New Home Builder Registration Application Instructions

STATE OF NEW JERSEYDEPARTMENT OF COMMUNITY AFFAIRS

DIVISION OF CODES AND STANDARDS

BUREAU OF HOMEOWNER PROTECTION

P.O. BOX 805

TRENTON, NJ 08625-0805

(For Hand/Overnight Deliveries Only Use the Street Address:)

101 SOUTH BROAD STREET, TRENTON, NJ 08608



PHONE: (609) 984-7905 E-MAIL: BHP_[email protected] FAX: (609) 292-2839

www.state.nj.us/dca

NEW HOME BUILDER REGISTRATION APPLICATION INSTRUCTIONS

Please read these instructions carefully before completing this application. The application

must be typed or completed in ink.

New Home Builders are governed by the New Home Warranty and Builders’ Registration

Act, N.J.S.A. 46:3B-10 and promulgated regulations, N.J.A.C. 5:25-1.1 et seq.

(https://www.nj.gov/dca/divisions/codes/codreg/pdf_regs/njac_5_25.pdf)

PLEASE BE SURE TO COMPLETE THE APPLICATION IN ITS ENTIRETY.

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. The date of filing will be

the date the Bureau of Homeowner Protection, Builder Registration Section receives a completed

application, including all required documentation. All questions and sections of the Builder

Registration Application Form must be completed. If a question is inapplicable, so indicate. If

there is insufficient room on the form to provide a complete answer to the question, you may copy

and submit additional sheets of paper with the application. By completing this application, you

consent to a criminal history records check for a noncriminal justice purpose.



A nonrefundable registration fee of $200.00 must accompany this application. Make check

or money order payable to “State of New Jersey New Home Warranty Fund”. Maker of

check must be the registering business or a principal named in the application. We do not

accept starter checks. 

Allow at least 20 working days for the processing of this application.

Late application filings will not be expedited.

Applications may be deemed incomplete and closed after 30 days, if after having been notified by

the New Home Builder Registration Unit of a deficiency, the applicant fails to correct the deficient

application submission. If an application is closed a new application and a new $200.00

application fee is required to restart or continue the application process. 

BEFORE COMPLETING THIS APPLICATION, PLEASE READ THE

INSTRUCTIONS RELATED TO EACH CORRESPONDING QUESTION.

NEW HOME BUILDER REGISTRATION APPLICATION INSTRUCTIONS-continued.

1. Type of Application: Please check one of the choices given. (If you are filing a renewal

application, you must also complete this form). There is a $25.00 fee for Amendments

to applications that require the issuance of a new builder’s registration card prior to the

builder’s expiration date.

2. Applicant Information: LIST THE NAME OF YOUR BUSINESS. THE NAME OF THE

BUSINESS OR PERSON WHO OWNS THE PROPERTY AND IS TRANSFERRING

TITLE IS THE ENTITY/PERSON THAT MUST REGISTER AS A NEW HOME BUILDER

AND ISSUE THE WARRANTY FOR THE NEW HOME. This exact name should appear

on your application for registration as a new home builder in the State of New Jersey. If

you are the only owner of the business and are doing business under your own name as

a sole proprietor, list your own name.



Physical Business Address: Post Office Boxes are not acceptable. This is the address

from which you do business. This must be a street address.

Mailing Address: This is the address at which you want to receive mail; it may be a P.O.

Box.

3. Alternate Name or Trade Names:List all other names under which the new home

builderwillbedoingbusiness(includeacopyoftheTradeCertificateorAlternateName

Certificate of assumed name on file with the county or state.) NOTE: D/B/As, AKAs,

tradenames,fictitiousnames,etc.mustbefiledwiththeStateDepartmentofTreasury

orthecountyortownwherethenew

homebuilderisconductingbusiness.



4. Agent: An agent for service of process is the person (a business name is not acceptable)

in New Jersey authorized by your business to accept legal papers on behalf of your

business. If you are a corporation, limited liability company or limited partnership you are

required to have a registered agent for service of process. Your agent must have a New

Jersey address, and the address you provide must be a physical address; P.O. Boxes

are not acceptable.



