Fillable FORM D-1: DESIGNATION OF PERSON FOR RECEIPT OF (Department of Technology and Information)

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FORM D-1: DESIGNATION OF PERSON FOR RECEIPT OF (Department of Technology and Information)

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U.S.A. forms for Department of Technology and Information

BROWSE DEPARTMENT OF TECHNOLOGY AND INFORMATION (DE) FORMS

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1351 West North Street, Dover, DE 19904 •
insurance.delaware.gov
(302) 674-7300 Dover • (302) 739-5280 fax • (302) 577-5280 Wilmington
STATE OF DELAWARE
DEPARTMENT OF INSURANCE
OFFICE OF THE
COMMISSIONER
DESIGNATION OF PERSON FOR
RECEIPT OF SERVICE OF PROCESS
FORM D-1
TO: THE INSURANCE COMMISSIONER OF THE STATE OF DELAWARE
(NAME OF COMPANY)
hereby designates the following as the person to whom process served upon the Commissioner against
the above-cited company is to be forwarded [ 18 Del. C. §524(e)]
NAME OF DESIGNEE: _____________________________________________________________
TITLE: ___________________________________________________________________________
ADDRESS: _______________________________________________________________________
PHONE: (_____) _____________
EMAIL ADDRESS: ________________________________________________________________
FEIN #: ________________ NAIC #: _________________
STATE OF INCORPORATION: ______________________________________________________
WITNESS my hand and seal of the Company affixed hereto this _____day of ____________, 20____.
(SEAL) BY: _______________________________________
TITLE: _______________________________________
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FORM D-1: DESIGNATION OF PERSON FOR RECEIPT OF (Department of Technology and Information)

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Completed 13 August 2020

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