Filing Transmittal Form No. NDPC-100 (6/88)

[LOGO] EARL R. POMEROY COMMISSIONER OF INSURANCE STATE OF NORTH DAKOTA STATE CAPITOL BISMARCK, NORTH DAKOTA 58505 701-224-2440 # BULLETIN 88-4 TO: ALL PROPERTY/CASUALTY COMPANIES FROM: Earl R. Pomeroy, Commissioner of Insurance DATE: May 27, 1988 SUBJECT: Filing Transmittal Form No. NDPC-100 (6/88) Earl R. Pomeroy Pursuant to North Dakota Century Code Chapters 26.1-25 and 26.1-30, the Commissioner is given the authority and responsibility for the regulation of insurance forms and rates. In keeping with this authority we are introducing a "Filing Transmittal Form" No. NDPC-100 (6/88) to be used on all form and rate filings. The purpose of this form is twofold: 1) The proper completion of the form will make the processing of filings within the Department more timely and efficient. 2) The form will provide a definitive guide to companies by listing the requirements for filing. The Department is making every effort to process filings in a timely and efficient manner. Due to the limited size of our staff we are hampered in providing timely service by the fact that many filings are incomplete. This of course makes it necessary for us to have to go back to companies for this material, further delaying the process. We believe the use of a "Filing Transmittal Form" by all companies on each filing will be of great help to both the Department and the companies. The "Filing Transmittal Form" should be placed as the first page of the filing (on top). The form requires and provides space for the completion of specific data, as well as a check list of other items required as exhibits. If you have any questions, contact the Property/Casualty Division of the North Dakota Insurance Department at (701) 224-2440. klp # NORTH DAKOTA INSURANCE DEPARTMENT # PROPERTY/CASUALTY DIVISION # FILING TRANSMITTAL FORM Company(s): Lines of Insurance: Title of Program: ☐ Form Filing ☐ New ☐ Rate Filing ☐ Revision ☐ Manual/Rule Filing ☐ Withdrawal ☐ Member/Subscriber of Rating Organization ☐ Independent Filing ☐ Reference Filing ☐ Deviation Filing Company/Bureau Designation # Date Filed: Proposed Effective Date: Retaliatory Fee: Form $ Rate/Rule $ State of Domicile: States this has been filed in States that have approved this filing # FORM FILING REQUIREMENTS ☐ 1. Description of form(s) ☐ 2. List of forms (company, title, number, edition date) ☐ 3. Explanation of coverages that are broadened, reduced or limited ☐ 4. Copy of forms (if not a reference filing) NDPC-100 (6/88) Page 2 # RATE FILING REQUIREMENTS 1. Net effect of filing ____________% 2. Number of policies in the state ____________ 3. Estimated dollar (impact) of this filing to North Dakota policyholders ____________ 4. Summary of rate history for previous 5 years. 5. Countrywide loss experience for each of the last 5 years to include written premium, earned premium, incurred losses, loss adjustment expense, loss ratio, and IBNR. 6. Regional loss experience for each of the last 5 years to include same items as #3 above. (Region = ND, SD, MT, WY, NE, and UT). 7. Statewide loss experience for each of the last 5 years to include same items as #3 above. 8. Countrywide, regional, and statewide expense exhibits. 9. Copy of Rate Pages (draft copies acceptable) 10. Actuarial memorandum (if appropriate) to include loss development, loss adjusting expense, trending, credibility, permissible loss ratio, indicated rate level, and investment income, etc. 11. Explanation if rates are based solely upon those of another company(ies) offering a similar product and the comparison with that company. 12. Explanation if rates are based solely on underwriting judgement, describing all factors considered. # MANUAL/RULE FILING REQUIREMENTS 1. List of new rules 2. List of rules being replaced 3. Explanation of rule change 4. Impact in rate due to rule change 5. If rates are impacted, include appropriate supporting documents (refer to previous section) Name & Title: ________________________________ Signature: ____________________________________ Telephone #: _________________________________ NDPC-100 (6/88)