NYSID FORM 129 -- C - Department of Financial Services
FOR NEW YORK DEPARTMENT OF FINANCIAL SERVICES USE ONLY File No.: A - Received: // Assigned: // Unit: Examiner: Disposition Code: Date Closed: / / PACIFIC LOB codes: -- -- -- -- -- Comments A. INSURER INFORMATION Insurer's NAIC Code: - Name of Insurer Insurer's File No. B. FILING INFORMATION Type of filing (check one) “a” Rate Umbrella Excess Is this risk in a market … ................
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