(a)  Forms A, B, C, and D are guides in the preparation of the statements required by G.S. 58‑19‑15, 58‑19‑25, and 58‑19‑30.  They are not blank forms that are to be filled in.  The statements filed shall contain the numbers and captions of all items, but the text of the items may be omitted if the answers to the items are prepared in such a manner as to indicate clearly the scope and coverage of the items.  All instructions, whether appearing under the items of the form or elsewhere in the form, are to be omitted.  Unless expressly provided otherwise, if any item is inapplicable or the answer to the item is in the negative, a statement to that effect shall be made.

(b)  One complete copy of each statement, unless otherwise prescribed by the Commissioner, including exhibits and all other papers and documents filed as a part of the statement, shall be filed with the Commissioner by mail addressed to: Insurance Commissioner, State of North Carolina, Financial Compliance Section, P.O. Box 26387, Raleigh, North Carolina, 27611.  The copy or copies shall be manually signed in the manner prescribed on the form.  If the signature of any person is affixed under a power of attorney or other similar authority, a copy of the power of attorney or other authority shall also be filed with the statement.

(c)  Statements shall be prepared on paper 8 1/2" x 11" in size and bound at the top or the top left‑hand corner.  Exhibits and financial statements, unless specifically prepared for the filing, may be submitted in their original sizes.  All copies of any statement, financial statements, or exhibits shall be clear, easily readable, and suitable for photocopying.  Debits in credit categories and credits in debit categories shall be designated so as to be clearly distinguishable as such.  Statements shall be in the English language and monetary values shall be stated in United States currency.  If any exhibit or other paper or document filed with the statement is in a foreign language, it shall be accompanied by a translation into the English language and any monetary value shown in a foreign currency normally shall be converted into United States currency.

(d)  Information required by an item of Form A, Form B, or Form D may be incorporated by reference in answer or partial answer to any other item.  Information contained in any financial statement, annual report, proxy statement, statement filed with a governmental authority, or any other document may be incorporated by reference in answer or partial answer to any item of Form A, Form B, or Form D, provided the document or paper is filed as an exhibit to the statement.  Excerpts of documents may be filed as exhibits if the documents are extensive.  Documents currently on file with the Commissioner that had been filed within the preceding three years need not be attached as exhibits.  References to information contained in exhibits or in documents already on file shall clearly identify the material and shall specifically indicate that the material is to be incorporated by reference in answer to the item.  Matter shall not be incorporated by reference if incorporation would render the statement incomplete, unclear, or confusing.

(e)  If an item requires a summary or outline of the provisions of any document, only a brief statement shall be made as to the pertinent provisions of the document.  In addition to this statement, the summary or outline may incorporate by reference particular parts of any exhibit or document currently on file with the Commissioner that had been filed within the preceding three years and may be qualified in its entirety by the reference.  If two or more documents required to be filed as exhibits are substantially identical in all material respects except as to the parties thereto, the dates of execution, or other details, a copy of only one of the documents may be filed, along with a schedule identifying the omitted documents and setting forth the material details in which those documents differ from the documents filed.

(f)  Information required shall be given only insofar as it is known or reasonably available to the person filing the statement.  If any required information is unknown and not reasonably available to the person filing, either because the obtaining thereof would involve unreasonable effort or expense, or because it rests peculiarly within the knowledge of another person not affiliated with the person filing, the information may be omitted, subject to the following conditions:

(1)           The person filing shall give such information on the subject as it possesses or can acquire without unreasonable effort or expense, together with the sources thereof; and

(2)           The person filing shall include a statement either showing that unreasonable effort or expense would be involved or indicating the absence of any affiliation with the person within whose knowledge the information rests and stating the result of a request made to the person for the information.

(g)  If it is impractical to furnish any required information, document or report at the time it is required to be filed, there may be filed with the Commissioner as a separate document:

(1)           identifying the information, document or report in question;

(2)           stating why the filing thereof at the time required is impractical; and

(3)           requesting an extension of time for filing the information, document or report to a specified date.  The request for extension shall be deemed granted unless the Commissioner within 30 days after receipt thereof enters an order denying the request.

(h)  In addition to the information expressly required to be included in Form A, Form B, Form C, and Form D, there shall be added such further material information, if any, as may be necessary to make the information contained therein not misleading.  The person filing may also file such exhibits as it may desire in addition to those expressly required by the statement.  These exhibits shall be so marked as to indicate clearly the subject matters to which they refer.  Amendments to Forms A, B, C or D shall include on the top of the cover page the phrase "Amendment No. __________ to" and shall indicate the date of the amendment and not the date of the original filing.


History Note:        Authority G.S. 58‑2‑40; 58‑19‑15; 58‑19‑25; 58‑19‑30;

Eff. April 1, 1993;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.