Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 07 - INSURANCE RATING LAW
Chapter 31.07.03 - Review of Automobile Rating Territories
Section 31.07.03.04 - Certification Statement for Automobile Insurers
Current through Register Vol. 51, No. 19, September 20, 2024
A. Certification Statement for Insurers and Rating Organizations.
CERTIFICATION STATEMENT REVIEW OF AUTOMOBILE RATING TERRITORIES
I, ____________________, a duly authorized representative of _______________________ (insurer or rating organization), NAIC # ______ (if applicable), do hereby certify that the following information is true to the best of my knowledge and belief.
________________ _______________________________________ Date Signature of Authorized Representative
Name of Authorized Representative: ____________________________________________________________________________
Title: ______________________________
Address of Insurer: _________________________________________________________
Mail certification statement to: P & C Rate and Form Unit, Maryland Insurance Administration, 200 St. Paul Place, Baltimore, MD 21202.
B. Certification Statement for Insurers Adopting the Certification Statement of a Rating Organization.
CERTIFICATION STATEMENT REVIEW OF AUTOMOBILE RATING TERRITORIES
I, ______________, a duly authorized representative of __________ insurer), NAIC # _____, do hereby certify that the following information is true to the best of my knowledge and belief.
I understand that the Maryland Insurance Administration will rely on this certification, and if it is determined that this certification is materially false or incorrect, the insurer may be subject to administrative action, including appropriate penalties.
______________ ______________________________________ Date Signature of Authorized Representative
Name of Authorized Representative: ____________________________________
Title: _____________________________
Address of Insurer: ____________________
Mail certification statement to: P&C Rate and Form Unit, Maryland Insurance Administration, 200 St. Paul Place, Baltimore, MD 21202.