Fillable EXHIBIT A REQUEST FOR OPINION AS TO COMPLIANCE (State of New Jersey)

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EXHIBIT A REQUEST FOR OPINION AS TO COMPLIANCE (State of New Jersey)

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NAME OF INSURER: FORM NO.:
ADDRESS: DATE OF SUBMITTAL:
TELEPHONE:
I. PURPOSE OF POLICY SUBMISSION
1. Is an opinion as to whether the form complies with the Plain Language
Law being requested pursuant to N.J.S.A. 56:12-8?
Yes No
2. Is filing and approval pursuant to insurance laws and regulations by
the Department of Insurance also being requested?
Yes No
NOTE: Filings for approval of policies pursuant to insurance laws and
regulations should be prepared in accord with the Department's
existing procedures. Requests for readability certification should
include Exhibits A and B; two copies of the policy (including
related writings) to be reviewed; and any appropriate attachments.
3. If the form you are submitting has already been approved by the Department
of Insurance pursuant to insurance laws and regulations, please indicate
the following information:
DEPARTMENT FILE NO.
DATE OF DEPARTMENT OF INSURANCE APPROVAL:
EXHIBIT A
REQUEST FOR OPINION AS TO COMPLIANCE WITH
PLAIN LANGUAGE LAW (N.J.S.A. 56:12-1 ET SEQ., as amended)
II. REFERENCE TO OTHER FORMS
Pursuant to N.J.S.A. 56:12-5, an insurer need not request an opinion
as to compliance with the Plain Language Law for policy forms identical
to those which have already been certified for some other insurer or
rating organization.
1. If a policy is similar but not identical to a previously certified
policy, please identify the previously certified policy as specifically
as possible. Include the following information if available.
FILER:
FORM NUMBER:
DEPARTMENT FILING NUMBER:
DATE OF CERTIFICATION:
2. Describe how the policy now submitted for review differs from the
previously certified form.
Gary Joy
Digitally signed by 
Gary Joy
DN: cn=Gary Joy, 
o=NJDOBI, 
ou=Property 
Casualty, c=US
Date: 2006.11.22 
14:13:03 -05'00'
Signature 
Not Verified
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III. FLESCH READING EASE TEST
1. Identify any language not considered "text" as defined in N.J.A.C.
11:2-18.3 of the regulation on policy readability. This language may
be identified by reference to the policy section numbers.
2. If any of the language identified in item 1 is required, permitted or
approved by a law, regulation, rule or published interpretation of a
State or Federal agency, identify both the language and the law, rule
or interpretation.
3. If the text of the policy form does not score at least 40 on the Flesch
reading ease test, provide an explanation to enable the Commissioner
to determine whether the lower score is warranted by the nature of the
policy form (N.J.A.C. 11:2-18.4(i)3 of the regulation). A lower score
will be accepted only in exceptional circumstances.
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EXHIBIT A REQUEST FOR OPINION AS TO COMPLIANCE (State of New Jersey)

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Completed 21 July 2020

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