Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 21 - Insurer - Financial › Article 1 - Insurance Holding Companies › 3 AAC 21.090 - Annual registration of insurers; statement filing; Form B

Current through May 31, 2024
Except as provided in
					 3 AAC 21.110, an insurer required to file an annual
					 registration statement under
					 AS
					 21.22.060 shall furnish the required
					 information on Form B, made part of this section in substantially the following
					 form:
FORM B
INSURANCE HOLDING COMPANY SYSTEM ANNUAL REGISTRATION
					 STATEMENT
Filed with the Insurance Division/Department of the State
					 of ________
By
_________________
(Name of Registrant)
On behalf of the Following Insurance Companies
Name Address
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Date: ______________, 20 _____
Name, Title, Address, Electronic Mail Address, and
					 Telephone Number of lndividual to Whom Notices and Correspondence Concerning
					 This Statement Should be Addressed:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
ITEM 1. IDENTITY AND CONTROL OF REGISTRANT
Furnish the exact name of each insurer registering or being
					 registered (hereinafter called "the registrant"); the home office address and
					 principal executive offices of each registrant; the date on which each
					 registrant became part of the insurance holding company system; and the method
					 by which control of each registrant as acquired and is
					 maintained.
ITEM 2.
				  ORGANIZATION CHART
Furnish a chart or listing that clearly presents the
					 identity of and interrelationship of each affiliated person within the
					 insurance holding company system. The chart or listing must show the percentage
					 of each class of voting securities of each affiliate that is directly or
					 indirectly owned by another affiliate. If control of any person within the
					 system is maintained other than by the ownership or control of voting
					 securities, indicate the basis of the control. Indicate the type of
					 organization (e.g., corporation, trust, partnership) and the state or other
					 jurisdiction of domicile of each person specified in the chart or
					 listing.
ITEM 3. THE
				  ULTIMATE CONTROLLING PERSON
Furnish the following information about the ultimate
					 controlling person in the insurance holding company system:
(a) name;
(b) home office address;
(c) principal executive office
				  address;
(d) the organizational
				  structure of the person, i.e., corporation, partnership, individual, trust,
				  etc.;
(e) the principal business of
				  the person;
(f) the name and address
				  of a person who holds or owns 10 percent or more of any class of voting
				  security, the class of the security, the number of shares held of record or
				  known to be beneficially owned, and the percentage of class so held or owned;
				  and
(g) if a court proceeding
				  involving a reorganization or liquidation is pending, the title and location of
				  the court, the nature of the proceeding, and the date when
				  commenced.