5. Business Information: Check one box for the organizational formation for your business.

Fill in the date business was established which should correspond with formation

documentation and the State in which the entity was established. 

EIN: An Employer Identification Number (EIN) also known as a Federal Identification

Number, is a nine-digit number the IRS assigns to business entities. Employers, sole

proprietors, corporations, nonprofit organizations, trusts and estates, government

agencies, certain individuals and other business entities use EINs.

Check Yes or No to the remaining questions in this section. If you checked yes to any of

the questions, provide supporting documentation.



6. New Home Warranty Security Option: You must indicate the Plan name with which you

participate. If you have not yet been issued an ID number, check the box entitled, “Check

if plan is pending”. See the attached list of NJ-approved warranty plans. (If enrolling in

the State Plan, there is no separate application or member enrollment number required.)



7. Certification:Anauthorizedprincipalorofficerintheentitymustsignanddatehere.

EACH INDIVIDUAL LISTED IN THIS APPLICATION MUST COMPLETE THE

APPROPRIATE SCHEDULES, A, B and/or C. ADDITIONAL SHEETS MAY BE

PHOTOCOPIED IF NECESSARY.

New Home Builder Registration Application Check List



___ 1.BesuretocheckoneoptionfortheTypeofApplication. Ifthebuildingentityhasprovideda

warrantyforahomewhichisstillinitsfirsttwo(2)yearsofwarrantycoverage,youmustrenew

thenewhomebuilder’sregistration.

___ 2.Includecheckormoneyorderforregistrationfeeof$200.00,payableto:“StateofNewJersey

–NHWP”.

___ 3.ProvideAlternateNameorTrade

NameCertificate(s).

___ 4.NewJerseyAgent–mustbeaNewJerseystreetaddress.

___ 5.NewApplicants

 Applicants must provide Business Formation documents:Certificate of Incorporation,

PartnershipAgreement,JointVentureAgreement,CertificateofFormationForLLC,Trust

Agreement,etc.

 ***IftheCertificateofIncorporationorCertificateofFormationismorethan 1yearold,

also submit the Business Entity Status Report, Annual Report,  or Long Form

 Standing

showingthecurrentprincipals/officersandstatusofthecompany.

 Outofstate(foreign)entitiesmustalsosubmitaCertificateofAuthoritytodoBusiness

inNewJersey.

RenewalApplications

 ***Submit the Business Entity Status Report, Annual Report, or Long Form Standing

showingthecurrentprincipals/officersandstatusofthecompany.

 If there have been any changes since the previous renewal with regard to principals,

members, directors, partners or officers in this building entity, please include

documentationreflectingthosechange s.

o ForCorporationsprovide‐acopyoftheannualreportstatusform

indicatingthe

currentprincipalsintheentity.Acopyofaunanimousconsentinwritingoran

action by consent in writing from the secretary of the entity indicating

appointments/regenerationsand/orterminationsofofficersisacceptable.

o For Limited Liablity Companies provide a copy of the operating agreement or

annual

reportstylusformindictingthecurrentprincipalsinthecompany.

___ 6.ProvideOperatingAgreement(ifavailable).

*** BUSINESS ENTITY STATUS REPORTS, ANNUAL REPORTS, AND LONG FORM

STANDINGS MAY BE OBTAINED FROM THE DEPARTMENT OF TREASURY,

DIVISION OF REVENUE AND ENTERPRISE SERVICES. PLEASE VISIT THEIR

WEBSITE AT: https://www.njportal.com/DOR/businessrecords/ OR CALL 609-292-9292

FOR MORE INFORMATION.



___ 7.Provide judgment and discharge documents, if there were judgments issued against the

buildingentity.

___ 8.Providea pplicable documents,ifthebuildingentityhasgonethroughabankruptcy,business

reorganization,fianancialreorganizationorliquidation.

___ 9.Ifyouwill  beusingaprivatenewhomewarranty plan,provide

privateNewHomeWarranty

acceptanceletterandmemberenrollmentnumber,orproofofcurrentmembershipenrollment.

