Cal. Code Regs. tit. 10, § 2683.22 – Verification of Forms Required.

(a) Information statements, registration statements, annual supplements, reports of extraordinary dividends and distributions, reports of material changes, and disclaimers all shall be verified as follows:
1. (1) Those executed by domestic insurers shall be verified as provided in the Code of Civil Procedure for the verification of pleadings (Sections 446 and 2015.5 CCP); the same shall apply to such papers executed in a jurisdiction whose law on the subject of verification of pleadings is the same as that of this State.
2. (2) Otherwise, such papers shall be duly sworn to under oath before a public officer lawfully authorized to administer oaths, and the public officer's certificate evidencing such fact shall be attached thereto;
(b) Reports of declaration of regular dividends may be in unverified letter form by an executive officer of the declarant or the filing member who knows the facts. A single such report may be made for all members of an insurance holding company system provided the officer making the same knows the facts. However, each member reported for must be listed by name and the amount of its dividend separately stated.
(c) An acceptable form of California verification is:
“State of California
)
)
ss
County of San Mateo
)
John Smith, the undersigned, hereby certifies under penalty of perjury that he is the President of ABC Insurance Company, registrant in the foregoing registration statement; that he has read the said registration statement and knows the contents thereof and that the same are true of his own knowledge.
Dated this __________ day of__________ 19___, at Redwood City, California.
/S/ John Smith_________
/T/ John Smith President”
An acceptable form of verification by a foreign applicant is as follows:
“State of Illinois
)
)
ss
County of Cook
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John Smith, first being duly sworn, deposes and says that he is the President of ABC Insurance Company, the person preparing and filing the attached paper (s); that he has read the same and knows the contents thereof and that the contents are true of his own knowledge.
/S/ John Smith________
/T/ John Smith President
Subscribed and sworn to before me this __________day of__________, 19__________.
____________________(Notarial Seal)
Notary Public in and for said County and State My commission expires ______________________________”
The examples set forth above do not forbid verification of certain allegations on the basis of affiant's information and belief where that is permissible according to law.
(d) In the case of papers described in (a) of this section filed by foreign insurers they shall be verified (except as provided in (b) above) according to the applicable law and regulations of the place where the same were signed by the executive officer of the person making the filing.

History

1. Editorial correction of subsection (c) (Register 95, No. 42).

2. Change without regulatory effect amending subsection (a)(2) filed 7-14-2021 pursuant to section 100, title 1, California Code of Regulations (Register 2021, No. 29). Filing deadline specified in Government Code section 11349.3(a) extended 60 calendar days pursuant to Executive Order N-40-20.