Alaska Admin. Code tit. 3, § 21.180
An insurer required to file a statement under AS 21.22.060 shall also furnish the required information on Form C, made a part of this section in substantially the following form: FORM C SUMMARY OF CHANGES TO REGISTRATION STATEMENT ________________________ By (Name of Registrant) On Behalf of the Following Insurance Companies NameAddress _________ _________ _________ _________ ________________________ Name, Title, Address, Electronic Mail Address, and Telephone Number of Individual to Whom Notices and Correspondence Concerning This Statement Should be Addressed: _________ _________ _________ _________ Furnish a brief description of all items in the current registration statement that represent changes from the most recently filed registration statement. The description must be in a manner to permit the proper evaluation by the director, and must include specific references to item numbers in the annual registration statement and to the terms contained in it. Changes occurring under Item 2 of Form B, to the extent that changes in the percentage of each class of voting securities held by each affiliate are concerned, need only be included where the changes are ones that result in ownership or holdings of 10 percent or more of voting securities, loss or transfer of control, or acquisition or loss of partnership interest. Changes occurring under Item 4 of Form B need only be included when an individual is made a director or executive officer of the ultimate controlling person for the first time; a director's or executive officer's responsibilities for the ultimate controlling person are terminated; or an individual is named president, chief executive officer, treasurer, or chief financial officer of the ultimate controlling person. If a transaction disclosed on the prior year's annual registration statement has been changed, the nature of the change must be included. If a transaction disclosed on the prior year's annual registration statement has been completed, furnish the mode of completion and any flow of funds between affiliates resulting from the transaction. The insurer shall furnish a statement affirming that transactions entered into since the filing of the prior registration statement are not part of a plan or series of like transactions the purpose of which is to avoid statutory threshold amounts and the review that might otherwise occur. SIGNATURE AND CERTIFICATION Signature and certification are required as follows: SIGNATURE ________________________
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(Eff. 10/21/92, Register 124; am 11/26/2015, Register 216)
Authority: AS 21.06.090, AS 21.22.060, AS 21.22.130