(Ifyourcompanyisnotyetenrolled,onceenrolledyouhave30daystosubmitproofofenrollment

totheBureau.).

___ 10.TheBuilderDesigneemustcompletescheduleA(andSchedulesBandC

ifhe/she hasatleast

10%interestinthebuildingentity).

___ 11.All Principals andOfficerswithatleasta10% interestinthebuilding entitymust complete

SchedulesBandC.

___ 12.ProvideanysupportingdocumentationforSectionsA(3),A(4)andA(5).

___ 13.Provideanysupporting

documentationforSectionsB(3),B(4)andB(5).

___ 14.Each individual who holds 10% or more interest in the business must  complete and sign

ScheduleC.

___ 15.Registrationapplicationcompletedinitsentiretyandsignedbytheappropriateindividual(s).





Unusual Applications

ChangesinOwnershipDuetoDeathofSolePrincipal(Allbeneficiarieswith10%ormoreinterestmust

belistedasaprincipalonthenewhomewarrantyapplication)



A Builder who wantsto change the principal(s) inanentity due to the death of a soleprincipal, must

providethefollowingdocumentationbefore,renewingtheBuilder’sregistration:



1. AStatusReportshowingthecurrentprincipals;or

AnAnnualReportShowingthecurrentprincipals;or 

3. AnAmende dCertificateofIncorporationorFormationshowingthecurrentprincipals,ifnoneof

these documents have been updated, we may accept Letters of Administration or Letters of

Testamentary.(**Note:Theprincipal/officerinformationmustbe updatedwithTreasuryupon

applicationof

theBuilder’snextnewhomebuilderrenewalapplication.)



 NoWill(LettersofAdministration)

IftheCertificateofIncorporation(Formation)has notbeenamended,andTHEREISNOWILL,we

needLettersofAdministrationoranAdministrationShortCertificate.TheSurrogatewillissue 

LettersofAdministrationwhichistheauthorizationfortheadministratortoactonbehalfofthe

estate.



 Will(Lettersof

Testamentary)

IftheCertificateofIncorporationhasnotbeenamended,andTHEREISAWILLweneedLetters

of Testamentary or an Executor Short Certificate, and a copy of the Will showing the

beneficiaries.TheSurrogatewillissuethis,whichtheexecutorusesasproofofhisorherauthority

totransferorsellassets.Thewillmustbeprobatedifthedecedenthadassetssolelyinhisname.

(The Will is probated in order for thenamedexecutor in the Will to

be given the authority to

transfertheassets)



Anyone handling the estate must apply for the Letters of Administration and the Letters of

TestamentarywiththeSurrogate’sCourtinthecountywherethepersonresidedat thetimeof

his or her death.For additional information about requirements for obtaining the

 Letters of

Administration or Testamentary, the applicant should contact the Surrogates’ Office in the

appropriatecounty.



EstatesandTrusts

All beneficiaries of the “Estate of…” or “Trust” with 10% or more interest must be listed as a

principal/members/officers onthenewhomebuil derregistrationapplication.Allbeneficiarieslistedon

theapplicationmustalsofilloutSchedulesA,B,and/orCbyfollowingtheinstructions onthenewhome

builderregistration

application.Ifanybeneficiaryisunder theageof18theguardianortrusteeforthat

individual’sinterestmustbelisted.(SubmitacopyoftheTrustAgreementwithyourapplication.)



BusinessName/FormationTypeChange

A sole proprietor may change the business name by amending the new home builder registration

application.



A Corporation orLLC may change the business name by amending  the new home builder registration

application and forwarding a copy of the Amended Name Change Certificate.If there is no amended

certificate,thebuilder

mustregisterasanewcompa ny.



