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

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.

Form Details:

  • The latest edition provided by the Connecticut Insurance Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form AR-1 by clicking the link below or browse more documents and templates provided by the Connecticut Insurance 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
I,
,
(name of senior officer)
(title of officer)
of
, 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)
1.
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).
2.
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.
3.
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.
4.
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
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
I,
,
(name of senior officer)
(title of officer)
of
, 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)
1.
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).
2.
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.
3.
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.
4.
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