Filings of Previously Approved Forms

Department of Business Regulation 1511 Pontiac Avenue Cranston, RI 02920 Insurance Bulletin Number 2005-7 FILINGS OF PREVIOUSLY APPROVED FORMS WHEN A COMPANY CHANGES IT'S NAME OR OFFICERS OR TRANSFERS A BLOCK OF BUSINESS Use this procedure when your company submits forms for approval due to -- • A change in the COMPANY NAME, including cases in which a block of business has been sold or transferred to an affiliate, or • A change in OFFICERS' NAMES AND SIGNATURES. Instead of the usual complete filing and transmittal letter, submit: 1. A letter that states the REASON FOR THE FILING, the NAME and NAIC NUMBER of the company that appears on the previously approved forms, the NAME and NAIC NUMBER of the company that will be issuing the new forms and a list of all forms for which approval is requested, giving the form number, the brief description and the date of approval in RI of each form. 2. A statement that the forms have been reviewed and that they comply with all applicable RI laws and regulations now in effect, signed by a company representative authorized to prepare form filings. 3. One complete sample of one of the forms on the list, prepared in a proper manner for filing as if it were a new form that had not been approved in RI. The department, after examining the letter, may require filing of one or more of the listed forms. Joseph Torti III Associate Director and Superintendent of Insurance August 23, 2005