Revision of Bulletin Issued November 27-2002 - clean

State of New Hampshire Insurance Department

56 Old Suncook Road

Concord, New Hampshire 03301

Paula T. Rogers

Commissioner

BULLETIN

INS NO. 02-027-AB

REVISED

TO:

ALL PROPERTY & CASUALTY INSURERS WRITING

COMMERCIAL LINES INSURANCE PRODUCTS

ALL INSURERS ON THE NAIC QUARTERLY

LISTING OF ALIEN INSURERS

RE:

VOLUNTARY EXPEDITED FILING PROCEDURES FOR

COMPLIANCE WITH THE PROVISIONS OF THE

TERRORISM RISK INSURANCE ACT OF 2002

FROM:

Paula T. Rogers

Insurance Commissioner

DATE:

January 30, 2003

Supercedes November 27, 2002 Version

Background

There has been much uncertainty in the markets for commercial lines property and casualty insurance

coverage in light of the substantial losses experienced by the industry on September 11, 2001. Soon after

the tragic events, many reinsurers announced that they did not intend to provide coverage for acts of

terrorism in future reinsurance contracts. This led to a concerted effort on behalf of all interested parties

to seek a temporary federal backstop to calm market fears over future terrorist attacks and the ability of

the insurance industry to allocate capital to provide coverage for these unpredictable and potentially

catastrophic events. Congress recently enacted and the President has signed into law, the Terrorism Risk

Insurance Act of 2002 (The Act). This federal law provides a federal backstop for defined acts of

terrorism and imposes certain obligations on insurers.

The intent of this bulletin is to advise you of certain provisions of the Act that may require insurers to

submit a filing in this state and to inform you regarding a voluntary procedure for insurers to use to

expedite the filing and timely review of the disclosure notices, policy language and the applicable rates

that are discussed in the Act.

Section 102(6) of the Act defines “insurers” for purposes of the Act

bulletin is to advise you of certain provisions of the Act that may require insurers to

submit a filing in this state and to inform you regarding a voluntary procedure for insurers to use to

expedite the filing and timely review of the disclosure notices, policy language and the applicable rates

that are discussed in the Act.

Section 102(6) of the Act defines “insurers” for purposes of the Act. “Insurer” means any entity and

affiliate thereof--(A) that is--(i) licensed or admitted to engage in the business of providing primary or

excess insurance in any State; (ii) an eligible surplus line carrier listed on the Quarterly Listing of Alien

BULLETIN: Terrorism Risk Insurance Act of 2002

Page Two

January 30, 2003

Insurers of the NAIC, or any successor thereto; (iii) approved for the purpose of offering property and

casualty insurance by a Federal agency in connection with maritime, energy, or aviation activity; (iv) a

State residual market insurance entity or State workers’ compensation fund; (B) that receives direct

earned premium for any type of commercial property and casualty insurance coverage. The Secretary of

Treasury may extend the Act to other classes or types of captive insurers and other self-insured

arrangements by municipalities and other entities as well as to group life insurance.

Section 102(12) of the Act states the term “property and casualty insurance” (A) means commercial

lines of property and casualty insurance, including excess insurance, workers' compensation insurance,

and surety insurance, and (B) does not include crop or livestock insurance, private mortgage or title

insurance, financial guaranty insurance issued by monoline financial guaranty insurance corporations,

medical malpractice, health or life insurance including group life, flood insurance provided under the

National Flood Insurance Act, or reinsurance or retrocessional reinsurance

ion insurance,

and surety insurance, and (B) does not include crop or livestock insurance, private mortgage or title

insurance, financial guaranty insurance issued by monoline financial guaranty insurance corporations,

medical malpractice, health or life insurance including group life, flood insurance provided under the

National Flood Insurance Act, or reinsurance or retrocessional reinsurance.

All insurers, as defined in the Act, are required by the Act to participate in the Terrorism Insurance

Program (the Program) and make available coverage for insured losses in all of their covered

commercial lines policies. The term “insured loss” means any loss resulting from an act of terrorism

(including an act of war, in the case of workers’ compensation) that is covered by primary or excess

property and casualty insurance issued by an insurer if such loss—(i) occurs within the United States; or

(ii) occurs in an air carrier (as described in section 40102 of title 49, United States Code), to a United

States flag vessel (or a vessel based principally in the United States, on which United States income tax

is paid and whose insurance coverage is subject to regulation in the United States), regardless of where

the loss occurs, or at the premises of a United States mission. The Act also advises that insured loss

excludes amounts awarded in a civil action that are attributable to punitive damages. The Act further

requires insurers to make available property and casualty insurance coverage for insured losses that do

not differ materially from the terms, amounts, and other coverage limitations applicable to losses arising

from events other than acts of terrorism.

