Please complete the following documentation and submit the information as a complete package to the attention of Chief Financial Analyst Michael Shull.

• Please make certain the following information is indicated on the South Carolina Application for Registration as a Purchasing Group (Form 1032):
  • The agency shown in Item 6A is licensed in South Carolina.
  • The agent shown in Item 6B is licensed with the insurer or registered risk group shown in Item 12.
  • Broker shown in Item 6B is licensed as a broker in SC.
  • Show in Item 12 the licensed insurer, registered risk retention group, or approved eligible surplus lines insurer in South Carolina from which the Group intends to purchase liability insurance.
• Fill out the South Carolina Appointment of Attorney to Accept Service (Form 1033).
• Fees -  South Carolina's fee is strictly retaliatory.  Thus, if the insurer's domiciliary Department requires a fee from a South Carolina domestic Purchasing Group to make such a filing with that Department, a check, made payable to the South Carolina Department of Insurance, in the amount of that fee should be included with your filing to this Department.
• Provide copy of the Certificate of Authority or registration from the state of domicile.