Common use of Request for Actuarial Change Form Clause in Contracts

Request for Actuarial Change Form. The Request for Actuarial Change form must be signed and dated by the producer, the insurance agent, and the authorized representative of the AIP. By signing the Request for Actuarial Change form, the producer accepts the applicable statements contained on the form, and certifies that all information provided on the form and documentation contained in the request for a WA is correct. See Exhibit 3A for the Request for Actuarial Change form standards and Exhibit 4 for a Request for Actuarial Change form example.

Request for Actuarial Change Form. The Request for Actuarial Change form must be signed and dated by the producer, the insurance agent, and the authorized representative of the AIP. By signing the Request for Actuarial Change form, the producer accepts the applicable statements contained on the form, and certifies that all information provided on the form and documentation contained in the request for a WA is correct. See Exhibit 3A for the Request for Actuarial Change form standards and Exhibit 4 for a Request for Actuarial Change form example.. 14-20 (Reserved)

Request for Actuarial Change Form. ‌‌ The Request for Actuarial Change form must be signed and dated by the producer, the insurance agent, and the authorized representative of the AIP. By signing the Request for Actuarial Change form, the producer accepts the applicable statements contained on the form, and certifies that all information provided on the form and documentation contained in the request for a WA is correct. See Exhibit 3A 3 for the Request for Actuarial Change form standards and Exhibit 4 for a Request for Actuarial Change form example.example.‌ 14-20 (Reserved)‌ Section 2 WA Submission Requirements‌

Request for Actuarial Change Form. ‌ The Request for Actuarial Change form must be signed and dated by the producer, the insurance agent, and the authorized representative of the AIP. By signing the Request for Actuarial Change form, the producer accepts the applicable statements contained on the form, and certifies that all information provided on the form and documentation contained in the request for a WA is correct. See Exhibit 3A for the Request for Actuarial Change form standards and Exhibit 4 for a Request for Actuarial Change form example.

Request for Actuarial Change Form. The Request for Actuarial Change form must be signed and dated by the producer, the insurance agent, and the authorized representative of the AIP. By signing the Request for Actuarial Change form, the producer accepts the applicable statements contained on the form, and certifies that all information provided on the form and documentation contained in the request for a WA is correct. See Exhibit 3A 3 for the Request for Actuarial Change form standards and Exhibit 4 for a Request for Actuarial Change form example.. 14-20 (Reserved)