The Act voids any terrorism exclusions in a contract for property and casualty insurance that is in force

on the date of enactment of this Act to the extent that it excludes losses that would otherwise be insured

losses

for insured losses that do

not differ materially from the terms, amounts, and other coverage limitations applicable to losses arising

from events other than acts of terrorism.

The Act voids any terrorism exclusions in a contract for property and casualty insurance that is in force

on the date of enactment of this Act to the extent that it excludes losses that would otherwise be insured

losses. The Act also voids any state approval of any terrorism exclusion from a contract for property or

casualty insurance that is in force on the date of enactment of this Act to the extent that it excludes

losses that would otherwise be insured losses. The Act allows insurers to “reinstate a preexisting

provision in a contract for commercial property and casualty insurance that is in force on the date of

enactment of this Act and that excludes coverage for acts of terrorism only” if one of two conditions are

met:

The insurer must have received a written statement from the insured that affirmatively authorizes

such reinstatement; or,

if the insurer has provided notice to the insured, at least 30 days before any such reinstatement, and

the insured fails to pay any increased premium charged by the insurer for providing such terrorism

coverage.

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January 30, 2003

Definition of Insured Loss

Section 102(5) of the Act provides a definition of insured loss

t 30 days before any such reinstatement, and

the insured fails to pay any increased premium charged by the insurer for providing such terrorism

coverage.

BULLETIN: Terrorism Risk Insurance Act of 2002

Page Three

January 30, 2003

Definition of Insured Loss

Section 102(5) of the Act provides a definition of insured loss. It states, “the term “insured loss” means

any loss resulting from an act of terrorism (including an act of war, in the case of workers’

compensation) that is covered by primary or excess property and casualty insurance issued by an insurer

if such loss—(A) occurs within the United States; or (B) occurs to an air carrier (as defined in section

40102 of title 49, United States Code), to a United States flag vessel (or a vessel based principally in the

United States, on which United States income is paid and whose insurance coverage is subject to

regulation in the United States), regardless of where the loss occurs, or at the premises of any United

States mission.”

As a result of the definition contained in the Act, there are essentially two distinct types of losses that a

business might face that result from terrorism. One type of loss is the insured loss that is defined within

and covered by the provisions of the Act. For convenience, we will adopt the term “certified loss” to

refer to losses resulting from certified acts of terrorism. The second type of loss that a business might

face is one that does not fit within the definition of insured loss as described in the Act. For

convenience, we will adopt the term “non-certified loss” to refer to losses resulting from terrorism that is

not certified. The most significant difference between these losses is that the certified losses will always

involve a foreign person or foreign interest, while the non-certified losses may not

ce is one that does not fit within the definition of insured loss as described in the Act. For

convenience, we will adopt the term “non-certified loss” to refer to losses resulting from terrorism that is

not certified. The most significant difference between these losses is that the certified losses will always

involve a foreign person or foreign interest, while the non-certified losses may not.

Please note that the preemption of this state’s filing law, RSA 412, with respect to contract language,

applies only as described below. If an insurer intends to reinstate an exclusion on in-force policies as

allowed under the Act, it may only reinstate an exclusion that previously existed on the policy.

This state has allowed, and will continue to allow, some significant limitations that provide coverage for

acts of terrorism under certain circumstances. For policies providing property insurance coverage the

following limitations apply to non-certified losses:

Exclusion for acts of terrorism only apply if the acts of terrorism result in industry-wide insured

losses that exceed $25,000,000 for related incidents that occur within a 72 hour period;

Exclusions for acts of terrorism are not subject to limitations above if:

o The act involves the use, release or escape of nuclear materials, or that directly or

indirectly results in nuclear reaction or radiation or radioactive contamination;

o The act is carried out by means of the dispersal or application of pathogenic or poisonous

biological or chemical materials; or

o Pathogenic or poisonous biological or chemical materials are released, and it appears that

one purpose of the terrorism was to release such materials.

For policies providing liability insurance coverage the following limitations apply to non-certified

losses:

Exclusion for acts of terrorism only apply if the acts of terrorism result in industry-wide insured

losses that exceed $25,000,000 for related incidents that occur within a 72 hour period; or

e released, and it appears that

one purpose of the terrorism was to release such materials.

