Ill. Admin. Code tit. 50, § 3801.ILLUSTRATION B
| The following illustrates an acceptable statement to be filed when the opining actuary or pre-approved individual has indicated reliance on data provided by company personnel: | |
| I [name of officer], [title], of [name of carrier], hereby affirm that the listings (summaries, rate manuals, etc.) of relevant data prepared for and submitted to [name of appointed actuary] were prepared under my direction and, to the best of my knowledge and belief, are substantially accurate and complete. | |
| Name of Officer of the Carrier (typewritten) | |
| Signature of Officer of the Carrier | |
| Date |