Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) The following forms
shall be used pursuant to this article:
(1)
Certificate of Compliance:
VARIABLE CONTRACT CERTIFICATE OF COMPLIANCE
Name of Applicant Company:
Address:
Date:
Person to Whom Correspondence Should Be Addressed:
(Directions: This Certificate may be utilized in lieu of
applicant seeking a prior approval of its changes in its variable contract
operation; such an approval being based upon a full review by the Department. This
Certificate must be executed by an executive officer of the applicant, who has
responsibility for applicant's variable contract operation. Please answer each
question in the accompanying Forms completely. If more room is needed, attach a
sheet of paper indicating the question being responded to.)
TO THE INSURANCE COMMISSIONER OF THE STATE OF
CALIFORNIA
I, [____________________], a duly appointed executive officer of
the Applicant Company, having responsibility for its variable contract operation, do
state, under oath, that I have carefully read this Certification and the attached
Forms, and that the information and answers to questions herein is true to the best
of my own knowledge, except as to those specifically stated to be upon information
and belief, and as to those I believe the answers to be true.
Further I state that the variable contract changes described
herein comply with pertinent statutes, regulations, and bulletins, and have been
reviewed by me, or that I have been advised by competent legal counsel, representing
the company, that the changes are in full compliance with the California Insurance
Code, Regulations, Bulletins, and underlying guidelines. In particular, I state that
this filing complies with Title 10 California Code of Regulations sections
2534.40-2534.46.
All material changes occurring since my company's most recent
amendment of its variable contract qualification, (and the approval or
acknowledgment by the Department of that amendment), are explained and described
herein, or in accompanying materials and documentation. The information given here
does not relate to any changes previously submitted to the Department and
disapproved by the Department, unless corrective action has been taken by my company
to meet the objections previously stated by the Department to those changes.
I understand and acknowledge that false statements which are
intended to mislead or deceive the Commissioner, or the willful omission of any
material fact with the same intent, may be punishable under such sections of the
Insurance Code as may be applicable.
WITNESS MY SIGNATURE this [__________] day of [__________],
[___], at [__________].
| Signature | ___________________________[___________ | ] |
|
|
| (Affiant) |
|
|
|
| ___________________________[___________ | ] |
| | (Printed or typed name and
title) | |
SUBSCRIBED AND SWORN TO before me on the date and year above
written.
[________________________________________]
(Notary Public in and for said County and State)
My commission expires [_______________]
(2) New Matters Form:
DESCRIPTION OF NEW MATTERS FORM
1.
Background Information:
a. Applicant's name:
b. Applicant's state of domicile:
c. Date of applicant's California Certificate of
Authority:
d. Date of applicant's
original qualification for California Variable Authority:
e. Date and type of applicant's last amendment to
its California Variable Authority:
f.
What variable products is the applicant currently offering in California?
g. Has the applicant ever been subject to a
regulatory disciplinary action, at either a state or federal level, for actions
arising out of its variable annuity or variable life business? If yes, identify each
action:
2. What amendments to
the applicant's current variable qualification are being requested in this
application? (Be sure to include a new product form, new fund form, new
subaccount/portfolio form and/or other material changes form for each applicable
amendment).
a. New Product:
b. New Fund:
c. New Subaccount/Portfolio:
d. Other Material Changes:
3. Has the applicant included an original
certificate of compliance?
4. Please
identify the type(s) of investments presented in this application (for example):
a. Mutual Fund (2534.42 (b)(1))
b. ERISA or Other Plan (2534.42.(b)(2))
c. California Insurance Code Section
10506.3 Product
(2534.42(b)(3))
d. Issued to a trust
under California Insurance Code Section
10541
(2534.42(b)(4)
e. Private Placement
(2534.42(b)(5))?
5. If the
amendments set forth in the application require a filing with the Securities and
Exchange Commission, the application must include an effective prospectus and
statement of additional information. Applications for amended variable
qualification will not be accepted for filing until an effective prospectus has been
submitted.
6. If the amendments
set forth in the application do not require a filing with the Securities and
Exchange Commission, the application must include a private placement memorandum or
comparable disclosure documentation available to purchasers of the product(s).
Applications for amended variable qualification will not be accepted for
filing until disclosure documents have been submitted
(3) New Product Form
NEW PRODUCT FORM
1.
PRODUCT NAME: What is the name of
the New Product?
2.
PRODUCT
DESCRIPTION: Provide a brief description of the New Product.
3.
POLICY FORM: Attach a specimen
copy of the New Product policy form.
4.
MARKETING: How will this new product be marketed? Who will be the
target market for this new product? Attach copies of any advertising or marketing
information that will be distributed to the applicant's marketing agents and/or
sales force.
5.
DISTRIBUTION: How will the New Product be distributed? Will a third
party handle distribution? If yes, attach a copy of the distribution
agreement.
6.
ADMINISTRATION: Will the administration of this New Product be
delegated to a third party? If yes, attach a copy of the administration agreement.
Administration of a life or annuity product by a third party will require a third
party administrator's license (California Insurance Code Section
1759).
7.
SALES COMMISSION: What is the
sales commission on this New Product?
8.
SURRENDER CHARGE: What is the surrender charge on the New
Product?
9.
CONTRACT FEE:
What is the annual contract fee on this New Product?