APPROVED WARRANTY PLANS ACCEPTABLE IN

THE STATE OF NEW JERSEY

ESIDENTIAL WARRANTY CO., LLC (RWC)

5300 Derry Street

Harrisburg, Pennsylvania 17111-3598

Telephone: 1 800-247-1812

http://www.rwcwarranty.com

TRUCSURE HOME WARRANTY, LLC

6825 E. Tennessee Ave., Suite 410

Denver, Colorado 80244

Telephone: 1 877-806-8777

https://www.strucsure.com

EW JERSEY NEW HOME WARRANTY

PROGRAM (NHW)

Department of Community Affairs

New Home Warranty Program

Post Office Box 805

renton, New Jersey 08625-0805

Telephone: 609-633-3994

https://www.nj.gov/dca/divisions/codes/offices

/homeownerprotection.html

2-10 HOME BUYERS WARRANTY

CORP. III (HBW)

13900 E. Harvard Avenue

Aurora, Colorado 80014

Telephone: 1 800-488-8844

http://www.2-10.com

AMERICAN eWARRANTY

119 Aster Drive, Suite 105

Harrisburg, Pennsylvania 17112

Telephone: 717-526-2090/866-526-2090

www.americanewarranty.com

PROFESSIONAL WARRANTY SERV CORP (PWSC)

Post Office Box 800

Annandale, Virginia, 22003-0800

Telephone: 1 800-850-2799

http://www.pwsc.com

QUALITY BUILDERS WARRANTY CORP. (QBW)

3500 Market Street, Suite 204

Camp Hill, Pennsylvania 17011

Telephone: 717-737-2522/ 1 800-334-9143

https://www.qbwc.com

The State of New Jersey New Home Warranty Plan is open to all registered new home builders.

Any builder not participating in an approved private warranty plan is automatically enrolled in

the state’s new home warranty plan. Upon acceptance into an approved private plan,

notification must be given in writing to the New Jersey Department of Community Affairs, Bureau

of Homeowner Protection, PO Box 805, Trenton, New Jersey 08625-0805.

As set forth in N.J.A.C. 5:25-2.5(b) (4), a Certificate of Builder Registration may be suspended if

material changes in the most recent builder registration or amendment thereto is not reported

within 30 days of the change (including a change in the new home warranty security plan). In

accordance with N.J.A.C. 5:25-2.6, any builder who fails to file an amended application shall be

subject to an administrative penalty levied by the Bureau of Homeowner Protection and collected

in accordance with the Penalty Enforcement Law.

NOTE: The Builder is responsible for providing his or her private new home warranty provider

with a copy of his or her approval letter and or validated new home builder’s registration card,

bearing the name of the registered new home builder and the registration expiration date.

STATE OF NEW JERSEY DEPARTMENT OF COMMUNITY AFFAIRS

Division of Codes and Standards Bureau of Homeowner Protection

P.O. Box 805

101 South Broad Street 08608 (Hand/Overnight Deliveries Only)

Trenton, New Jersey 08625-0805

Phone: (609) 984-7905 Fax: (609) 292-2839

NEW HOME BUILDER REGISTRATION APPLICATION

NOTICE: Any changes, additions or deletions to the information in this application must be reported in writing to the New

Home Warranty Program within 30 days. Failure to do so may result in the denial or suspension of the builder’s registration.

Failure to amend may result in a $2,000.00 administrative penalty as set forth in N.J.A.C. 5:25-2.6.

TYPE OF APPLICATION

(check one) If the builder has provided warranties to homes which are still in the first 2 years of

coverage, you must renew the new home builder’s registration.



New



Renewal



Amendment



Business Is No Longer Constructing New Homes

2. APPLICANT INFORMATION

Name of New Home Building Business Reg. Exp. Date Reg. Number

Physical Business Address (P.O. Box NOT accepted) City State Zip Code

Mailing Address (For Official Notification) City State Zip Code

Telephone number Fax number E-mail Address

ALTERNATE NAMES OR TRADE NAMES

List all other names under which the new home builder will be doing

business (include a copy of the Trade Certificate or Alternate Name Certificate of assumed name on file with the county or state.)

AGENT INFORMATION

(Corporations, LLCs, and LPs only) Agent must be a PERSON with a New Jersey Address,

NOT a business entity.

