana upon whom may be serviced any notice, process, or pleading in any action or proceeding against it arising out of, or in connection with, the sale, distribution or supplying of goods or services through a multilevel distribution company or out of violation of the aforesaid laws of the State of Montana; and the undersigned does hereby consent that any such action or proceeding against it may be commenced i n any court of competent jurisdiction and proper venue within Montana by service of process upon the officers so designated with the same effect as if the undersigned was organized or created under the laws of that State and have been served lawfully with process in that State: The Company requests that a copy of any notice, process or pleading served hereunder be mailed to the Company or its agents at the following address: ________________________________________________________________ Name ________________________________________________________________ Address Dated this ______ day of ___________, 19 __ By:_________________________________ Title:________________________________ By:_________________________________ Title:________________________________ Orig. 9/99 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 5 STATE AUDITORS OFFICE AGENT FOR SERVICE OF PROCESS FACT SHEET The State Auditor of Montana acts as the ex-officio Insurance Commission er and Securities Commissioner. The State Auditor is charged with the duties of regulatin g the insurance and securities industry in Montana. Pursuant to Montana statutes, the Audit or, in performing those duties, shall act as the Agent for Service of Process under certain circ umstances. The following information is being provided to you as a basis for effect uating Service of Process through the State Auditor. WHAT ENTITIES DOES THE COMMISSIONER ACT AS AGENT FOR? All insurance companies doing business in All broker/dealer firms doing business in MT MT All investment advisory firms doing business Non-resident insurance producers (agents) in MT Montana Guaranty Associations All securities salespersons doing business in Risk retention and purchasing groups MT registered in MT All licensed firms and persons offering or All securities issuers registered or notice selling living trusts in Montana filed with the Montana Securities Department All multi-level distribution companies doing business in Montana WHAT ITEMS NEED TO BE SENT TO THE COMMISSIONER? Duplicate (two) copies of all service of process. Original summons not needed. $10.00 service fee per insurance company made payable to the Commissione r of Insurance. (Not applicable to securities services) Specific company name. The commissioner cannot accept service for a grou p of companies. One signed original and one copy of the n
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