LIFE, ACCIDENT AND HEALTH INSURERS



LIFE, ACCIDENT AND HEALTH/FRATERNAL INSURERSCOMPANY NAME:Contact:NAIC Company Code:Telephone: REQUIRED FILINGS IN THE STATE OF: CALIFORNIA Filings Made During the Year 2021FRATERNAL COMPANIES BEGIN FILING LIFE/FRATERNAL STATEMENT EFFECTIVE WITH FIRST QUARTER, 2019.(1)Checklist(2)Line#(3)REQUIRED FILINGS(4)NUMBER OF COPIES(5)CARequired Filing Format(6)DUE DATE(7)FORM SOURCE(8)APPLICABLENOTESDomesticForeignCANAICCAI. NAIC FINANCIAL STATEMENTS1Annual Statement (8 ?”x14”)xxxEOxxxComplete PDF (Signed) to NAICandOriginal Signature Page(s) to CA3/1NAICFAD2011.1Printed Investment Schedule detail (Pages E01-E29)xxxEOxxxPDF3/1NAIC2Quarterly Financial Statement (8 ?” x 14”)xxxEOxxxComplete PDF (Signed) to NAICandOriginal Signature Page(s) to CA5/15, 8/15, 11/15NAICFAD2013Separate Accounts Annual Statement (8 ?”x14”)xxxEOxxxPDF3/1NAICII. NAIC SUPPLEMENTS11Accident & Health Policy Experience ExhibitxxxEOxxxPDF4/1NAIC12Credit Insurance Experience ExhibitxxxEOxxxPDF4/1NAIC13Life, Health & Annuity Guaranty Assessment Base Reconciliation Exhibit1EOxxxPDF4/1NAICFAD17014Life, Health & Annuity Guaranty Assessment Base Reconciliation Exhibit Adjustment Form1EOxxxPDF4/1NAICFAD17115Long-term Care Experience Reporting FormsxxxEOxxxPDF4/1NAIC16Management Discussion & AnalysisxxxEOxxxPDF4/1Company17Medicare Supplement Insurance Experience ExhibitxxxEOxxxPDF3/1NAIC18Medicare Part D Coverage SupplementxxxEOxxxPDF3/1, 5/15, 8/15, 11/15NAIC19Risk-Based Capital ReportxxxEOxxxComplete PDF (Signed) to NAICandOriginal Signature Page(s) to CA3/1NAICFAD39020Schedule SIS - Stockholder Information Supplement1N/AN/APDF3/1NAICFAD42021Supplemental Compensation Exhibit1N/AN/APDF3/1NAICFAD46022Supplemental Health Care Exhibit (Parts 1, 2 and 3)xxxEOxxxPDF4/1NAIC23Supplemental Health Care Exhibit’s Allocation ReportxxxEOxxxPDF4/1NAIC24Supplemental Investment Risk Interrogatories xxxEOxxxPDF4/1NAIC25Supplemental Schedule OxxxEOxxxPDF3/1NAIC26Supplemental Term and Universal Life Insurance Reinsurance ExhibitxxxEOxxxPDF4/1NAIC27Trusteed Surplus StatementxxxEOxxxPDF3/1, 5/15, 8/15, 11/15NAIC28Variable Annuities SupplementxxxEOxxxPDF4/1NAIC29VM 20 Reserves SupplementxxxEOxxxPDF3/1NAIC30Workers’ Compensation Carve-Out SupplementxxxEOxxxPDF3/1, When ApplicableNAICActuarial Related Items31Actuarial Certification regarding use 2001 Preferred Class TablexxxEOxxxPDF3/1Company32Actuarial Certification Related Annuity Non-forfeiture Ongoing Compliance for Equity Indexed AnnuitiesxxxEOxxxPDF3/1Company33Actuarial Memorandum Related to Universal Life with Secondary Guarantee Policies required by Actuarial Guideline XXXVIII 8D1N/A1PDF4/30,When ApplicableCompanyFAD471 D34Actuarial OpinionxxxEOxxxComplete PDF (Signed) to NAICandOriginal Signature Page(s) to CA3/1CompanyFAD44035Actuarial Opinion on Separate Accounts Funding Guaranteed Minimum BenefitxxxEOxxxPDF3/1Company36Actuarial Opinion on Synthetic Guaranteed Investment ContractsxxxEOxxxPDF3/1Company37Actuarial Opinion on X-FactorsxxxEOxxxPDF3/1Company38Actuarial Opinion required by Modified Guaranteed Annuity Model RegulationxxxEOxxxPDF3/1Company39Request for Life PBR Exemption (formerly Companywide Exemption)1EOxxxPDFCommissioner 7/1, NAIC 8/15,When ApplicableCompanyFAD60QNEW40Full VM-31 PBR Actuarial Report required by the Valuation Manual1N/A1PDF andExcel4/1, When ApplicableCompanyFAD61Q41RAAIS required by Actuarial Opinion and Memorandum Regulation1N/A1FAD63PDF (Signed) & XLSorFAD64DOC (Signed) & XLS4/1, When ApplicableCompanyFAD63orFAD64D, E42Reasonableness & Consistency of Assumptions Certification required by Actuarial Guideline XXXVxxxEOxxxPDF3/1,5/15, 8/15, 11/15Company43Reasonableness of Assumptions Certification required by Actuarial Guideline XXXVxxxEOxxxPDF3/1,5/15, 8/15, 11/15Company44Reasonableness & Consistency of Assumptions Certification required by Actuarial Guideline XXXVI (Updated Average Market Value)xxxEOxxxPDF3/1,5/15, 8/15, 11/15Company45Reasonableness & Consistency of Assumptions Certification required by Actuarial Guideline XXXVI (Updated Market Value)xxxEOxxxPDF3/1,5/15, 8/15, 11/15Company46Reasonableness of Assumptions Certification for Implied Guaranteed Rate Method required by