Name of Agent

Street Address City State Zip Code

For Official Use Only

Check received:

CLEAR:

Compliance:

VALIDATION (registration expires on this date)

Information provided on this application is subject to public disclosure as required by the Open Public Records Act (OPRA).

STATE OF NEW JERSEY DEPARTMENT OF COMMUNITY AFFAIRS

Division of Codes and Standards

Bureau of Homeowner Protection

New Home Warranty Program

NEW HOME BUILDER REGISTRATION APPLICATION

5. BUSINESS INFORMATION

Type of Business Organization (check one)



Corporation



LLC



Limited Partnership



Joint Venture



Trust



General Partnership



Sole Proprietorship



Other

Date Business Established

State of Organization

Employer Identification No. (EIN):

Are there any satisfied or unsatisfied Judgments against this Building entity?



Yes



If yes, Amount of Judgment

Date of Judgment

*Include a copy of judgment and discharge papers.

Is this business entity in bankruptcy, declared bankruptcy or made application for bankruptcy, business

reorganization, financial reorganization or liquidation?



Yes



If yes, provide documentation.

Is your new home builder’s registration/license currently suspended or revoked in any other State?



Yes



If yes, which state?

*New applicants must include a copy of the Certificate of Incorporation, Partnership, Joint Venture, Certificate

of Formation for LLC, Trust Agreement, or any other document evidencing the formation of the business entity.

If a foreign corporation or LLC, include a Certificate of Authority to do business in New Jersey.

6. NEW HOME WARRANTY SECURITY OPTION (check one)

 State Plan  Private Plan* (specify)

 Check if plan is pending

Name of Plan

Member Enrollment Number

Provide a current letter of acceptance from the private plan showing that this business entity is current

with a new expiration date.

7. CERTIFICATION

I attest that the information stated herein is truthful and accurate without omissions to the best of my

knowledge and understand that failure to fully and accurately disclose any information may delay

processing the application while the Department investigates. Further, I understand, pursuant to the

Regulations Governing New Home Warranties and Builders’ Registrations, N.J.A.C. 5:25-2.5 any willfully

made misstatement of material fact may result in the denial, suspension or revocation of my new home

builders’ application or registration.

Authorized Signature (Must be Officer/Principal of Business Entity) Title:

Name (Print or Type) Date:

Information provided on this application is subject to public disclosure as required by the Open Public Records Act (OPRA).

STATE OF NEW JERSEY DEPARTMENT OF COMMUNITY AFFAIRS

Division of Codes and Standards

Bureau of Homeowner Protection

New Home Warranty Program

NEW HOME BUILDER REGISTRATION APPLICATION

SCHEDULE A - BUILDER DESIGNEE

NAME OF BUSINESS

The builder designee must be the name of an INDIVIDUAL who is a primary partner, principal, officer, member

or director designated as such in the builder’s application for registration, and is the INDIVIDUAL responsible

for participating in the claims process, if necessary. (SOLE PROPRIETORS MUST ALSO COMPLETE

THIS PAGE)

SECTION A(1) - BUILDER DESIGNEE (print or type)

Name

Title

Percentage of Ownership

Home Address

City

State Zip Code

Business Telephone Number

Fax Number

E-mail Address

SECTION A(2)

If you are or have ever been a builder designee, officer, partner, member, director, or a holder of a minimum of

10% interest in any other NJ new home building business, list them below. ALL CURRENT AS WELL AS

INACTIVE BUSINESSES MUST BE LISTED.

From

Company Name

Registration

No.

Position

Ownership

(Y/N)

Percentage

SECTION A(3)

Has the individual executing this disclosure ever been personally subject to, or been an officer, director,

partner, principal or a member in a company that has been subject to a civil, criminal or administrative

proceeding and as a result of such, the individual or company was suspended, revoked or barred from

engaging in the business of the construction of new homes in any state within the United States?



