Cal. Code Regs. tit. 10 § 2623.4
Name
Address
Telephone Number of Petitioner or Attorney
BEFORE THE INSURANCE COMMISSIONER OF THE STATE OF CALIFORNIA
| In the Matter of | ) | |||
| ) | Case No. | |||
| Insurance Company, | ) | |||
| ) | REQUEST FOR | |||
| Applicant (or | ) | INTERIM FUNDING | ||
| Respondent). | ) | |||
| ) | ||||
Petitioner ____________________ hereby request Interim Funding in the above matter.
I
On (date) ____________________ Petitioner became a party (or) participant (whichever is appropriate) in the above hearing.
II
On (date) ____________________ The Commissioner issued a Preliminary Determination of Eligibility to Receive Compensation in this matter.
III
___________________________
Petitioner
____________________
has substantially contributed to the proceeding to date in that (describe contribution)
___________________________
IV
___________________________
A detailed description of the work performed and its relevance to the proceedings is as follows: (
cite to the record)
___________________________
___________________________
V
A detailed description of services and expenditures of ____________________ in this proceeding are attached and made a part of this petition and is summarized as follows:
VI
WHEREFORE, Petitioner requests that the Commissioner issue an order awarding interim funding found in this Petition and the attached exhibits.
VII
___________________________
But for the ability to receive interim funding Petitioner continued participation in the proceeding would be jeopardized because:
___________________________
DATED:
Respectfully Submitted,
____________________
Signature
Cal. Code Regs. Tit. 10, § 2623.4
Note: Authority cited: Sections 1861.10, 12921 and 12926, Insurance Code. Reference: Section 1861.10(a), Insurance Code; and CalFarm Insurance Company, et al. v. George Deukmejian, et al., 48 Cal.3d 805 (1989).