California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 2 - Policy Forms and Other Documents
Article 6.9 - Standard Credit Life and Credit Disability Policy Forms
Section 2249.10 - Schedule Blocks
Universal Citation: 10 CA Code of Regs 2249.10
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
| MH1 | ||
|
Insurers Name and Complete Address Called We or Us |
||
|
SCHEDULE |
||
| SC1 | Primary Borrower, called you, and Address | |
| SC2 | Co-Borrower, also called you | |
| SC3 | Policy Number | |
| SC4 | Source Code | |
| SC5 | Creditor Beneficiary and Insurance Agent's License No. | |
| SC6 | Class of Business | |
| SC7 | Secondary Beneficiary | |
| SC8 | Term of Insurance | |
| SC9 | Effective Date | |
| SC10 | Original Amount of Life Insurance | |
| SC11 | Scheduled Expiration Date | |
| SC12 | Monthly Loan Payment | |
| SC13 | Monthly Total Disability Benefit | |
| SC14 | Decreasing Life: Single () joint () Premium: | |
| SC15 | Disability: 30-day Elimination Period Premium: | |
| SC16 | Total Premium:SC17 Maximum Monthly Disability Benefit: | |
| SC18 | Maximum Amount of Life Insurance: | |
| SC19 | Decreasing Single Life Premium: | |
| SC20 | Number of Monthly Installments | |
| SC21 | First Installment Due Date | |
| SC22 | Final Installment Due Date | |
| SC23 | Amount of Level Life Insurance: | |
| SC24 | Level Life: Single () joint () Premium: | |
| SC25 | Level Life Single Premium; | |
| SC26 | Group Policy Number | |
| SC27 | Certificate Number | |
| SC28 | Date of Issue of this Certificate | |
| SC29 | Credit Insurance Applied for: ___ Single Life___Joint Life ___30 Day Elimination Disability | |
| SC30 | Monthly Premium per $100 of insured debt: Single Life $___ Joint Life $___ Disability $___ | |
| SC31 | Credit Insurance Applied for:___Single Life ___Joint Life | |
| SC32 | Monthly Premium per $100 of insured debt: Single Life $___Joint Life $___ | |
| SC33 | Credit Insurance Applied for:___Single Life___30 Day Elimination Disability | |
| SC34 | Monthly Premium per $100 of insured debt: Single Life $___Disability $___ | |
| SC35 | Monthly Life Insurance Premium per $100 of insured debt: $___ | |
| SC36 | Monthly Disability Premium per $100 of insured debt $___ | |
| SC37 | Maximum Disability Benefit Period | |
| SC 38 | Disability, 30-day Elimination Period: Single () Joint () Premium: | |
| SC 39 | Credit Insurance Applied for: Life: Single () Joint (); 30 Day Elimination Disability: Single () Joint () | |
| SC 40 | Monthly Premium per $100 of insured debt: Life: Single $___, Joint $___ ; Disability: Single $___, Joint $___ | |
1. Amendment
filed 7-25-83; effective thirtieth day thereafter (Register 83, No.
31).
2. Amendment of section and NOTE filed 10-2-2006; operative
11-1-2006 (Register 2006, No. 40).
Note: Authority cited: Sections 779.21 and 779.27, Insurance Code. Reference: Sections 779.4, 779.6 and 1758.99, Insurance Code.
Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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