NAME OF INSURER: FORM NO.:
ADDRESS: DATE OF SUBMITTAL:
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?
2. Is filing and approval pursuant to insurance laws and regulations by
the Department of Insurance also being requested?
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:
REQUEST FOR OPINION AS TO COMPLIANCE WITH
PLAIN LANGUAGE LAW (N.J.S.A. 56:12-1 ET SEQ., as amended)