Actuarial Guideline XXXVIxxxEOxxxPDF3/1,5/15, 8/15, 11/15Company47RBC Certification required under C-3 Phase IxxxEOxxxPDF3/1Company48RBC Certification required under C-3 Phase IIxxxEOxxxPDF3/1Company49Statement on non-guaranteed elements - Exhibit 5 Int. #3xxxEOxxxPDF3/1Company50Statement on par/non-par policies – Exhibit 5 Int. 1&2xxxEOxxxPDF3/1Company51Actuarial Guideline 51 Report1N/A1PDF4/1,When ApplicableCompanyFAD62D,EIII. ELECTRONIC FILING REQUIREMENTS61Annual Statement Electronic FilingxxxEOxxx3/1NAIC62March .PDF FilingxxxEOxxx3/1NAIC63Risk-Based Capital Electronic FilingxxxEON/A3/1NAIC64Risk-Based Capital .PDF FilingxxxEON/A3/1NAIC65Separate Accounts Electronic FilingxxxEOxxx3/1NAIC66Separate Accounts .PDF FilingxxxEOxxx3/1NAIC67Supplemental Electronic FilingxxxEOxxx4/1NAIC68Supplemental .PDF FilingxxxEOxxx4/1NAIC69Quarterly Statement Electronic FilingxxxEOxxx5/15, 8/15, 11/15NAIC70Quarterly .PDF FilingxxxEOxxx5/15, 8/15, 11/15NAIC71June .PDF FilingxxxEOxxx6/1NAICIV. AUDIT/INTERNAL CONTROL RELATED REPORTS81Accountants Letter of QualificationsxxxEOxxxPDF6/1Company82Audited Financial ReportsxxxEOxxxPDF6/1Company83Audited Financial Reports Exemption Affidavit1N/AxxxPDFWhen ApplicableCompanyFAD12084Communication of Internal Control Related Matters Noted in Audit1EON/APDF8/1CompanyFAD22285Independent CPA (change)1N/AN/APDFWhen ApplicableCompanyFAD12486Management’s Report of Internal Control Over Financial Reporting1N/AN/APDF8/1, When ApplicableCompanyFAD22387Notification of Adverse Financial Condition1N/A1PDFWhen ApplicableCompanyFAD12288Relief from the five-year rotation requirement for lead audit partnerxxxEOxxxPDF3/1, When ApplicableCompany89Relief from the one-year cooling off period for independent CPAxxxEOxxxPDF3/1, When ApplicableCompany90Relief from the Requirements for Audit CommitteesxxxEOxxxPDF3/1, When ApplicableCompany91Request for Extension/Exemption 1N/AN/APDFWhen ApplicableCompanyFAD12592CPA Awareness Letter1N/AN/APDF6/1CompanyFAD12193Request to File Consolidated Audited Annual Statements1N/AN/APDFWhen ApplicableCompanyFAD126V. STATE REQUIRED FILINGS101A & H Insurers/Reinsurers with Workers Compensation Exposures 101Complete PDF (Signed)andOriginal Signature Page(s)When ApplicableCAFAD151J102Actuarial Guideline 43/VM-2110 1FAD28DOC & XLSor FAD29 PDF & XLS4/1, When ApplicableCompanyFAD28orFAD29D, E103Actuarial Memorandum10 1FAD24DOC & XLS orFAD25PDF & XLS4/1, When ApplicableCompanyFAD24orFAD25D, E104Actuarial Statement of Reserve and Pricing Adequacy for Certain Separate Account Guarantees for General Account10 1PDF3/1, When ApplicableCompanyFAD27D105California specific Annual Statement, if required due to CCR Sections 2582-2582.3 (Recognition of Preferred Mortality Tables for Use in Determining Minimum Reserve Liabilities)101PDF3/1, When ApplicableCA Blue BookFAD 35P106Authorization for Disclosure of Financial Records10 1Complete PDF (Signed) andOriginal Signature Page(s)3/1CAFAD107107CA Affidavit – Declaration to Valuation of Property & Securities/Verification 10 1Complete PDF (Signed)andOriginal Signature Page(s)3/1CAFAD105108CA Trusteed Surplus Statement 10 1PDF3/1, 5/15, 8/15, 11/15CAFAD490B109Certificate of Compliance001PDF3/1State of DomicileFAD101A110Certificate of Deposit001PDF3/1CompanyFAD102B111Certificate of Valuation00 1PDF6/30CompanyFAD104112Disclosure of Iran-Related Investments100PDF & XLS6/30CAFAD470L113Disclosure of Material Transactions100See NoteSee NoteSee NoteK114Ending Surplus (Book Value & Market Value) for All Stochastic Scenarios10 1XLS4/1, When ApplicableCompanyFAD30D, E115Form B (Holding Company Registration Statement)10 1Complete PDF (Signed)andOriginal Signature Page(s)4/30NAICFAD500H116Form C (Summary of Registration Statement)10 1Complete PDF (Signed)andOriginal Signature Page(s)4/30NAICFAD501H117Form F (Enterprise Risk Report)10See NotePDF 4/30,When ApplicableNAICFAD502M118Insurer Climate Risk Disclosure Survey10 1See NoteSee NoteSee NoteI119Premium Tax Return/Payment10 1See NoteSee NoteSee NoteC120Reinsurance Disclosure Report100See NoteSee NoteSee NoteN121Special California Schedule P10 1XLS,Complete PDF (Signed)andOriginal Signature Page(s) 3/1CAFAD152G122Special California Schedule P - Discounted101XLS,Complete PDF (Signed)andOriginal Signature Page(s) 3/1, When ApplicableCAFAD153G123Valuation of Securities (A110)10 1XLS,Complete PDF (Signed)andOriginal Signature Page(s) 3/1, 5/15 & As RequiredCAFAD110F124Corporate Governance Annual Disclosure (CGAD) - (Submit via E-mail)100Complete PDF (Signed)andOriginal Signature Page(s)6/1CompanyFAD503O125Own Risk and Solvency Assessment (ORSA) - (Submit via E-mail)100Complete PDF (Signed)andOriginal Signature Page(s)QTR-4CompanyFAD504O126Biographical Affidavits and Fingerprints101See NoteWhen ApplicableSee NoteRGENERAL INSTRUCTIONSSubmission Pursuant to California Code of Regulation (“CCR”) 2308.1, the Insurance Commissioner (“Commissioner”) designates the Internet-based financial filing system operated by the National Association of Insurance Commissioners (“NAIC”) as the filing system to receive and store electronic filings of annual and quarterly financial statements from all admitted insurers. When filed, solely for purposes of a filing made with the NAIC, a document is considered filed with the Commissioner when the filing is accepted by the NAIC. Any financial statements, which are not required to be filed with the NAIC or required to be filed with the NAIC that is not accepted for filing by the NAIC, shall be filed directly with the California Department of Insurance (“CDI”) via the Online Assistance System for Insurer Submittals (“OASIS”). For documents requiring original signature(s)/certification/notarization, the electronic PDF file must contain the required signature(s)/certification/notarization. In addition, a paper original of a properly executed Jurat page from the related financial statement filed electronically shall be provided to the Commissioner as confirmation of each electronic filing. For admitted foreign and alien insurers, a paper original of such properly executed Jurat page is not needed, if it is already on file with its domestic regulator. All original signature pages must be mailed to:California Department of InsuranceFinancial Analysis Division, Financial Records Unit300 South Spring Street, South Tower, 13th FloorLos Angeles, CA 90013Original Signatures and Signature/Notarization/CertificationRefer to California Insurance Code Section (“CIC §”) 903 and CIC § 903.5 for guidance. For signature(s), please use BLUE INK.Note: As of January 1, 2008, all documents notarized in the state of California must comply with Section 8202 of the Government Code and Section 1185 of the Civil Code in reference to establishing an affiant’s identity. Contact InformationFor questions regarding filings, please contact Financial Records Unit at (213)346-6423 / Financial_Records@insurance. or visit the CDI’s website at: insurance.. Late FilingsElectronic filings must be submitted before 12:00 midnight of the due date. Paper filings must be postmarked on or before the due date. Any company that fails to make a timely and complete filing may be subject to a late filing fee. A late filing fee will be assessed for the first month and every month or fractional part thereof until the required filing is submitted. The company is required to pay the late filing fee through OASIS.Amended FilingsAmended items must be filed timely along with an explanation of the amendments. If there are signature requirements for the original filing, same should be followed for any subsequent amendment. Please contact Financial Records Unit at (213) 346-6423 or Financial_Records@insurance. prior to submitting any amendment via OASIS.Request for Extension/ExemptionNot all documents can be given an extension of time to file or to be exempted from filing. Please refer to CIC and CCR for guidance. Pursuant to CIC § 924, applicable late filing fees will be assessed even with a granted extension. Unless otherwise specified in the CIC or CCR, the request for extension/exemption must be received by the CDI:For a domestic insurer, at least 30 days prior to the filing due date.For a foreign insurer, at least 10 days prior to the filing due date. The request must be accompanied by a copy of the domiciliary state insurance regulator’s approval letter.For requests relating to Section IV - AUDIT/INTERNAL CONTROL