Section Rep 401.03 - Renewal Application The applicant shall supply the following information on the renewal application form:
(a) The applicant's full name;(b) The applicant's business, name, address and telephone number;(c) The applicant's home address and telephone number;(d) The applicant's e-mail address;(e) The applicant's license number and expiration date;(f) The renewal amount due;(g) An attestation and documentation that the applicant has complied with the continuing education requirements of Rep 403;(h) A statement indicating any disciplinary action brought against the applicant;(i) A statement indicating whether the applicant has ever been convicted of any felony, any misdemeanor, or a violation and if so, the name of the court, the details of the offense and the date of conviction and the sentence imposed;(j) A statement indicating that the applicant has adhered to the ethical and professional standards of Rep 500;(k) Acknowledgement that, if the applicant provided false information in the application it is a basis for disciplinary action by the board;(l) A surety bond for the penal sum of $1,000 with one or more sureties approved by the attorney general and conditioned that the applicant conform to and not violate any of the duties, terms, conditions, provisions or requirements of this subdivision; and(m) The applicant's signature and date.N.H. Admin. Code § Rep 401.03
Amended by Volume XXXV Number 45, Filed November 12, 2015, Proposed by #10967, Effective 10/31/2015, Expires 10/31/2025.