For policies providing liability insurance coverage the following limitations apply to non-certified

losses:

Exclusion for acts of terrorism only apply if the acts of terrorism result in industry-wide insured

losses that exceed $25,000,000 for related incidents that occur within a 72 hour period; or

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January 30, 2003

Fifty or more persons sustain death or serious physical injury for related incidents that occur

within a 72 hour period. For purposes of this provision serious physical injury means:

o

Physical injury that involves a substantial risk of death;

o

Protracted and obvious physical disfigurement; or

o

Protracted loss of or impairment of the function of a bodily member or organ.

Exclusions for acts of terrorism are not subject to limitations above if;

o

The act involves the use, release or escape of nuclear materials, or that directly or

indirectly results in nuclear reaction or radiation or radioactive contamination;

o

The act is carried out by means of the dispersal or application of pathogenic or poisonous

biological or chemical materials; or

o

Pathogenic or poisonous biological or chemical materials are released, and it appears that

one purpose of the terrorism was to release such materials.

Definition of Act of Terrorism

Section 102(1) defines an act of terrorism for purposes of the Act

ontamination;

o

The act is carried out by means of the dispersal or application of pathogenic or poisonous

biological or chemical materials; or

o

Pathogenic or poisonous biological or chemical materials are released, and it appears that

one purpose of the terrorism was to release such materials.

Definition of Act of Terrorism

Section 102(1) defines an act of terrorism for purposes of the Act. Section 102(1)(A) states, “The term

“act of terrorism” means any act that is certified by the Secretary of the Treasury, in concurrence with

the Secretary of State, and the Attorney General of the United States—(i) to be an act of terrorism; (ii) to

be a violent act or an act that is dangerous to—(I) human life: (II) property; or (III) infrastructure; (iii) to

have resulted in damage within the United States, or outside the United States in the case of—(I) an air

carrier or vessel described in paragraph (5)(B); or (II) the premises of a United States mission; and (iv)

to have been committed by an individual or individuals acting on behalf of any foreign person or foreign

interest, as part of an effort to coerce the civilian population of the United States or to influence the

policy or affect the conduct of the United States Government by coercion.” Section 102(1)(B) states,

“No act shall be certified by the Secretary as an act of terrorism if—(i) the act is committed as part of

the course of a war declared by the Congress, except that this clause shall not apply with respect to any

coverage for workers’ compensation; or (ii) property and casualty insurance losses resulting from the

act, in the aggregate, do not exceed $5,000,000.” Section 102(1)(C) and (D) specify that the

determinations are final and not subject to judicial review and that the Secretary of the Treasury cannot

delegate the determination to anyone

xcept that this clause shall not apply with respect to any

coverage for workers’ compensation; or (ii) property and casualty insurance losses resulting from the

act, in the aggregate, do not exceed $5,000,000.” Section 102(1)(C) and (D) specify that the

determinations are final and not subject to judicial review and that the Secretary of the Treasury cannot

delegate the determination to anyone.

This state will not allow exclusions of coverage for acts of terrorism that fail to be certified losses solely

because they fall below the $5,000,000 threshold in Section 102(1)(B) on any policy that provides

coverage for certified losses. Insurers required to file policy forms may submit language containing

coverage limitations for total industrywide certified losses that exceed $100 billion.

The Act includes a definition of acts of terrorism that is used within this bulletin to mean certified

losses. Policies subject to policy form filing requirements should also define what constitutes an act of

terrorism for non-certified losses. For non-certified losses, this state would accept the following

definition, or one that is more liberal to policyholders:

The phrase “non-certified act of terrorism” means a violent act or an act that is dangerous to

human life, property; or infrastructure that is committed by an individual or individuals and that

appears to be part of an effort to coerce a civilian population or to influence the policy or affect

ses, this state would accept the following

definition, or one that is more liberal to policyholders:

The phrase “non-certified act of terrorism” means a violent act or an act that is dangerous to

human life, property; or infrastructure that is committed by an individual or individuals and that

appears to be part of an effort to coerce a civilian population or to influence the policy or affect

BULLETIN: Terrorism Risk Insurance Act of 2002

Page Five

January 30, 2003

the conduct of any government by coercion, and the act is not certified as a terrorist act pursuant

to the Federal Terrorism Risk Insurance Act of 2002.