RELATED REPORTS, please submit them via OASIS. For other requests, please e-mail them to Financial Records Unit at Financial_Records@insurance. directly.NONE or 0 FilingsFor NAIC Submissions, see Official NAIC Annual Statement Blank for Supplemental Exhibits and Schedules Interrogatories.For CA Supplemental Submissions, when there is nothing to report or the form is not applicable, the word “NONE” or “0” must appear stamped/written on the required form. Company information must be filled in (e.g., Company name and NAIC #).Column (1)ChecklistCompanies may use the checklist to submit to a state, if the state requests it. Companies should copy the checklist and place an “x” in this column when submitting information to the state.Column (2)Line #Line # refers to a standard filing number used for reference only. This line number may change from year to year.Column (3)Required FilingsName of form or document to be filed.Under Section III. ELECTRONIC FILING REQUIREMENTS:The Annual Statement Electronic Filing includes the annual statement data and all supplements due March 1, per the Annual Statement Instructions. This includes all detail investment schedules and other supplements for which the Annual Statement Instructions exempt printed detail.The March .PDF Filing is the .pdf file for annual statement data, detail for investment schedules and supplements due March 1.The Risk-Based Capital Electronic Filing includes all risk-based capital data.The Risk-Based Capital .PDF Filing is the .pdf file for risk-based capital data.The Separate Accounts Electronic Filing includes the separate accounts annual statement and investment schedule detail.The Separate Accounts .PDF Filing is the .pdf file for the separate accounts annual statement and all investment schedule detail.The Supplemental Electronic Filing includes all supplements due April 1, per the Annual Statement Instructions. The Supplement .PDF Filing is the .pdf file for all supplemental schedules and exhibits due April 1.The Quarterly Electronic Filing includes the quarterly statement data.The Quarterly .PDF Filing is the .pdf for quarterly statement data.The June .PDF Filing is the .pdf file for the Audited Financial Statements and Accountants Letter of Qualifications.Column (4)Number of CopiesXXX = If a hardcopy (or a paper original of a properly executed Jurat page from the related financial statement filed electronically) is filed with the state of domicile and the data is filed electronically with the NAIC, California does not require a separate filing of this financial statement.0 = Filing is required with the domiciliary state only. 0 = California domestic companies are not required to file.EO = Electronic only filing. Electronic filing is intended to include filing via the Internet and are not required to submit diskettes to the NAIC. Companies are not required to file hard copy filings with the NAIC.Column (5)California Required Electronic Filing FormatAdobe PDF (PDF)For document requiring original signature(s)/certification/notarization, the PDF file must contain the required signature(s)/certification/notarization.MS Excel (XLS)For document requiring an Excel version, the related form is provided on our Website. The Excel version does not require signature(s)/certification/notarization.Note: For Special California Schedule P (SCASP) & Valuation of Securities (A-110) filing, please follow the naming standards on the SCASP & A-110 instruction page.Column (6)Due DateIndicates the date on which the company must file the form.Column (7)Form SourceNAIC = Company must obtain the forms from the appropriate vendor. CA = CDI will prescribe the forms with the filing instructions. Company = Company, or its representative is expected to provide the form based upon the appropriate state instructions or the NAIC Annual Statement Instruction.State of Domicile = Document issued by the domiciliary state insurance regulator.Column (8)Applicable NotesThis column contains references to the Notes that apply to each item listed on the checklist. It also contains the CDI form numbers (in red - FADXXX) for reference only. The company should carefully read these notes before submitting a filing. NOTESACertificate