Revision of Filing Transmittal Form

[LOGO] # EARL R. POMEROY # COMMISSIONER OF INSURANCE STATE OF NORTH DAKOTA 701-224-2440 STATE CAPITOL BUILDING BISMARCK, NORTH DAKOTA 58505 # BULLETIN 88-6 TO: ALL PROPERTY/CASUALTY INSURANCE COMPANIES LICENSED IN NORTH DAKOTA FROM: Earl R. Pomeroy, Commissioner of Insurance DATE: August 30, 1988 SUBJECT: Revision of Filing Transmittal Form Earl R. Pomeroy Recently, via Bulletin 88-4, the North Dakota Insurance Department implemented a Filing Transmittal Form #NDPC-100 (6/88). The purpose of this Bulletin is to inform companies of revisions to the form. These revisions are described below: 1) Page 1: "Company(s)" is changed to "Company(s) Name and Federal I.D. #____". 2) Page 1: Company/Bureau Designation has been changed to "Company or Bureau Filing Number". 3) Page 2: Items 6 and 7 under Rate Filing Requirements are corrected to refer to #5 not #3. 4) Page 2: Item 6 under Rate Filing Requirements is corrected to read -- (Region = ND, SD, MT, WY, NE, and IA). Attached is the revised form NDPC-100 (8/88) which replaces NDPC-100 (6/88). jmb Attachment # NORTH DAKOTA INSURANCE DEPARTMENT # PROPERTY/CASUALTY DIVISION # FILING TRANSMITTAL FORM Company's Name and Federal I.D. No.: Lines of Insurance: Title of Program: ☐ Form Filing ☐ Rate Filing ☐ Manual/Rule Filing ☐ New ☐ Revision ☐ Withdrawal ☐ Member/Subscriber of Rating Organization ☐ Independent Filing ☐ Reference Filing ☐ Deviation Filing Company or Bureau Filing Number: 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 (8/88) 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 #5 above. (Region = ND, SD, MT, WY, NE, and IA). 7. Statewide loss experience for each of the last 5 years to include same items as #5 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 judgment, 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 and Title: ____________________________________________________ Signature: _________________________________________________________ Telephone Number: _________________________________________________ NDPC-100 (8/88)