210 Neb. Admin. Code, ch. 24, § 004 - Forms - General requirements

004.01 Forms A, B, C, D, and F are intended to be guides in the preparation of statements required by Neb.Rev.Stat. §§ 44-2120 through 44-2133. They are not intended to be blank forms which are to be filled in. The statements filed shall contain the numbers and captions of all items, but the text of the items may be omitted provided the answers thereto are so prepared as to indicate to the reader the coverage of items without the necessity of his referring to the text of the items or the instructions thereto. 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.

004.02 Two complete copies of each statement including exhibits and all other papers and documents filed as a part thereof, shall be filed with the Director by personal delivery or mail addressed to: Insurance Director of the State of Nebraska, 941 "O" Street, Suite 400, Lincoln, Nebraska 68508, Attention: Director of Insurance. Alternatively, statements other than the Form A statement required by Neb.Rev.Stat. § 44-2126 may be submitted to the Department via electronic mail. At least one of the copies shall be 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.

004.03 If an applicant requests a hearing on a consolidated basis under Neb.Rev.Stat. § 44-2127(3) of the Act, in addition to filing the Form A with the commissioner, the applicant shall file a copy of Form A with the National Association of Insurance Commissioners (NAIC) in electronic form.

004.04 Statements should be prepared electronically. Statements shall be easily readable and suitable for review and reproduction. Debits in credit categories and credits in debit categories shall be designated so as to be clearly distinguishable as such on photocopies. Statements shall be 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 translation into the English language and any monetary value shown in a foreign currency normally shall be converted into United States currency.

Notes

210 Neb. Admin. Code, ch. 24, § 004