of ComplianceForeign insurer must file with the CDI a Certificate of Compliance issued by its state of domicile or port of entry insurance regulator.California domestic insurers that are required to file a Certificate of Compliance with other states should contact the Corporate and Regulatory Affairs Branch to obtain a copy.California Department of InsuranceCorporate and Regulatory Affairs BranchRe: Certificate of Compliance1901 Harrison StreetOakland, CA 94612 (415) 538-4154BCalifornia Trusteed Surplus Statement/Certificate of DepositApplies to alien insurer only. Refer to CIC § 1591 for guidance.CPremium Tax Return/PaymentTax forms, instructions & information are available on the CDI website: insurance.. Under “Insurers”, click on “Applications, Forms & Filings” and go to “Tax Forms, Instructions & Information”.For questions concerning the completion of the tax return, please contact the Premium Tax Audit Unit at premiumtaxaudit@insurance..For premium tax payment, please mail it to:Mailing AddressOvernight MailCalifornia Department of InsuranceTax Accounting/EFT UnitP.O. BOX 1918Sacramento, CA 95812-1918California Department of InsuranceTax Accounting/EFT Unit300 Capitol Mall, Suite 14000Sacramento, CA 95814DContact Information for Actuarial OfficeQuestions and Mailing Address Senior Life Actuary California Department of Insurance 300 South Spring Street, South Tower, 14th Floor Los Angeles, CA 90013 E-mail: Ahmad.Kamil@insurance. Phone: (213) 346-6147Note: All licensed companies are required to submit the RAAIS.? Please mail the 2020 RAAIS in paper format to the address above. Actuarial Memoranda will be viewed as confidential, and will be destroyed after review is completed.EActuarial MemorandumRefer to instructions in the 2020 Actuarial Memorandum and Executive Summary.FValuation of Securities (A110) For insurers licensed to transact workers’ compensation insurance in California or authorized to reinsure the injury, disablement, or death portions of workers’ compensation policies. A110 as of December 31, 2020 is due on March 1, 2021. A110 as of March 31, 2021 is due on May 15, 2021.An updated A110 with the most current valuations must be submitted in hardcopy together with the workers’ compensation deposit withdrawal request in order for the request to be processed.GSpecial California Schedule P (SCASP)For insurers licensed to transact workers’ compensation insurance in California or authorized to reinsure the injury, disablement, or death portions of workers’ compensation policies.SCASP filings must be submitted via OASIS. Please follow the naming standards on the SCASP instruction page.For companies that choose to discount their workers’ compensation deposit, the Discounted SCASP must be submitted via OASIS, while the payment pattern used for discounting [in company’s own form] must be submitted via email to FADWC@insurance..HForms B and C (Holding Company RegistrationStatement and Summary)Apply to California domestic and commercially domiciled insurers only.IInsurer Climate Risk Disclosure SurveyCheck the CDI website: CLIMATE RISK DISCLOSURE SURVEY for the latest information. For questions, please email to ClimateRiskSurvey@insurance..JA & H Insurers/Reinsurers with Workers Compensation Exposures (FAD 151)For insurers or reinsurers authorized to reinsure the injury, disablement, or death portions of workers’ compensation policies that wish to be on the Published List, pursuant to California Insurance Code Section 11691.3, please submit signed form to:California Department of InsuranceFinancial Analysis Division300 South Spring Street, 13th Floor, South TowerLos Angeles, CA 90013Attn: Rosa RuizAlso, submit a scanned copy with signature in PDF format to FADWC@insurance.. For insurers that are already on the Published List, they are NOT required to file Form 151 Notice annually, but they will need to comply with all the filing requirements.KDisclosure of Material TransactionsRefer to financial-filing-notices-forms - annual notices - disclosure for guidance. When applicable, the report shall be filed within 15 days after the end of the calendar month in which the transactions occur. LDisclosure of Iran-Related InvestmentsFor your