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: 10. State of Incorporation: 11. Date of Incorp. - 9. State of domicile: Execution Both the undersigned and the above named multi-level distribution company represent that the information and statements contained herein, including attached schedules, exhibits and other information field herewith, are current, true, 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 Auditor’s Office each time there is a material change to the information contained within this form. Orig. 9/99 American LegalNet, Inc. www.USCourtForms.com Schedule 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 : SSN AND Date of Birth & State of Residence Mailing address: Full legal name: Full legal name: (city) (State) (Zip) (State) (Zip) Date title acquired: (city) (State) (Zip) Date title acquired: (city) Title : SSN AND Date of Birth & State of Residence Mailing address: (Zip) Date title acquired: Title : SSN AND Date of Birth & State of Residence Mailing address: Full legal name: (city) Title : SSN AND Date of Birth & State of Residence Mailing address: (State) Date title acquired: Title : SSN AND Date of Birth & State of Residence Mailing address: Full legal name: (city) Title : SSN AND Date of Birth & State of Residence Mailing address: Full legal name: Date title acquired: (State) (Zip) Date title acquired: (city) (State) (Zip) Orig. 5/04 American LegalNet, Inc. www.USCourtForms.com 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 applicant’s program. American LegalNet, Inc. www.USCourtForms.com 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 in 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 STATE AUDITOR’S OFFICE AGENT FOR SERVICE OF PROCESS FACT SHEET The State Auditor of Montana acts as the ex-officio Insurance Commissioner and Securities Commissioner. The State Auditor is charged with the duties of regulating the insurance and securities industry in Montana. Pursuant to Montana statutes, the Auditor, in performing those duties, shall act as the Agent for Service of Process under certain circumstances. The following information is being provided to you as a basis for effectuating Service of Process through the State Auditor. WHAT ENTITIES DOES THE COMMISSIONER ACT AS AGENT FOR? All broker/dealer firms doing business in MT All insurance companies doing business in All investment advisory firms doing business MT in MT Non-resident insurance producers (agents) All securities salespersons doing business in Montana Guaranty Associations MT Risk retention and purchasing groups All licensed firms and persons offering or registered in MT selling living trusts in Montana All securities issuers registered or notice All multi-level distribution companies doing filed with the Montana Securities Department 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 Commissioner of Insurance. (Not applicable to securities services) Specific company name. The commissioner cannot accept service for a group of companies. One signed original and one copy of the notice and acknowledgement of service by mail.** HOW IS SERVICE DELIVERED TO THE COMMISSIONER? U.S. Mail** Sheriff’s Office Process Server Personal Delivery Levying Officer WHAT MONTANA CODE SECTIONS PERTAIN TO SERVICE OF PROCESS? Sections: Commissioner – Attorney for Service of Process (insurance companies) 33-1-601 Serving process – time to plead, costs (insurance companies) 33-1-603 Risk retention groups not chartered in Montana 33-11-104(1)(c) Notice and registration requirements of purchasing groups 33-11-108(2) Commissioner – Attorney for service of process (non-resident producers) 33-17-405 Serving process – broker/dealers; investment advisors; multi-level distribution 30-10-208 companies; securities salespersons. Serving process – living trust 30-10-908 Consent to Service – multi-level distribution company 30-10-326 Montana Rules of Civil Procedure concerning service of process. 25-10, MCA, Rule 4D generally, and 4D(4) **If items are delivered through the U.S. mail, they must be accompanied by one signed original and one copy of the notice of acknowledgement of service by mail. American LegalNet, Inc. www.USCourtForms.com American LegalNet, Inc. www.USCourtForms.com