(1) An application for registration as a provider must be in a form prescribed by the administrator.
(2) Subject to adjustment of dollar amounts pursuant to § 47-18-5532(f), an application for registration as a provider must be accompanied by: The fee established by the administrator;
(3) The bond required by § 47-18-5513;
(4) Identification of all trust accounts required by § 47-18-5522 and an irrevocable consent authorizing the administrator to review and examine the trust accounts;
(5) Evidence of insurance in the amount of two hundred fifty thousand dollars ($250,000): Against the risks of dishonesty, fraud, theft and other misconduct on the part of the applicant or a director, employee or agent of the applicant;
(6) Issued by an insurance company authorized to do business in this state and rated at least “A” or equivalent by a nationally recognized rating organization approved by the administrator;
(7) With a deductible not exceeding five thousand dollars ($5,000);
(8) Payable for the benefit of the applicant, this state and individuals who are residents of this state, as their interests may appear; and
(9) Not subject to cancellation by the applicant or the insurer until sixty (60) days after written notice has been given to the administrator;
(10) A record consenting to the jurisdiction of this state containing: The name, business address and other contact information of its registered agent in this state for purposes of service of process; or
(11) The appointment of the administrator as agent of the provider for purposes of service of process; and
(12) If the applicant is exempt from taxation under the Internal Revenue Code, 26 U.S.C. § 501, evidence of that status.