Regulations of Connecticut State Agencies
(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 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); 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) One (1) original and five (5) complete copies of Form A statements including exhibits and all other papers and documents filed as a part thereof, and one (1) complete copy of Forms B, C, D, D-1, E, and F including exhibits and all other papers and documents filed as a part thereof, shall be filed with the Commissioner by personal delivery addressed to:
State of Connecticut Insurance Department
153 Market Street (7th Floor)
Hartford, CT 06103
Attention: Financial Analysis Unit, Financial Regulation Division
or, by U.S. mail addressed to:
State of Connecticut, Insurance Department
P.O. Box 816
Hartford, CT 06142-0816
Attn: Financial Analysis Unit, Financial Regulation Division
At least one (1) of the copies shall be manually signed in the manner prescribed on the form. Unsigned copies shall be conformed. If the signature of any person is affixed pursuant to a power of attorney or other similar authority, a copy of such power of attorney or other authority shall also be filed with the statement.
(c) If an applicant requests a hearing on a consolidated basis under section 38a-132(b)(3) of the Connecticut General Statutes, in addition to filing the Form A with the Commissioner, the applicant shall file a copy of the Form A with the National Association of Insurance Commissioners (NAIC) in electronic form.
(d) Forms and statements shall be prepared in conformance with the requirements of the Commissioner and published on the Insurance Department website. Forms and statements shall be submitted in paper copy. Copies of the form and statement may be submitted electronically with the prior consent of the Commissioner but date received will be based on the date the paper copy original was received by the Insurance Department. All copies of any form, paper statement, financial statements, or exhibits shall be clear, easily readable and suitable for photocopying. Copies submitted electronically shall be readily printable. Debits in credit categories and credits in debit categories shall be designated so as to be clearly distinguishable as such on photocopies. 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 paper or 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 currency38a-138-16
(Effective July 26, 1993; Amended June 27, 2013; Amended March 4, 2015)