054.00.12 Exhibit B. NOTARIZED CREDIT INSURANCE AFFIDAVIT
AR ADC 054.00.12 Exhibit BArkansas Administrative Code
Ark. Admin. Code 054.00.12 Exhibit B
054.00.12 Exhibit B. NOTARIZED CREDIT INSURANCE AFFIDAVIT
(To be filed with the State Insurance Commissioner, State of Arkansas, on or before January 1, 1988, and on the same date of each year thereafter.)
AFFIANT, __________, President/Vice President hereby declares upon oath on behalf of __________ that for the year ending __________ this insurance company, or anyone representing this company has not paid, or agreed to pay, any compensation in excess of reasonable compensation as defined in Rule & Regulation 12 of the Arkansas Insurance Department to recipients as defined therein.
The presumed reasonable compensation of forty percent (40%) of the net written life insurance premiums and of the net written disability insurance premiums allowed to be paid to defined recipients is further defined as follows:
“Compensation” shall include, but not be limited to, the receipt directly or indirectly or reciprocally of commissions, service fees, policy fees, expense allowances or reimbursements, dividends or other distribution of earnings based solely upon the profits derived from issuing or reinsuring any policy of credit life or credit disability insurance procured, issued, or delivered by such creditor, agent or limited insurance representative, gifts, all benefits insurance procured, issued, or delivered by such creditor, agent or limited insurance representative, gifts, all benefits such as items of merchandise, equipment, travel, conventions, vacations, rewards, bonuses, trading stamps, scripts, or any other form of remuneration resulting directly or indirectly from the sale of credit insurance or as an inducement to or payment for sales made or volume of sales obtained. Experience refunds, retrospective rate credits, and dividends are treated as compensation for the sole purpose of determining presumptively reasonable compensation allowances under this section. Compensation shall also include any amounts or things of value received from or paid by any person other than an insurer in consideration of the sale or retention of credit insurance.
__________
President/Vice President
ACKNOWLEDGEMENT
STATE OF __________ | ) |
SS | |
County of __________ | ) |
Subscribed and sworn before me this __________ day of __________, 19 ___.
__________
(Notary Public)
My Commission Expires: __________
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.12 Exhibit B, AR ADC 054.00.12 Exhibit B
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