Form E-CR-1 (v. 20151101)
Financial Affairs Division
Arizona Department of Insurance
100 North 15
th
Avenue, Suite 102 Phone: (602) 364-3999
Phoenix, Arizona 85007-2624 Email: financialfilings@azinsurance.gov
CERTIFICATE OF CERTIFIED REINSURER
I, ____________________________________________________ , _________________________________________
(name of officer) (title of officer)
of __________________________________________________________________________ , the assuming insurer
(name of assuming insurer)
under a reinsurance agreement with one or more insurers domiciled in ,
(name of state)
in order to be considered for approval in the State of Arizona, hereby certify that
______________________________________________________("Assuming Insurer"):
(name of assuming insurer)
1. Submits to the jurisdiction of any court of competent jurisdiction in Arizona for the adjudication of any issue arising out
of the reinsurance agreement, agrees to comply with all requirements necessary to give such court jurisdiction, and will
abide by the final decision of such court or any appellate court in the event of an appeal. Nothing in this paragraph
constitutes or should be understood to constitute a waiver of Assuming Insurer's rights to commence an action in any
court of competent jurisdiction in the United States, to remove an action to a United States District Court, or to seek a
transfer of a case to another court as permitted by the laws of the United States or of any state in the United States.
This paragraph is not intended to conflict with or override the obligation of the parties to the reinsurance agreement to
arbitrate their disputes if such an obligation is created in the agreement.
2. Designates the Director of Insurance of the State of Arizona as its lawful attorney upon whom may be served any lawful
process in any action, suit or proceeding arising out of the reinsurance agreement instituted by or on behalf of the ceding
insurer. A copy of lawful process against or affecting the Assuming Insurer served upon the Director of Insurance
should be mailed to:
__________________________________
(name and full mailing address, including country and zip code)
3. Agrees to provide security in an amount equal to 100% of liabilities attributable to U.S. ceding insurers if it resists
enforcement of a final U.S. judgment or properly enforceable arbitration award.
4. Agrees to provide notification within 10 days of any regulatory actions taken against it, any change in the provisions of
its domiciliary license or any change in its rating by an approved rating agency, including a statement describing such
changes and the reasons therefore.
5. Agrees to annually file information comparable to relevant provisions of the NAIC financial statement for use by
insurance markets in accordance with this Article.
6. Agrees to annually file the report of the independent auditor on the financial statements of the insurance enterprise.
7. Agrees to annually file audited financial statements, regulatory filings, and actuarial opinion in accordance with this
Article.
8. Agrees to annually file an updated list of all disputed and overdue reinsurance claims regarding reinsurance assumed
from U.S. domestic ceding insurers.
9. Is in good standing as an insurer or reinsurer with the supervisor of its domiciliary jurisdiction.
Dated:
(name of assuming insurer)
(signature of officer)
(title of officer)
