Consent to Rate Guidelines

[LOGO] EARL R. POMEROY COMMISSIONER OF INSURANCE STATE OF NORTH DAKOTA STATE CAPITOL BISMARCK, NORTH DAKOTA 58505 701-224-2440 # BULLETIN 87-5 TO: ALL PROPERTY AND CASUALTY INSURANCE COMPANIES FROM: Earl R. Pomeroy, Commissioner of Insurance DATE: June 18, 1987 SUBJECT: Consent to Rate Guidelines Earl R. Pomeroy North Dakota Century Code sections 26.1-25-04(6) and (7) provide authority for the Commissioner to deal with specific rating situations which cannot practicably be filed before they are used and/or those rates which are in excess of that provided by a filing. This is better known as "consent to rate." The intent of this Bulletin is twofold: First, to be sure there is a procedural mechanism which properly informs the insurance buyer of his unique situation; and second, to provide a uniform method of processing "consent to rate" applications. Attached to this Bulletin is a sample "consent to rate" application. This application includes specific information which is important to the insured and to the Department. The items set forth in this application are those specific items which need to be documented for proper review. The completed application is due in the Department no later than 30 days from the effective date of the policy. The Department expects to receive two copies of the application and a return envelope. Upon completion of our review, the Department will return a copy to the company. LM/rer Attachment TO: NORTH DAKOTA INSURANCE DEPARTMENT STATE CAPITOL BUILDING, FIFTH FLOOR BISMARCK, NORTH DAKOTA 58505 ## CONSENT TO RATE APPLICATION Please file and approve the following rates, which I understand are in Excess of those rates otherwise filed with the Department of Insurance. ### POLICY INFORMATION Type of Business: ____________________________________________________. Location(s) of Risk: ____________________________________________________. Description of Coverage: ____________________________________________________. Policy Number: ____________________________________________________. Effective Dates/Term of Policy: ____________________________________________________. Policy Limits: ____________________________________________________. Filed-Manual Premium at Above Limits: ____________________________________________________. Proposed Premium at Above Limit is: ____________________________________________________. ### APPLICANT INFORMATION I am agreeable to paying this premium because (reason): ____________________________________________________. Name of Insured (Applicant): ____________________________________________________. Mailing Address: ____________________________________________________. Signature of Named Insured: ____________________________________________________ Date: ____________________. ### COMPANY SUBMITTING APPLICATION Name: ____________________________________________________. Address: ____________________________________________________. Company Representative: ____________________________________________________ Date: ____________________.