Submission of Rates, Policy Form Language and Disclosure Notices

Insurers are required to comply with the Act and with state law. Section 106(a)(2)(B) of the Act states

that “during the period beginning on the date of enactment of this Act and ending on December 31,

2003, rates and forms for terrorism risk insurance coverage covered by this title and filed with any State

shall not be subject to prior approval or a waiting period under any law of a State that would otherwise

be applicable…” The subsection further notes that rates remain subject to subsequent regulatory review

based on whether a rate is “excessive, inadequate, or unfairly discriminatory” and other applicable state

law. Similarly, policy forms are subject to subsequent review based on all applicable laws and

regulations. Thus, a system is created where insurers can immediately implement prospective rate

changes for coverage of insured losses related to acts of terrorism as defined in the Act. Additionally,

this state will use the same filing mechanism, relating to policy language changes and related pricing for

non-certified losses, for a period beginning on the date of enactment of this Act and ending

December 31, 2003

stem is created where insurers can immediately implement prospective rate

changes for coverage of insured losses related to acts of terrorism as defined in the Act. Additionally,

this state will use the same filing mechanism, relating to policy language changes and related pricing for

non-certified losses, for a period beginning on the date of enactment of this Act and ending

December 31, 2003.

If an insurer relies on an advisory organization to file loss costs and related rating systems on its behalf,

no rate filing is required unless an insurer plans to use a different loss cost multiplier than is currently on

file for coverage for certified losses. The rate filing should provide sufficient information for the

reviewer to determine what price would be charged to a business seeking to cover certified losses. This

state will accept filings that contain a specified percentage of premium to provide for coverage for

certified losses. Insurers may also choose to use rating plans that take into account other factors such as

geography, building profile, proximity to target risks and other reasonable rating factors. The insurer

should state in the filing the basis that it has for selection of the rates and rating systems that it chooses

to apply. The supporting documentation should be sufficient for the reviewer to determine if the rates

are excessive, inadequate or unfairly discriminatory.

Insurers subject to policy form and rate regulation must submit the policy language and rates that they

intend to use in this state within 30 days after they are implemented. The policy should define acts of

terrorism and both certified and non-certified losses in ways that are consistent with the Act, state law

and the guidance provided in this bulletin. The definitions, terms and conditions should be complete and

accurately describe the coverage that will be provided in the policy

that they

intend to use in this state within 30 days after they are implemented. The policy should define acts of

terrorism and both certified and non-certified losses in ways that are consistent with the Act, state law

and the guidance provided in this bulletin. The definitions, terms and conditions should be complete and

accurately describe the coverage that will be provided in the policy.

The New Hampshire Insurance Department (“Department”) requests that the disclosure notices be filed

for informational purposes, along with the policy forms, rates and rating systems as they are an integral

part of the process for notification of policyholders in this state and should be clear and not misleading

to business owners in this state. The disclosures should comply with the requirements of the Act and

should be consistent with the policy language and rates filed by the insurer. Details about the applicable

requirements are contained in the following two paragraphs.

In-force business receives special consideration under the Act. Section 105 (a) voids any terrorism

exclusion on existing policies to the extent that it excludes losses that would otherwise be insured losses

as defined in the Act. It details a process for insurers and policyholders to reinstate the voided

BULLETIN: Terrorism Risk Insurance Act of 2002

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January 30, 2003

exclusions. Under that process, an insurer may reinstate a preexisting provision in a contract that is in

force on the date of enactment of this Act and that excludes coverage for an act of terrorism only if the

insurer has received a written statement from the insured that affirmatively authorizes such

reinstatement or if the insured fails to pay any increased premium charged by the insurer for providing

such coverage and the insurer provided notice, at least 30 days before any such reinstatement as

provided in Section 105 of the Act

Act and that excludes coverage for an act of terrorism only if the

insurer has received a written statement from the insured that affirmatively authorizes such

reinstatement or if the insured fails to pay any increased premium charged by the insurer for providing

such coverage and the insurer provided notice, at least 30 days before any such reinstatement as

provided in Section 105 of the Act.

There are also disclosures required for new business and renewal business. Although voidance of

contract language is not an issue, insurers must make certain disclosures to policyholders to remain in

compliance with the Act. Section 103(b)(2) requires insurers to provide a clear and conspicuous

disclosure to the policyholder of the premium charged for covered insured losses and advise that a

federal program exists where the federal government will share significant portions of major insured

losses with insurers.

