Form AR-1 "Certificate of Assuming Insurer" - Connecticut

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What Is Form AR-1?

This is a legal form that was released by the Connecticut Insurance Department - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

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Download Form AR-1 "Certificate of Assuming Insurer" - Connecticut

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S T A T E O F C O N N E C T I C U T

INSURANCE DEPARTMENT

FORM AR-1

CERTIFICATE OF ASSUMING INSURER

(name of senior officer)

(title of officer)

, the assuming insurer

(name of assuming insurer)

under a reinsurance agreement(s) with one or more insurers domiciled in the State of

Connecticut, hereby certifies that

(name of assuming insurer)

Submits to the jurisdiction of any court of competent jurisdiction within the State of

Connecticut for the adjudication of any issues arising out of the reinsurance

agreement(s), agrees to comply with all requirements necessary to give such court

jurisdiction, and will abide by the final decision of such court or any appellate court in the

event of an appeal. Nothing in this paragraph constitutes or should be understood to

constitute a waiver of the Assuming Insurer’s rights to commence an action in any court

of competent jurisdiction in the United States, to remove an action to a United States

District Court, or to seek a transfer of a case to another court as permitted by the laws

of the United States or of any state in the United States. This paragraph is not intended

to conflict with or override the obligation of the parties to the reinsurance agreement(s)

to arbitrate their disputes if such an obligation is created in the agreement(s).

Designates the Insurance Commissioner of the State of Connecticut as its lawful

attorney upon whom may be served any lawful process in any action, suit or proceeding

arising out of the reinsurance agreement(s) instituted by or on behalf of the ceding

insurer.

Submits to the authority of the Insurance Commissioner of the State of Connecticut to

examine its books and records and agrees to bear the expenses of any such

examination.

Submits with this form a current list of insurers domiciled in the State of Connecticut

reinsured by Assuming Insurer and undertakes to submit additions to or deletions from

the list to the Insurance Commissioner at least once per calendar quarter.

Dated:

(name of assuming insurer)

By:

(name of officer)

(seal)

(title of officer)

P. O. Box 816 Hartford, CT 06142-0816

An Equal Opportunity Employer