Form Ecoasummary - Certificate Of Authority Applicant Summary - Department Of Insurance Of State Of Arizona

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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
CERTIFICATE OF AUTHORITY APPLICANT SUMMARY
APPLICANT NAME
DOM
NAIC
This Applicant Summary is required to accompany an application for an Arizona Certificate of Authority.
Enter the Responses to each item.
ENTER RESPONSE
1.
Length of time (in years) that Applicant has operated under current
management and control
2.
RBC ratio, as reported in the Applicant’s most recently-filed
annual statement
3.
RBC ratio for the first preceding year
4.
RBC ratio for the second preceding year
5.
RBC ratio for the third preceding year
6.
BCAR assigned by A.M. Best
7.
A.M. Best Rating (letter and FSC)
8.
Moody’s rating (if applicable)
9.
Standard & Poor’s rating (if applicable)
10.
Applicant’s auditors
11.
Applicant’s actuaries
12.
Please indicate each line of business requested and length of time
(in years) that each line has been transacted by the Applicant:
13.
Line 1:
14.
Line 2:
15.
Line 3:
16.
Line 4:
17.
Line 5:
18.
Line 6:
TYPED NAME OF PREPARER
DATE PREPARED
SIGNATURE
FORM ECOASummary (06/00)
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