Exhibit A- Mississippi Department of Insurance Expedited Review Filing

Exhibit A- Mississippi Department of Insurance Expedited Review Filing Election Form EXHIBIT A MISSISSIPPI DEPARTMENT OF INSURANCE EXPEDITED REVIEW FILING ELECTION FORM Company Name:________________________________________________ Form Filing SERFF Number:______________________________________ Check One: ______________ I elect to use the expedited for filing procedure. I have enclosed a check payable to the Mississippi Department of Insurance for all applicable statutory fees. I also verify I have sent a check to the Actuarial Resources Corporation of Georgia for the applicable expedited review fee. ______________ I elect to use the Standard Filing Procedure.