10.
MORTALITY AND EXPENSE RISK
CHARGES: What are the mortality and expense risk charges on this New
Product?
11.
PRODUCT PROSPECTUS
AND STATEMENT OF ADDITIONAL INFORMATION: Does this new product require the
filing of a prospectus with the Securities and Exchange Commission? If yes, attach a
copy of the product prospectus and statement of additional information. (All
insurers must provide an effective product prospectus and statement of additional
information before an application to amend their variable qualification will be
accepted for filing).
12.
PLAN
DOCUMENTS: If this New Product is not subject to filing with the Securities
and Exchange Commission, attach a copy of the Plan Documents or other documentation
which provides information about the new product.
(4) New Fund Form:
NEW FUND FORM
1.
FUND NAME: What is the name of the
New Fund?
2.
INVESTMENT
ADVISOR: Who is the investment advisor for the new fund? Attach a copy of the
investment advisory agreement.
3.
DISTRIBUTOR: Who is the distributor (broker/dealer) for the New
Fund?
4.
USE OF FUND(S) BY OTHER
INSURANCE COMPANIES: Has this New Fund ever been qualified for use in
California as an investment for variable products? If yes, please provide the names
of the insurance companies you know are qualified to offer this fund.
5.
DISCIPLINARY ACTIONS: Has this New
Fund, its investment advisor or its broker-dealer been subject to any disciplinary
action by the Securities and Exchange Commission, the California Department of
Corporations or any other State securities regulator, the National Association of
Securities Dealers or any other self-regulatory organizations, or the Commodities
Futures Trading Commission within the past ten years? If yes, attach a copy of each
action.
6.
FUND PROSPECTUS AND
STATEMENT OF ADDITIONAL INFORMATION: Does this New Fund require a filing with
the Securities and Exchange Commission? If yes, attach a copy of the effective fund
prospectus and statement of additional information. The fund prospectus and
statement of additional information must be effective before the application for
amended variable qualification will be accepted for filing.
7.
PLAN DOCUMENTS: If the New Fund is
not subject to filing with the Securities and Exchange Commission, attach a copy of
the Plan Documents or other documentation which provides information about the New
Fund.
(5) New Subaccount Form:
NEW SUBACCOUNT FORM
1.
SUBACCOUNT NAME: What is the name
of the New Subaccount?
2.
INVESTMENT OBJECTIVE: What is the principal investment objective of the
New Subaccount?
3.
SUBACCOUNT
MANAGER: Who is the Subaccount manager for the New Subaccount?
4.
FEES: Are any fees charged by the
New Subaccount? If yes, identify each charge.
5.
DISCIPLINARY ACTIONS: Has the New
Subaccount or its portfolio manager been subject to any disciplinary action by the
Securities and Exchange Commission, the California Department of Corporations or any
other State securities regulator, the National Association of Securities Dealers or
any other self-regulatory organizations, or the Commodities Futures Trading
Commission within the past ten years? If yes, attach a copy of the action.
6.
PROSPECTUS AND STATEMENT OF ADDITIONAL
INFORMATION: Does the New Subaccount require a filing with the Securities and
Exchange Commission? If yes, attach a copy of the effective product and/or fund
prospectus and statement of additional information relating to the addition of this
New Subaccount. The product and/or fund prospectus must be effective before the
application for amended variable qualification will be accepted for
filing.
7.
PLAN DOCUMENTS OR OTHER
INFORMATIONAL MATERIAL: If the New Subaccount is not subject to Securities
and Exchange Commission filing, attach a copy of the Plan Documents or other
informational material which provides information about the
subaccount/portfolio.
(6)
Other Material Changes Form:
OTHER MATERIAL CHANGES
1.
OTHER MATERIAL CHANGES: Identify
any material changes to the applicant's current variable qualification.
(Examples of material changes are as follows:
1) change of custodian;
2) change of administrator;
3) change of broker/dealer;
4) change of investment advisor;
5) change of portfolio manager;
6) change in fund or portfolio name;
7) change in fund or portfolio investment
objective;
8) disciplinary action taken
by the Securities and Exchange Commission, the California Department of Corporations
or any other State securities regulator, the National Association of Securities
Dealers or any other self-regulatory organizations, or the Commodities Futures
Trading Commission against fund, investment advisor, portfolio manager or
broker/dealer;
9) regulatory action
against the insurer arising out of its variable annuity or variable life
business;
10) amendments to:
a) the Board of Directors resolutions,
b) the agreement establishing the separate
account,
c) the variable contract,
or
d) registration statement or
prospectus; and 11) any substantial change in management of the Separate
Account).
2.
PROSPECTUS AND STATEMENT OF ADDITIONAL INFORMATION: If filing with the
Securities and Exchange Commission is required for any of the changes listed above,
attach a copy of the effective prospectus and statement of additional information
which reflects these changes.
3.
PLAN DOCUMENTS: If filing with the Securities and Exchange Commission
for any of the changes identified above is not required, attach a copy of the Plan
Documents or other documentation which provides information about these
changes.
1. New section
filed 12-13-2006; operative 1-12-2007 (Register 2006, No.
50).
Note: Authority cited: Section
10506(h),
Insurance Code. Reference: Section
10506(h),
Insurance Code.
