"Affidavit - Insurance Data Security Act" - Delaware

Affidavit - Insurance Data Security Act is a legal document that was released by the Delaware Department of Insurance - a government authority operating within Delaware.

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STATE OF DELAWARE
OFFICE OF THE
DEPARTMENT OF INSURANCE
COMMISSIONER
AFFIDAVIT
INSURANCE DATA SECURITY ACT
I,
in my capacity as
_______________________________________,
_____________________________________________
(Name)
(Title)
of
hereby certify that
__________________________________________________
(Group or Company Name)
is in compliance with
18 Del. Chapter
86.
____________________________________________________
(Group Name & Number OR Company Name & NAIC Number)
In the event of a cybersecurity event,
will notify
____________________________________________________
(Group or Company Name)
the Commissioner as promptly as possible but in no later than 3 business days from the licensee’s
determination that a cybersecurity event has occurred pursuant to
18 Del. C. §
8606.
DATED this
day of
, 20
(Signature)
STATE OF
COUNTY OF
Personally appeared before me the above named
,
personally known to me, who, being duly sworn, deposes and says that he/she executed the above instrument and
that the statements and answers contained therein, are true and correct to the best of his/her knowledge and belief.
Subscribed and sworn to before me this
day of
, 20
(Notary Public)
(SEAL) My commission expires:
1351 West North Street, Dover, DE 19904 • insurance.delaware.gov
(302) 674-7300 Dover • (302) 739-5280 fax • (302) 577-5280 Wilmington
STATE OF DELAWARE
OFFICE OF THE
DEPARTMENT OF INSURANCE
COMMISSIONER
AFFIDAVIT
INSURANCE DATA SECURITY ACT
I,
in my capacity as
_______________________________________,
_____________________________________________
(Name)
(Title)
of
hereby certify that
__________________________________________________
(Group or Company Name)
is in compliance with
18 Del. Chapter
86.
____________________________________________________
(Group Name & Number OR Company Name & NAIC Number)
In the event of a cybersecurity event,
will notify
____________________________________________________
(Group or Company Name)
the Commissioner as promptly as possible but in no later than 3 business days from the licensee’s
determination that a cybersecurity event has occurred pursuant to
18 Del. C. §
8606.
DATED this
day of
, 20
(Signature)
STATE OF
COUNTY OF
Personally appeared before me the above named
,
personally known to me, who, being duly sworn, deposes and says that he/she executed the above instrument and
that the statements and answers contained therein, are true and correct to the best of his/her knowledge and belief.
Subscribed and sworn to before me this
day of
, 20
(Notary Public)
(SEAL) My commission expires:
1351 West North Street, Dover, DE 19904 • insurance.delaware.gov
(302) 674-7300 Dover • (302) 739-5280 fax • (302) 577-5280 Wilmington