054.00.94 Appendix C. Issuer Certification Form.
AR ADC 054.00.94 Appendix CArkansas Administrative Code
Ark. Admin. Code 054.00.94 Appendix C
054.00.94 Appendix C. Issuer Certification Form.
ISSUER CERTIFICATION FORM
(relating to Qualified State Long-Term Care Insurance Partnership)
In order to provide the Insurance Commissioner with information necessary to provide a certification for policies, this Issuer Certification Form requires information and a certification from issuers of long-term care insurance policies with respect to policy forms that may be covered under the Qualified Partnership of the State.
An insurance company may request certification of policies from time to time and, accordingly, may supplement this issuer certification form, e.g., as it introduces new long-term care insurance policy forms for issuance.
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Specimen copies of each of the above policy forms, including any riders and endorsements, shall be provided upon request.
B. I hereby certify to the best of my knowledge and belief that all producers who sell, solicit or negotiate long-term care insurance products on {insert issuer name's} behalf have received the training required for Partnership policies and that they demonstrate an understanding of the policies and their relationship to public and private long-term care coverage.
____________________ | ______________________________ |
Date | Name and title of officer of the Issuer |
______________________________ | |
Signature of officer of the Issuer |
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.94 Appendix C, AR ADC 054.00.94 Appendix C
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