N.J. Admin. Code § Tit. 11, ch. 4, subch. 9, app B
Current through Register Vol. 56, No. 24, December 18, 2024
| NEW JERSEY FORM NA--1 | ||||
| NON-ADOPTION OF PROSPECTIVE LOSS COST | ||||
| 1. | Insurer: | ....................... | NAIC#: | ....................... |
| ....................... | ....................... | |||
| ....................... | ....................... | |||
| ....................... | ....................... | |||
| ....................... | ....................... | |||
| ....................... | ....................... | |||
| ....................... | ....................... | |||
| ....................... | ....................... | |||
| ....................... | ....................... | |||
| 2. | Rating Organization Affiliation: ........................................ | |||
| 3. | Line of Insurance: ...................................................... | |||
| 4. | Rating Organization Designation Number: ................................. | |||
| 5. | Effective Date of Non-Adoption: ......................................... | |||
| 6. | Rating Organization Designation Number | |||
| Currently Being Used: ................................................... | ||||
| 7. | Effective Date of Use: .................................................. | |||
N.J. Admin. Code Tit. 11, ch. 4, subch. 9, app B