convenience, the Disclosure of Iran-Related Investments form and the Department of General Services List are being made available on our Website.MForm F (Enterprise Risk Report)Refer to CIC § 1215.4 (m) for guidance. A California commercially domiciled company is required to file Form F only when the lead state does not require it.Note: For those states that have adopted the NAIC updated Holding Company Model Act, a Form F Filing is required annually by holding company groups. Consistent with the Form B filing requirements, the Form F is a state filing only and should not be submitted by the company to the NAIC. Note however that this filing is intended to be submitted to the lead state. For more information on lead states, see the NAIC URL: NAIC public lead state reportNReinsurance Disclosure ReportRefer to Disclosure of Reinsurance Recoverable and Reinsurance Program Diversification for guidance. When applicable, the report shall be filed within 30 days after the event occurs.OORSA and CGADORSA - Refer to CIC § 935.1 – 935.11 for guidance. CGAD - Refer to CIC § 936.1 – 936.9 for guidance.The filing must be submitted via e-mail in encrypted .PDF format to FADCGADORSA@insurance. with the signature page be sent through regular mail to:California Department of InsuranceFinancial Analysis Division, Financial Records Unit – CGAD/ORSA300 South Spring Street, South Tower, 13th FloorLos Angeles, CA 90013The format of the Subject line on e-mail is as follows:Subject:CGAD/ORSA – AS YYYY - Company/Group name – NAIC Number/Group NumberExample:CGAD – AS 2020 – ABC Company – 12345ORSA – AS 2020 – EFG Group – 0890Note:AS = Annual Statement; YYYY = AS YearFor submission questions, please call (213) 346-6423.CGAD - For those states that have adopted the NAIC CGAD Model Act, an annual disclosure is required of all insurers or insurance groups by June 1. The CGAD is a state filing only and should not be submitted by the company to the NAIC. Note however that this filing is intended to be submitted to the lead state if filed at the insurance group level.ORSA - For those states that have adopted the NAIC Risk Management and ORSA Model Act, a summary report is required annually by insurers and insurance groups above a specified premium threshold. The ORSA Summary Report is a state filing only and should not be submitted by the company to the NAIC. Note however that this filing is intended to be submitted to the lead state if filed at the insurance group level. For more information on lead states, see the NAIC URL: NAIC public lead state report.PCalifornia specific Annual Statement, if required due to CCR Sections 2582-2582.3 (Recognition of Preferred Mortality Tables for Use in Determining Minimum Reserve Liabilities)Refer to CCR Sections 2582-2582 (Article 17.3 - Recognition of Preferred Mortality Tables for Use in Determining Minimum Reserve Liabilities) for guidance.QLife PBR Exemption and VM-31 PBR Actuarial ReportContact Information for the Office of Principle-Based Reserving (OPBR)Questions and Mailing AddressSenior Life ActuaryOffice of Principle-Based Reserving(213)346-6151Elaine.Lam@insurance.Please submit Life PBR Exemption and VM-31 PBR Actuarial Report electronically via OASIS. ?Note: All licensed companies completing a VM-31 PBR Actuarial Report are required to submit the PBR Actuarial Report. VM-31 PBR Actuarial Reports will be treated as confidential.RBiographical Affidavits and FingerprintsApply to California domestic and commercially domiciled insurers only.Pursuant to CIC § 704.5, biographical affidavits and fingerprints are required for changes in officers, directors, or trustees from the previous Financial Statement filing. Please direct questions regarding biographical affidavits and fingerprints to:Holly KinneyChief, Curriculum and Officer Review BureauCalifornia Department of Insurance320 Capitol MallSacramento, CA 95814 Office: (916) 492-3650 or Holly.Kinney@insurance.Biographical Affidavits [to be submitted to Curriculum and Officer Review Bureau, Attn: Holly Kinney]Cert-of-authority-instructions CAIV Item7and 8FingerprintsCert-of-authority-instructions CAIV Item 7 ................
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