Name

Address

Telephone Number of Petitioner or Attorney

BEFORE THE INSURANCE COMMISSIONER OF THE STATE OF CALIFORNIA

In the Matter of

)

No.

)

Insurance Company,

)

PETITION TO INTERVENE

)

Applicant (or

)

Respondent).

)

)

______________________________ hereby petitions the Insurance Commissioner to intervene in this proceeding and in support of its petition alleges:

I

Petitioner is ______________________________ (describe the status of petitioner.)

II

The position and interest of petitioner in this proceeding is

III

The grounds for petitioner's proposed intervention are

IV

Petitioner's position is in support of (or in opposition to) the action sought by ____________________Insurance Company in this proceeding in that

Wherefore, petitioner requests that the Insurance Commissioner allow petitioner to intervene in this proceeding, having all rights and responsibilities accorded any other party to the proceeding.

DATED:

Respectfully Submitted,

____________________

Signature

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).

History

1. New article and section filed 2-1-93; operative 2-1-93 (Register 93, No. 6). For prior history, see Register 92, No. 39.