Effect on Workers’ Compensation Insurance Coverage

Treatment of workers’ compensation is slightly different than for other property and casualty insurance

coverages. First, Section 102(1)(B)(i) provides that the federal program will share the risk of loss for

workers’ compensation for acts of war in addition to acts of terrorism. This treatment occurs because of

the statutory nature of the workers’ compensation program, which does not provide an exclusion for

losses resulting from an act of war. Under New Hampshire law there is no exclusion for workers’

compensation losses resulting from an act of war. There is no provision in the Act that would preempt

the compulsory coverage aspects of workers’ compensation insurance policies. In other respects,

however, workers’ compensation coverage is treated under the Act as any other covered line of

insurance. Therefore, the notice requirements of Section 103(b)(2) and the mandatory “make available”

requirements of Section 103(c) apply to workers’ compensation policies

ion in the Act that would preempt

the compulsory coverage aspects of workers’ compensation insurance policies. In other respects,

however, workers’ compensation coverage is treated under the Act as any other covered line of

insurance. Therefore, the notice requirements of Section 103(b)(2) and the mandatory “make available”

requirements of Section 103(c) apply to workers’ compensation policies. In this connection, workers’

compensation insurers are required to separately state (the amount of) the estimated portion of the

premium being charged a policyholder for acts of terrorism, as defined in the Act. The National Council

of Compensation Insurers (“NCCI”) has submitted and received approval of the advisory loss cost

associated with coverage for acts of terrorism effective December 20, 2002 for new and renewal

policies. For the purposes of complying with the provisions of this Act, we are making an exception

from normal practices and are allowing insurers to use an effective date up to 120 days beyond the

approved NCCI new and renewal date. As with other types of insurance, a disclosure notice should be

used which identifies the additional premium being charged. NCCI endorsement WC 00 04 20 includes

a disclosure notice and is an acceptable means by which to comply with the provisions of the Act. As

this state’s workers’ compensation law does not have any exclusions for terrorism or war, neither

insurers nor policyholders may use the Act’s procedures to create such an exclusion. With regard to the

filing and approval of rates and forms, workers’ compensation insurers are also covered by the Act,

specifically Section 106(a)(2)(B) that waives any state prior approval or time requirements for the first

year of the Act. Such insurers shall therefore, at the appropriate time, follow the alternative filing

procedures established in this bulletin

to create such an exclusion. With regard to the

filing and approval of rates and forms, workers’ compensation insurers are also covered by the Act,

specifically Section 106(a)(2)(B) that waives any state prior approval or time requirements for the first

year of the Act. Such insurers shall therefore, at the appropriate time, follow the alternative filing

procedures established in this bulletin. Specifically, we are requiring filings only if the insurer elects to

use an effective date subsequent to the NCCI date of December 20, 2002 or intends to use a different

loss cost multiplier than is on file for other Workers’ Compensation classifications. Otherwise, a filing

is not necessary.

BULLETIN: Terrorism Risk Insurance Act of 2002

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Optional Provision for Standard Fire Policy States

In this state, the requirements for fire coverage are established by law and where applicable, must meet

or exceed the provisions of the Standard Fire Policy. These legal requirements cannot be waived. Thus,

a business cannot voluntarily waive this statutorily mandated coverage. It is appropriate for insurers

to develop and use a premium charge for the fire portion of the statutorily mandated terrorism

coverage for those situations where the insured has rejected the non-fire portion of coverage for certified

losses. Such a charge should be filed with the Department according to the procedures described

elsewhere in the bulletin.

Explanation and Instructions for Terrorism Rate and Form Review

The Act preempts any state prior approval law pertaining to rates or forms—including any law that

imposes waiting periods—prior to use of a rate or form for purposes of terrorism coverage, as defined by

the Act.

This preemption remains in effect for the first year of the Act

he procedures described

elsewhere in the bulletin.

Explanation and Instructions for Terrorism Rate and Form Review

The Act preempts any state prior approval law pertaining to rates or forms—including any law that

imposes waiting periods—prior to use of a rate or form for purposes of terrorism coverage, as defined by

the Act.

This preemption remains in effect for the first year of the Act. Consistent with these

requirements of the Act, this bulletin establishes a system for rates and forms, requiring insurers or

advisory organizations to file their rates and forms no later than 30 days after their first date of use. The

procedure for obtaining an expedited review of such rates and forms is set forth below. However,

nothing in this bulletin shall be construed as establishing a rate or form filing review or approval

requirement where one does not otherwise exist under this state’s law.

