19 Miss. Code. R. 1-38.08 - Exhibit A- Mississippi Department of Insurance Expedited Review Filing Election Form

EXHIBIT A

MISSISSIPPI DEPARTMENT OF INSURANCE EXPEDITED REVIEW FILING ELECTION FORM

Company Name: ________________________________________________

Form Filing SERFF Number: ______________________________________

Check One:

______________ I elect to use the expedited for filing procedure. I have enclosed a check payable to the Mississippi Department of Insurance for all applicable statutory fees. I also verify I have sent a check to the Actuarial Resources Corporation of Georgia for the applicable expedited review fee.

______________ I elect to use the Standard Filing Procedure.

Notes

19 Miss. Code. R. 1-38.08

Miss. Code Ann. § 83-9-3(5)(Rev. 2011)