Yes



If yes, please provide the following:

Name of Entity/Person Against Whom

Action Was Taken

Date of Action

Name of Government Entity

that Took Action

Action Taken

SCHEDULE A

SECTION A(4)

Has the individual executing this disclosure ever been personally subject to, or been an officer, director, partner,

principal or a member in a company subject to a civil, criminal or administrative proceeding or adjudged liable

in a civil or administrative action in any state or federal agency involving any of the following situations:

Obtaining a license, certificate or registration through fraud, deception or misrepresentation;

ii.

Engaging in the use or employment of dishonesty, fraud, deception, misrepresentation, false promise

or false pretense;

iii.

Engaging in gross negligence, gross malpractice or gross incompetence;

iv.

Engaging in acts of negligence, malpractice or incompetence involving the construction of a new home;

Engaging in professional or occupational misconduct; and/or

vi.

Engaging in theft, fraud or deceptive business practices?

 Yes  No

If yes, please provide the following:

Name of Entity/Person Against Whom

Action Was Taken

Date of Action

Name of Government Entity

that Took Action

Action Taken

SECTION A(5)

Name of Person Against Whom Judgment was Issued

Date of Action

Amount of Judgment

For each occurrence listed above, in Sections A(3), A(4) and A(5), please provide a true copy of all final orders and/or judgments,

consents and agreements. For the purposes of these paragraph, a judgment of liability in an administrative or civil action shall include,

but not be limited to, any finding or admission that the applicant, or any of its partners, officers, directors, principals, members or persons

with an ownership of 10 percent or more in the applicant engaged in an unlawful practice or practices related to any of the named

situation herein above, regardless of whether that finding was made in the context of an injunction, a proceeding resulting in the denial,

suspension or revocation of a license, certification or registration, consented to in an assurance of voluntary compliance or any similar

order or legal agreement with any state or federal agency.

CERTIFICATION

I certify that all information provided in connection with the application is true to the best of my

information, knowledge and belief. I understand that any omissions, inaccuracies or failure to make full

disclosures may be deemed sufficient to deny this registration, suspend or revoke a registration issued by

the New Home Warranty Program.

Authorized Signature (Must be signed by individual listed in section A(1)) Title:

Name (Print or Type) Date:

SCHEDULE A

 Yes  No

Does the INDIVIDUAL executing this disclosure have any unsatisfied judgments?

STATE OF NEW JERSEY DEPARTMENT OF COMMUNITY AFFAIRS

Division of Codes and Standards

Bureau of Homeowner Protection

New Home Warranty Program

NEW HOME BUILDER REGISTRATION APPLICATION

SCHEDULE B - OFFICERS/PRINCIPALS

NAME OF BUSINESS

A SEPARATE SCHEDULE B MUST BE COMPLETED FOR EACH OFFICER, MEMBER, DIRECTOR,

PARTNER AND PRINCIPAL IN THIS BUSINESS. Also complete a separate Schedule B for ALL

individuals who hold a minimum of 10% interest. EACH INDIVIDUAL NAMED IN THE CERTIFICATE

OF INCORPORATION, PARTNERSHIP/JOINT VENTURE AGREEMENT, TRUST OR LIMITED

LIABILITY COMPANY MUST COMPLETE A SEPARATE SCHEDULE B (PAGES 5 & 6).

SECTION B(1) – OFFICERS/PRINCIPALS (print or type)

Name

Title

Percentage of Ownership

Home Address

City

State Zip Code

Business Telephone Number

Fax Number

E-mail Address

SECTION (B)2

If you are or have ever been a builder designee, officer, partner, member, director, or a holder of a minimum of

10% interest in any other NJ new home building business, list them below. ALL CURRENT AS WELL AS

INACTIVE BUSINESSES MUST BE LISTED.

From

Company Name

Registration

No.

Position

Ownership

(Y/N)

Percentage

SECTION B(3)

Has the individual executing this disclosure ever been personally subject to, or been an officer, director, partner,

principal or a member in a company that has been subject to a civil, criminal or administrative proceeding and as

a result of such, the individual or company was suspended, revoked or barred from engaging in the business of

the construction of new homes in any state within the United Stated?

