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Application Instructions

The application requires a six (6) step process. Each step (except for Steps 1 & 6) will require that you accept the terms to become a owner/insured of the Lone Star Risk Retention Group, Inc. Please read each document carefully. At the end of each document, you will be required to accept the terms disclosed in that document and click accept in order to move to the next step. The following are the six (6) steps:
 
Step 1. Select Agent: Only three (3) insurance agents have been approved by Lone Star Risk Retention Group, Inc. to market its plan. It is required that you pick one of the three agents listed on this site.
 
Step 2. Read Information Circular and provide electronic signature:1 Outlines the technical aspects of the organization and the risks involved, read it carefully. This document must be signed (via electronic signature).
 
Step 3. Read Subscription Agreement and provide electronic signature:1 Sets out the Company's terms for purchasing stock and your acceptance of the conditions. Once this document is reviewed, please sign (via electronic signature). A check in the amount of $55 per licensed bed located within the facility to be insured must be sent to Lone Star Risk Group, Inc. This represents the payment for shares of the Company. All checks must be made payable to Lone Star Risk Retention, Inc. This document must be signed (via electronic signature).
 
Step 4. Read Voting Agreement and Irrevocable Proxy and provide electronic signature:1 Authorizes a Proxy to vote your shares at its discretion regarding the operations of the Company. This document must be signed (via electronic signature).
 
Step 5. Fill-out Application and provide electronic signature.1 The application must be completely filled out to be reviewed by the Company's underwriting committee. In addition, all required information asked within the application, if applicable, must accompany the application. These required items will be outlined in step 6. This document must be signed (via electronic signature).
 
Step 6. Submit any remaining required documents: This Step generates a letter outlining the agent you selected, an application reference number, and lists all documentation/information/other items required to be submitted to Lone Star Risk Retention Group, Inc.
 
  1Your application for insurance and your agreement to be bound by the terms and conditions of the various documents and agreements posted on this web site through the electronic processes and electronic agents provided herein constitute one or more "transactions" within the meaning of the Texas Uniform Electronic Signatures Act (the "Act"). By using the electronic processes and electronic agents provided through this web site, you are (i) agreeing to conduct each transaction by electronic means pursuant to and in accordance with the terms and conditions of the Act, (ii) intending for each such use to constitute your electronic signature within the meaning of the Act and to signify your intent to be bound by all of the terms and conditions to which such electronic signature relates; and (iii) acknowledging that, subject to the terms and conditions of the various documents and agreements posted on this web site, use of such electronic processes and electronic agents will complete each transaction and create legally valid and binding obligations, enforceable against you in accordance with the terms and conditions of such transaction.

No insurance may be bound until all of the items listed above are complete and approved by the Company.

Click here to begin step 1