Forms with Instructions

Attached to this bulletin is a uniform filing transmittal form (Attachment A) that has been agreed upon

by this state and other states. An insurer or advisory organization wishing to receive expedited treatment

of its filing shall complete the EXPEDITED FILING TRANSMITTAL DOCUMENT—FOR

TERRORISM RISK INSURANCE FORMS AND PRICING as directed. In addition, the insurer(s) or

advisory organization submitting the filing must certify that the filing is consistent with this bulletin,

state law and the provisions of the Act. Certification is made by signing the appropriate blank on the

transmittal form. Filings for policy language changes and related pricing for non-certified losses may be

made using the attached filing transmittal form. The attached expedited filing transmittal document

replaces all otherwise applicable filing forms and filing transmittal forms for these filings.

To be complete, an expedited filing must include the following:

1.

A completed, certified Expedited Filing Transmittal Document for each insurer or advisory

organization.

2

on-certified losses may be

made using the attached filing transmittal form. The attached expedited filing transmittal document

replaces all otherwise applicable filing forms and filing transmittal forms for these filings.

To be complete, an expedited filing must include the following:

1.

A completed, certified Expedited Filing Transmittal Document for each insurer or advisory

organization.

2.

One copy of each policy form or endorsement that the insurer intends to use, unless the

insurer has given an advisory organization authorization to file them on its behalf.

3.

A copy of the rates and rating systems along with the supporting documentation.

A copy of any disclosure notices that will be used to convey information to policyholders in

this state.

5.

4.

The appropriate filing fees (RSA 400-A:35).

6.

A postage-paid, self-addressed envelope large enough to accommodate the return.

BULLETIN: Terrorism Risk Insurance Act of 2002

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January 30, 2003

If this filing is for multiple companies, please provide a copy of the transmittal header for each company

and an extra copy for return to the company. (i.e., 7 companies = 2 copies)

Disclosure Forms

Attached are sample disclosure forms, developed by the National Association of Insurance

Commissioners (“NAIC”) (Attachments B and C). The Department is providing these for information

only. Each insurer must decide how best to comply with the disclosure notice provisions of the Act.

Effective Date

This bulletin shall take immediate effect. The expedited filing process outlined herein shall expire on

December 31, 2003. The remainder of the bulletin shall expire on December 31, 2005, unless Congress

extends the duration of the Act.

rtment is providing these for information

only. Each insurer must decide how best to comply with the disclosure notice provisions of the Act.

Effective Date

This bulletin shall take immediate effect. The expedited filing process outlined herein shall expire on

December 31, 2003. The remainder of the bulletin shall expire on December 31, 2005, unless Congress

extends the duration of the Act.

___________________________

___________________________

___________________________

Attachment A

EXPEDITED FILING TRANSMITTAL DOCUMENT

FOR TERRORISM RISK INSURANCE FORMS AND PRICING

This page applies to the following state(s) ___________

Indicate Type of Filing

Department Use only

Certified Losses

Filing Related to ڤ

Non-Certified Losses

Filing Related to ڤ

Filing Applicable to Both Certified and Non-Certified Losses ڤ

Company Name(s)

Domicile

NAIC #

FEIN #

Contact Info for Filer

Name and address of Filer(s)

Telephone #

FAX #

e-mail

Filing information

Line of Insurance (see attachment)

Company Program Title (Marketing title)

(if applicable)

Filing Type ** see note below

This application is used with:

Effective Date Requested

Filing date

Company Tracking Number

Date filing approved in domiciliary state,

if applicable

Component/Form Name

/Description/Synopsis

Form # or Rate Page

Include edition date

Replacement

Or withdrawn?

If replacement,

Give form # or rate

Page(s) it replaces

Previous State

Filing Number,

if required

by state

01

[ ] Replacement

[ ] Withdrawn

[ ] Neither

02

[ ] Replacement

[ ] Withdrawn

[ ] Neither

To be complete, a filing must include the following:

A completed Expedited Filing Transmittal Document for each insurer or advisory organization.

One copy of each endorsement, disclosure form or other policy language, unless the insurer has given an advisory organization

authorization to file them on its behalf.

A copy of the rates, rating systems and supporting documentation

Neither

To be complete, a filing must include the following:

A completed Expedited Filing Transmittal Document for each insurer or advisory organization.

One copy of each endorsement, disclosure form or other policy language, unless the insurer has given an advisory organization

authorization to file them on its behalf.

A copy of the rates, rating systems and supporting documentation.

The appropriate filing fees, (RSA 400-A:35).

A postage-paid, self-addressed envelope large enough to accommodate the return.

The insurer(s) submitting this filing certifies that it:



Is in compliance with the terms of the Terrorism Risk Insurance Act of 2002 and the laws of this state; and



Is in compliance with the requirements of the bulletin containing the voluntary expedited filing procedures.

Signature

Print Name:

Title: