Connecticut Administrative Code
Title 38a - Insurance Department
138 - Insurance Holding Company Act
Section 38a-138-1 - Forms - general requirements

(a) Sections 38a-138-1 to 38a-138-16, inclusive, and the forms prescribed in the Appendixes A, B, C, D, E and F of sections 38a-138-1 to 38a-138-16, inclusive, of the Regulations of Connecticut State Agencies are intended to implement the provisions of the Connecticut Insurance Holding Company System Regulatory Act, sections 38a-129 to 38a-140, inclusive, of the Connecticut General Statutes. Appendix A of sections 38a-138-1 to 38a-138-16, inclusive, of the Regulations of Connecticut State Agencies contains "Form A" (Statement Regarding the Acquisition of Control of or Merger With a Domestic Insurer); Appendix B of sections 38a-138-1 to 38a-138-16, inclusive, of the Regulations of Connecticut State Agencies contains "Form B" (Insurance Holding Company System Annual Registration Statement); Appendix C of sections 38a-138-1 to 38a-138-16, inclusive, of the Regulations of Connecticut State Agencies contains "Form C" (Summary of Changes to Registration Statement); Appendix D of sections 38a-138-1 to 38a-138-16, inclusive, of the Regulations of Connecticut State Agencies contains "Form D" (Prior Notice of a Transaction) and "Form D-1" (Prior Notice Of Dividends On Common Stock And Other Distributions); Appendix E of sections 38a 138-1 to 38a-138-16, inclusive, of the Regulations of Connecticut State Agencies contains "Form E" (Pre-Acquisition Notification Form Regarding Potential Competitive Impact Of A Proposed Merger Or Acquisition By A Non-Domiciliary Insurer Doing Business In This State Or By A Domestic Insurer); and Appendix F of sections 38a-138-1 to 38a-138-16, inclusive, of the Regulations of Connecticut State Agencies contains "Form F" (Enterprise Risk Report). These forms are intended to be guides in the preparation of the statements required by sections 38a-130, 38a-135, and 38a-136 of the Connecticut General Statutes; they are not intended to be blank forms which are to be filled in. Each form, when filed, shall contain the numbers and captions of all items, but the text of the items may be omitted provided the answers thereto are prepared in such a manner as to indicate clearly the scope and coverage of the items. All instructions, whether appearing under the items of the form or elsewhere therein, are to be omitted. Unless expressly provided otherwise, if any item is inapplicable or the answer thereto is in the negative, an appropriate statement to that effect shall be made.

(b)

(c) If an applicant requests a hearing on a consolidated basis under section 38a-132(b)(3) of the Connecticut General Statutes, the applicant shall follow all of the Form A and E filing procedures in subsection (b) of this section, and shall file a copy of the Form A with the National Association of Insurance Commissioners (NAIC) in electronic form.

(d) All electronic submissions of any Form, statement, financial statements, or exhibits shall be clear, easily readable, and of suitable quality for printing . Debits in credit categories and credits in debit categories shall be designated so as to be clearly distinguishable as such on submissions. Forms and statements shall be made in the English language and monetary values shall be stated in United States currency. If any exhibit or other document filed with the statement is in a foreign language, it shall be accompanied by a certified translation into the English language and any monetary value shown in a foreign currency normally shall be converted into United States currency.