Form E-Vaucaa - Ucaa - Variable Annuity Authority Requirements & Checklist printable pdf download

Department of Insurance

State of Arizona

Financial Affairs Division

2910 NORTH 44TH STREET, SUITE 210

Phoenix, Arizona 85018-7256

Telephone: (602) 912-8420 Telecopier: (602) 912-8421

UCAA - VARIABLE ANNUITY AUTHORITY REQUIREMENTS & CHECKLIST

This Checklist must be used to supplement a Uniform Certificate of Authority Application requesting authority to

transact the business of variable annuities. Index this information in the UCAA submission under a separate tab

with numbered dividers corresponding to the Item numbers. All certifications pertaining to this application must be

of recent date [within ninety (90) days prior to filing application]

The Preparer of this supplemental application must initial, or enter “N/A” if an item is Not

Applicable, on the line left of each item. This Checklist must be signed, dated and included as

the first page of the Variable Annuity Authority supplement section in a UCAA filing.

REQUIREMENTS: NOTE - USE FORM E-AFF.COAGEN FOR ALL AFFIDAVITS

1. Provide a listing of variable annuity contracts to be offered in this state [which are exempt from filing

pursuant to A.R.S. § 20-1110 and A.A.C. R20-6-218(C)], and an affidavit, executed by the President and

Secretary, which avows that such contracts comply with the requirements of A.R.S. § 20-2635 and § 20-

2636.

2. Provide an affidavit, executed by the President and Secretary, which avows that all advertising matter or

sales material for use in the sale or the presentation for sale of any variable annuity contract in this state

will be filed with the Life and Health Division of the Arizona Department of Insurance as required by

A.R.S. § 20-1110(E) and A.A.C. R20-6-707(D)(11).

THE FOLLOWING ITEM IS APPLICABLE TO FOREIGN INSURERS ONLY:

3. If the laws of a foreign company’s domiciliary state provide a degree of protection to the policyholders

and the public that is substantially similar to the degree of protection that is provided by A.R.S Title 20,

Chapter 16, Article 2, the Director may determine that the foreign company has complied with this Article

(A.R.S. § 20-2638). Your domiciliary state’s adoption of the NAIC Variable Annuity Model Regulation

(adopted 1975 and amended and reprinted 1980) may be deemed substantially similar.

If applicable, provide an affidavit, executed by the President and Secretary, which avows that the insurer

qualifies with A.R.S. § 20-2638 and attach a copy of the statutes and rules of the insurer’s state of

domicile under which the insurer is authorized to issue variable annuity contracts.

ARIZONA DOMESTIC INSURERS AND ALL APPLICANTS THAT DO NOT QUALIFY UNDER A.R.S. § 20-

2638 MUST ALSO FILE THE FOLLOWING ITEMS

4. A.R.S. § 20-2632 Qualifications to issue variable annuities.

I. A general description of the kinds of variable annuities the insurer intends to issue.

II. A copy of the statutes and rules of the insurer’s state of domicile under which the insurer is

authorized to issue variable annuities.

5. An affidavit executed by the President and Secretary, which avows that the insurer shall establish one or

more Separate Accounts for variable annuities in compliance with A.R.S. §§§§ 20-2633, 20-651, 20-515

and 20-536.01.

6. An affidavit executed by the President and Secretary, which avows that the insurer’s financial condition

or method of operation in connection with the issuance of variable annuity contracts will not be

hazardous to the public or its policyholders in this state.

Preparer’s Name___________________________ Signature and Date________________________________

Form E-VAUCAA (06/00)

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Form E-Vaucaa - Ucaa - Variable Annuity Authority Requirements & Checklist

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