Fillable REGULATIONS, BULLETINS, DIRECTIVES AND DESIGNATION OF PERSON TO (Department of Technology and Information)

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REGULATIONS, BULLETINS, DIRECTIVES AND DESIGNATION OF PERSON TO (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, Suite 101, Dover, DE 19904 •
insurance.delaware.gov
(302) 674-7300 Dover • (302) 739-5280 fax • (302) 577-5280 Wilmington
Offic
e of the
Commissioner
State of Delaware
Department of Insurance
DESIGNATION OF PERSON TO RECEIVE DELAWARE
REGULATIONS, BULLETINS, DIRECTIVES AND
NOTICE OF REGULATORY PROCEEDINGS
TO: THE INSURANCE COMMISSIONER OF THE STATE OF DELAWARE
____________________________________________________________________________
(NAM
E OF COMPANY)
hereby desi
gnates the following person to receive from the Delaware Department of Insurance
copies of Regulations, Bulletins, Directives, and Notice of Regulatory Proceedings:
NAME O
F DESIGNEE: _________________________________________________________
TITLE:
______________________________________________________________________
ADDRESS:
__________________________________________________________________
____________________________________________________________________________
EMAIL
ADDRESS: ____________________________________________________________
PHONE:
FAX: ________________
NAIC #:
_________ STATE OF INCORPORATION: ___________________
WITNE
SS my hand and seal of the Company affixed hereto this _____ day of ,
20____.
BY: ______________________________________________
(
SEAL)
TITLE:
______________________________________________
Form H-4
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REGULATIONS, BULLETINS, DIRECTIVES AND DESIGNATION OF PERSON TO (Department of Technology and Information)

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Completed 13 August 2020

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