Current
through Register Vol. 56, No. 6, March 18, 2024
(a) Applications shall be filed with the
Commissioner within 20 work days after the insured has signed it or within 20
work days of the inception date of the policy, whichever is earlier. All
applications shall be made by filing the appropriate application form included
in the Appendix to this subchapter as Exhibits A, B, and C, incorporated herein
by reference. The application forms are also available on the Department's
website at www.dobi.nj.gov. Applications
shall be sent to the Department through the use of the NAIC electronic filing
system SERFF (System for Electronic Rate and Form Filing).
(b) Each application shall include the
following information:
1. Name and address of
company, and signature by authorized company representative;
2. Name, address, New Jersey license number
and signature of producer;
3. Name
and address of insured;
4.
Effective date and expiration date of policy;
5. Policy number, if available;
6. Coverages applied for, including, but not
limited to, limits, amounts of insurance and deductibles;
7. Exposure identification class, territory,
description and use of automobile;
8. Premiums:
i. The premium developed by the rating system
approved for the company for the coverages applied for, identified as "Normal
Premium";
ii. The additional
premium to be charged in consideration of the additional hazard, identified as
"Additional Premium";
iii. The
total of the two amounts identified as "Premium Payable".
9. Underwriting information in support of the
additional premium under (b)8ii above. In the case of automobile insurance,
liability and physical damage, a copy of the abstract of driving record from
the Motor Vehicle Commission shall be submitted. Such abstract is not required
if the coverage applied for is excess coverage over the coverages and limits
available under any residual market mechanism providing automobile insurance
pursuant to statute. In the case of fire insurance, an inspection report, based
upon an inspection performed by a qualified person, shall be submitted.
10. The application shall be
signed by the insured and contain the following statement:
"I consent to the premium shown as 'Premium Payable' on this
application which is higher than would normally apply because of the greater
hazard involved."
11. The
application shall contain the following statement signed by the producer of
record or by an officer of the company providing the coverage:
"Under penalty of
17:29A-16 and
17:29A-22, I declare that this
application was fully completed as shown, before being signed by the
applicant."
