19 MAC Pt. 1, R. 20.04
Forms - General Requirements
Cite as 19 Miss. Admin. Code Pt. 1, R. 20.04
Forms - General Requirements
A. Forms A, B, C, D, E and F are intended to be guides in the preparation of the statements
required by Sections 83-6-24, 83-6-5, 83-6-21, and 83-6-24 of the Act. They are not
intended to be blank forms which are to be filled in. These statements filed shall contain
the numbers and captions of all items, but the text of the items may be omitted provided
the answers thereto are prepared in such a manner as to indicate clearly the scope and
coverage of the items. All instructions, whether appearing under the items of the form or
elsewhere therein, are to be omitted. Unless expressly provided otherwise, if any item is
inapplicable or the answer thereto is in the negative, an appropriate statement to that
effect shall be made.
B. One (1) complete copy of each statement including exhibits and all other papers and
documents filed as a part thereof, shall be filed with the Commissioner by personal
delivery or mail addressed to: Insurance Commissioner of the State of Mississippi,
Attention: Commissioner. The copy shall be manually signed in the manner prescribed on
the form. If the signature of any person is affixed pursuant to a power of attorney or other
similar authority, a copy of such power of attorney or other authority shall also be filed
with the statement.
C. If an applicant requests a hearing on a consolidated bases under Section 83-6-24(4)(d) of
the Act, in addition to filing the Form A with the commissioner, the applicant shall file a
copy of Form A with the National Association of Insurance Commissioners (NAIC) in
electronic form.
D. Statements should be prepared electronically. Statements shall be easily readable and
suitable for review and reproduction. Debits in credit categories and credits in debit
categories shall be designated so as to be clearly distinguishable as such on photocopies.
Statements shall be in the English language and monetary values shall be stated in United
States currency. If any exhibit or other paper or document filed with the statement is in a
foreign language, it shall be accompanied by a translation into the English language and
any monetary value shown in a foreign currency normally shall be converted into United
States currency.