N.J. Admin. Code § Tit. 11, ch. 2, subch. 36, app E

Current through Register Vol. 56, No. 24, December 18, 2024

Appendix E

POLICY FORM CERTIFICATION

I ................................, hereby certify that

(Name)

I am the .................................., an officer

(Title)

of .............................., and am authorized to

(Name of insurer)

execute this certified statement on behalf of the insurer.

I further certify that the policy form(s) and rating system issued to

.......................... has been filed with

(Purchasing Group)

the New Jersey Department of Banking and Insurance, if required by law, and are otherwise in compliance with N.J.S.A. 17:29AA-1 et seq., N.J.A.C. 11:13-1, and N.J.S.A. 17:22-6.43.

I further certify that I am aware that the New Jersey Department of Banking and Insurance will rely on this certification in connection with the registration of the above referenced Purchasing Group.

.....................................................................

(Signature)

.....................................................................

(Date)

N.J. Admin. Code Tit. 11, ch. 2, subch. 36, app E

New Rule, R.2001 d.6, effective 1/2/2001.
See: 32 New Jersey Register 3530(a), 33 New Jersey Register 85(a).