 Yes

 No

If yes, please provide the following:

Name of Entity/Person Against Whom

Action Was Taken

Date of Action

Name of Government Entity

that Took Action

Action Taken

SCHEDULE B

SECTION B(4)

Has the individual executing this disclosure ever been personally subject to, or been an officer, director, partner,

principal or a member in a company subject to a civil, criminal or administrative proceeding or adjudged liable

in a civil or administrative action in any state or federal agency involving any of the following situations:

Obtaining a license, certificate or registration through fraud, deception or misrepresentation;

ii.

Engaging in the use or employment of dishonesty, fraud, deception, misrepresentation, false promise

or false pretense;

iii.

Engaging in gross negligence, gross malpractice or gross incompetence;

iv.

Engaging in acts of negligence, malpractice or incompetence involving the construction of a new home;

Engaging in professional or occupational misconduct; and/or

vi.

Engaging in theft, fraud or deceptive business practices?



Yes



If yes, please provide the following:

Name of Entity/Person Against Whom

Action Was Taken

Date of Action

Name of Government Entity

that Took Action

Action Taken

SECTION B(5)

Name of Person Against Whom Judgment was Issued

Date of Action

Amount of Judgment

For each occurrence listed above, in Sections B(3), B(4), and B(5), please provide a true copy of all final orders and/or judgments,

consents and agreements. For the purposes of these paragraph, a judgment of liability in an administrative or civil action shall include,

but not be limited to, any finding or admission that the applicant, or any of its partners, officers, directors, principals, members or

persons with an ownership of 10 percent or more in the applicant engaged in an unlawful practice or practices related to any of the

named situation herein above, regardless of whether that finding was made in the context of an injunction, a proceeding resulting in the

denial, suspension or revocation of a license, certification or registration, consented to in an assurance of voluntary compliance or any

similar order or legal agreement with any state or federal agency.

CERTIFICATION

I certify that all information provided in connection with the application is true to the best of my

information, knowledge and belief. I understand that any omissions, inaccuracies or failure to make full

disclosures may be deemed sufficient to deny this registration, suspend or revoke a registration issued by

the New Home Warranty Program.

Authorized Signature (Must be signed by individual listed in section B(1)) Title:

Name (Print or Type) Date:

SCHEDULE B 6

 Yes  No

Does the INDIVIDUAL executing this disclosure have any unsatisfied judgments?

STATE OF NEW JERSEY DEPARTMENT OF COMMUNITY AFFAIRS

Division of Codes and Standards

Bureau of Homeowner Protection

New Home Warranty Program

SCHEDULE C - OFFICERS/PRINCIPALS

NAME OF BUSINESS

SECTION C(1) - OFFICERS/PRINCIPALS (Sole Proprietorships must also complete this section)

List below the names, addresses and positions of each principal, officer, partner, director, member and individual

in the business. Also list the names and addresses for all individuals who hold a minimum of 10% interest

in this business (this page may be photocopied if additional copies are needed).

NOTE: SOCIAL SECURITY NUMBERS WILL REMAIN CONFIDENTIAL AND WILL NOT REMAIN IN

FILES REVIEWED OR COPIED BY THE GENERAL PUBLIC.*

Name Social Security Number

Home Street Address City State Zip Code

Home Telephone No. Date of Birth

Other names by which known or previously known

Signature Date

Name Social Security Number

Home Street Address City State Zip Code

Home Telephone No. Date of Birth

Other names by which known or previously known

Signature Date

Name Social Security Number

Home Street Address City State Zip Code

Home Telephone No. Date of Birth

Other names by which known or previously known

Signature Date

*Pursuant to N.J.S.A. 2A:17—56.44e of the New Jersey Child Support Enforcement Law, N.J.S.A. 54:50-25 of the New Jersey Taxation

Law, the Division of Codes and Standards is required to obtain your Social Security number. The Division is further obligated to provide

your social security number to the Probation Division or other agency responsible for child support enforcement, and to the Director of

Taxation.

By completing and signing this application, you are consenting to a criminal history records check for a noncriminal

justice purpose.

SCHEDULE C 7