Review Requirements Checklist Form
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1Review Requirements Checklist
Title Insurance, Line 33
Insurer's Name(s): _____________________________
NAIC #(s):___________________________
REFERENCE (See
for
REVIEW REQUIREMENTS
applicable statute.)
COMMENTS
REFERENCE Form/Page/Para*
I. FORMS
Applications
Fraud Must Be Material
A.R.S. §§ 20-1561(B); 20-463(A)
Blank Forms
The ADOI will not approve blank forms. The forms should be completed in "John Doe"
Blank Forms
Unpublished Requirement
fashion to illustrate the type of language that will be placed on the form.
/
/
Filing Requirements
File and Use
A.R.S. § 20-1591
/
/
General Provisions
Required Exclusions
A.R.S. § 20-1591
Illegal Provisions
The form may not reference or refer the policyholder to agents, brokers, managing general
agents or other entities which do not possess an Arizona license and which are required
Non-Licensed Entities
Unpublished Requirement
pursuant to Title 20 to be licensed in this State.
/
/
Void Policy Restrictions
A.R.S. §§ 20-1561(B); 20-1115
/
/
Standards (Forms)
An insurer shall not make or issue a contract or policy except in accordance with the filings
A.R.S. §§ 20-1561(B); 20-107(A),
in effect for the insurer. Forms cannot be deceptive, misleading or ambiguous and shall
Generally
and 20-1591
comply with the applicable provisions of the Arizona Revised Statutes, Title 20.
/
/
Cannot Be Ambiguous, Misleading
A.R.S. §§ 20-1561(B); 20-107(A),
The Department may rely on current Arizona case law when determining whether a clause
Or Deceptive
and 20-1591
is ambiguous, misleading or deceptive.
/
/
Transmittal Form
Paper filings must include a completed Property & Casualty Transmittal Document. The
form may be found at the Department's website: As different
Filing Transmittal Form
Unpublished Requirement
laws apply, forms and rates must be filed separately.
/
/
II. RATES
Filing Requirements
File and Use
A.R.S. §§ 20-376(D); 20-377
/
/
Deviations
A.R.S. § 20-379
/
/
Supporting Data
A.R.S. § 20-377
/
/
Setting Rates
Rating standards
A.R.S. § 20-375(A)
/
/
Consideration
A.R.S. § 20-375(A)
Rating Plan Requirements
No Combined Rate
A.R.S. § 20-375(D)
Classification
A.R.S. § 20-375(B),(C)
CERTIFICATION
I, _____________________________________________, hereby certify that to the best of
my knowledge and belief that each form or rate filing involved in this filing: 1) Conforms to
all applicable requirements outlined above; 2) Contains no provision(s) previously
disapproved or required to be corrected and/or revised by the Arizona Department of
Insurance; and 3) Does not exceed this insurer's powers, the authority granted by its state of
domicile, and its Arizona certificate of authority.
Signature of Officer:_______________________________________________________
Date:__________________________
Page 1
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