Name

Address

Telephone Number of Petitioner or Attorney

BEFORE THE INSURANCE COMMISSIONER OF THE STATE OF CALIFORNIA

In the Matter of

)

)

Insurance Company,

)

REQUEST FOR FINDING

)

OF ELIGIBILITY TO

Applicant (or

)

SEEK COMPENSATION

Respondent).

)

)

____________________ hereby requests that the Insurance Commissioner find it eligible to seek compensation in Departmental proceedings. In support of its request, ____________________alleges:

I

____________________ represents a consumer interest not otherwise adequately represented, representation of which is necessary for a fair determination of the proceeding because

II

The individuals policyholder's economic interest or the economic interest of the members represented by a group or organization is small in comparison to the cost of effective participation because

III

The other interests Petitioner represents are as follows (or) Petitioner represents no other interests.

Wherefore, ____________________ requests that the Insurance Commissioner find it eligible to seek compensation in Departmental proceedings based on this petition and the attached exhibits.

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 section filed 2-1-93; operative 2-1-93 (Register 93, No. 6).