Fillable FORM D-2: DESIGNATION OF PERSON TO RECEIVE DELAWARE (Department of Technology and Information)

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FORM D-2: DESIGNATION OF PERSON TO RECEIVE DELAWARE (Department of Technology and Information)

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BROWSE DEPARTMENT OF TECHNOLOGY AND INFORMATION (DE) FORMS

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1351 West North Street, Dover, DE 19904-2465 •
www.insurance.delaware.gov
(302) 674-7300 Dover • (302) 739-5280 fax • (302) 577-5280 Wilmington
Office of the
Commissioner
Delaware
Department of Insurance
DESIGNATION OF PERSON TO RECEIVE DELAWARE
REGULATIONS, BULLETINS, DIRECTIVES AND
NOTICE OF REGULATORY PROCEEDINGS
FORM D-2
TO: THE INSURANCE COMMISSIONER OF THAT STATE OF DELAWARE
(NAME OF COMPANY)
hereby designates the following as the person to receive from the Delaware Department of Insurance
copies of Regulations, Bulletins, Directives, and Notice of Regulatory Proceedings:
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: _______________________________________
FORM D-1, REVISED 11/18/2019
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FORM D-2: DESIGNATION OF PERSON TO RECEIVE DELAWARE (Department of Technology and Information)

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Completed 13 August 2020

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