I,
, a duly authorized officer of
(insert name of company), do hereby certify that I am knowledgeable as
to the laws, regulations and circular letters applicable to the type of
insurance coverage and premium rates submitted, and that such rates, actuarial
memorandum, supporting rate materials and rate manual pages are in compliance
with the applicable laws, regulations and circular letters to the best
of my knowledge and belief. I further hereby certify that the information
relating to rates set forth in the Accident and Health Insurance Standard
Transmittal Form as submitted with, and made part of this filing, is true
to the best of my knowledge and belief. I understand that the
Department of Financial Services will rely on this certification, and should it be determined
that this certification is materially false or incorrect, appropriate
corrective and disciplinary action, as authorized by law, will be taken
by the Department of Financial Services against the company and the officer completing
this certification. |