Illinois Administrative Code
Title 50 - INSURANCE
Part 3801 - SMALL EMPLOYER CARRIER ACTUARIAL CERTIFICATION AND DOCUMENTATION REQUIREMENTS
ILLUSTRATION B - Statement of the Company Officer
Universal Citation: 50 IL Admin Code ยง ILLUSTRATION B
Current through Register Vol. 49, No. 13, March 28, 2025
The following illustrates an acceptable statement to be filed when the opining actuary or pre-approved individual has indicated reliance on data provided by company personnel:
I [name of officer], [title], of [name of carrier], hereby affirm that the listings (summaries, rate manuals, etc.) of relevant data prepared for and submitted to [name of appointed actuary] were prepared under my direction and, to the best of my knowledge and belief, are substantially accurate and complete.
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_________________________________ |
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Name of Officer of the Carrier (typewritten) |
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_________________________________ Signature of Officer of the Carrier |
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_________________________________ |
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Date |
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