Section 760 IAC 1-15.1-3 - Forms; general requirementsAuthority: IC 27-1-3-7
Affected: IC 27-1-23
Sec. 3.
(a) A person required to file or amend a statement regarding a proposed acquisition of control under IC 27-1-23-2 shall furnish the required information on Form A as provided in section 4 of this rule.(b) An insurer required to file or amend a registration statement under IC 27-1-23-3 shall furnish the required information on Form B as provided in section 5 of this rule.(c) An insurer required to file an annual registration statement under IC 27-1-23-3 is also required to furnish the information required on Form C as provided in section 6 of this rule and shall file a Form C with the commissioner.(d) An insurer required to give notice of a proposed transaction under IC 27-1-23-4 shall furnish the required information on Form D as provided in section 7 of this rule.(e) If: (1) a domestic insurer, including any person controlling a domestic insurer, is proposing a merger or acquisition under IC 27-1-23-2.5; or(2) a nondomiciliary insurer licensed to do business in this state is proposing a merger or acquisition; that person shall file a preacquisition notification form, Form E. No preacquisition notification form need be filed if the acquisition is beyond the scope of IC 27-1-23-2.5(c). In addition to the information required by Form E, the commissioner may require an expert opinion as to the competitive impact of the proposed acquisition.(f) Forms A through F are intended to be guides in the preparation of the statements required by IC 27-1-23-2 through IC 27-1-23-4. They are not intended to be blank forms that are to be filled in.(g) The statements filed shall contain the numbers and captions of all items, but the text of the items may be omitted provided the answers thereto are prepared in such a manner as to indicate clearly the scope and the coverage of the items.(h) All instructions, whether appearing under the items of the forms or elsewhere, are to be omitted. Unless expressly provided otherwise, if any item is inapplicable or the answer thereto is in the negative, an appropriate statement to that effect shall be made.(i) Three (3) complete copies of each statement, including exhibits and all other papers and documents filed as part thereof, shall be filed with the commissioner by personal delivery or mail addressed to: Insurance Commissioner
Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204
At least one (1) of the copies shall be signed in the manner prescribed on the form. Unsigned copies shall be conformed. If the signature of any person is affixed pursuant to a power of attorney or other similar authority, a copy of the power of attorney or other authority shall also be filed with the statement.
(j) Statements should be prepared on paper eight and one-half (8 1/2) inches by eleven (11) inches in size and preferably bound at the top left hand corner. Exhibits and financial statements, unless specifically prepared for the filing, may be submitted in their original size.(k) If a hearing is requested on a consolidated basis, in addition to filing the Form A with the commissioner, the acquiring person shall file a copy of Form A with the NAIC in electronic form.(l) All copies of any statement, financial statement, or exhibit shall be clear, easily readable, and suitable for review and reproduction. Debits in credit categories and credits in debit categories shall be designated so as to be clearly distinguishable as such on photocopies.(m) Statements, attached exhibits, and all other documents filed with the commissioner shall be in the English language, and monetary values shall be stated in United States currency. If any exhibit or other paper or document filed with the statement is in a foreign language, it shall be accompanied by a translation into the English language and any monetary value shown in a foreign currency normally shall be converted into United States currency. Department of Insurance; 760 IAC 1-15.1-3; filed Oct 18, 1994, 3:55 p.m.: 18 IR 517; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; readopted filed Nov 27, 2007, 4:01 p.m.: 20071226-IR-760070717RFA; readopted filed Nov 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFA; filed Dec 18, 2013, 11:11 a.m.: 20140115-IR-760130007FRAReadopted filed 11/19/2019, 9:18 a.m.: 20191218-IR-760190497RFA