Reg 64: Insurer Corporate Designee Form

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The Department requires each insurer to designate one individual per insurer as corporate officer responsible for its internal consumer services department.

Use this form to submit, confirm or update the existing information in our records as stipulated in Circular Letter No. 14.

The Department must be informed immediately whenever there is a change in any of the information on file with DFS.

Address

This should be the general phone number that we (DFS) will use to follow up on correspondence with you.