California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 11.3 - Mutual Fund Investments in Variable Products › Section 2534.46 - Forms

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The following
				  forms shall be used pursuant to this article:
(1) Certificate of Compliance:
VARIABLE CONTRACT CERTIFICATE OF
					 COMPLIANCE
Name of Applicant Company:
Address:
Date:
Person to Whom Correspondence Should Be Addressed:
(Directions: This Certificate may be utilized in lieu of
					 applicant seeking a prior approval of its changes in its variable contract
					 operation; such an approval being based upon a full review by the Department.
					 This Certificate must be executed by an executive officer of the applicant, who
					 has responsibility for applicant's variable contract operation. Please answer
					 each question in the accompanying Forms completely. If more room is needed,
					 attach a sheet of paper indicating the question being responded to.)
TO THE INSURANCE COMMISSIONER OF THE STATE OF
					 CALIFORNIA
I, [____________________], a duly appointed executive
					 officer of the Applicant Company, having responsibility for its variable
					 contract operation, do state, under oath, that I have carefully read this
					 Certification and the attached Forms, and that the information and answers to
					 questions herein is true to the best of my own knowledge, except as to those
					 specifically stated to be upon information and belief, and as to those I
					 believe the answers to be true.
Further I state that the variable contract changes
					 described herein comply with pertinent statutes, regulations, and bulletins,
					 and have been reviewed by me, or that I have been advised by competent legal
					 counsel, representing the company, that the changes are in full compliance with
					 the California Insurance Code, Regulations, Bulletins, and underlying
					 guidelines. In particular, I state that this filing complies with Title 10
					 California Code of Regulations sections
					 2534.40-2534.46.
All material changes occurring since my company's most
					 recent amendment of its variable contract qualification, (and the approval or
					 acknowledgment by the Department of that amendment), are explained and
					 described herein, or in accompanying materials and documentation. The
					 information given here does not relate to any changes previously submitted to
					 the Department and disapproved by the Department, unless corrective action has
					 been taken by my company to meet the objections previously stated by the
					 Department to those changes.
I understand and acknowledge that false statements which
					 are intended to mislead or deceive the Commissioner, or the willful omission of
					 any material fact with the same intent, may be punishable under such sections
					 of the Insurance Code as may be applicable.
WITNESS MY SIGNATURE this [__________] day of [__________],
					 [___], at [__________].
Signature
___________________________[___________
]
(Affiant)
___________________________[___________
]
(Printed or typed name and
							 title)
SUBSCRIBED AND SWORN TO before me on the date and year
					 above written.
[________________________________________]
(Notary Public in and for said County and State)
My commission expires [_______________]
(2) New Matters Form:
DESCRIPTION OF NEW MATTERS FORM
1.
Background Information:
a. Applicant's name:
b. Applicant's state of domicile:
c. Date of applicant's California Certificate
				  of Authority:
d. Date of
				  applicant's original qualification for California Variable Authority:
e. Date and type of applicant's last
				  amendment to its California Variable Authority:
f. What variable products is the applicant
				  currently offering in California?
g. Has the applicant ever been subject to a
				  regulatory disciplinary action, at either a state or federal level, for actions
				  arising out of its variable annuity or variable life business? If yes, identify
				  each action:
2. What
				  amendments to the applicant's current variable qualification are being
				  requested in this application? (Be sure to include a new product form, new fund
				  form, new subaccount/portfolio form and/or other material changes form for each
				  applicable amendment).
a. New
				  Product:
b. New Fund:
c. New Subaccount/Portfolio:
d. Other Material
				  Changes:
3. Has the
				  applicant included an original certificate of compliance?
4. Please identify the type(s) of investments
				  presented in this application (for example):
a. Mutual Fund (2534.42 (b)(1))
b. ERISA or Other Plan
				  (2534.42.(b)(2))
c. California
				  Insurance Code Section
				  10506.3
				  Product (2534.42(b)(3))
d. Issued
				  to a trust under California Insurance Code Section
				  10541
				  (2534.42(b)(4)
e. Private Placement
				  (2534.42(b)(5))?
5. If the
				  amendments set forth in the application require a filing with the Securities
				  and Exchange Commission, the application must include an effective prospectus
				  and statement of additional information.
Applications for amended
				  variable qualification will not be accepted for filing until an effective
				  prospectus has been submitted.
6. If the amendments set forth in the
				  application do not require a filing with the Securities and Exchange
				  Commission, the application must include a private placement memorandum or
				  comparable disclosure documentation available to purchasers of the product(s).
Applications for amended variable qualification will not be accepted for
				  filing until disclosure documents have been
				  submitted
(3) New
				  Product Form
NEW PRODUCT FORM
1.
PRODUCT NAME:
What is the
				  name of the New Product?
2.
PRODUCT DESCRIPTION:
Provide a brief description of the New
				  Product.
3.
POLICY
				  FORM
: Attach a specimen copy of the New Product policy form.
4.
MARKETING:
How will this new
				  product be marketed? Who will be the target market for this new product? Attach
				  copies of any advertising or marketing information that will be distributed to
				  the applicant's marketing agents and/or sales force.
5.
DISTRIBUTION:
How will the
				  New Product be distributed? Will a third party handle distribution? If yes,
				  attach a copy of the distribution agreement.
6.
ADMINISTRATION:
Will the
				  administration of this New Product be delegated to a third party? If yes,
				  attach a copy of the administration agreement. Administration of a life or
				  annuity product by a third party will require a third party administrator's
				  license (California Insurance Code Section
				  1759).
7.
SALES COMMISSION:
What is the
				  sales commission on this New Product?
8.
SURRENDER CHARGE
: What is the
				  surrender charge on the New Product?
9.
CONTRACT FEE:
What is the
				  annual contract fee on this New Product?
10.
MORTALITY AND EXPENSE RISK
				  CHARGES:
What are the mortality and expense risk charges on this New
				  Product?
11.
PRODUCT
				  PROSPECTUS AND STATEMENT OF ADDITIONAL INFORMATION:
Does this new
				  product require the filing of a prospectus with the Securities and Exchange
				  Commission? If yes, attach a copy of the product prospectus and statement of
				  additional information. (All insurers must provide an effective product
				  prospectus and statement of additional information before an application to
				  amend their variable qualification will be accepted for filing).
12.
PLAN DOCUMENTS:
If this New
				  Product is not subject to filing with the Securities and Exchange Commission,
				  attach a copy of the Plan Documents or other documentation which provides
				  information about the new product.
(4) New Fund Form:
NEW FUND FORM
1.
FUND NAME:
What is the name
				  of the New Fund?
2.
INVESTMENT ADVISOR:
Who is the investment advisor for the new
				  fund? Attach a copy of the investment advisory agreement.
3.
DISTRIBUTOR:
Who is the
				  distributor (broker/dealer) for the New Fund?
4.
USE OF FUND(S) BY OTHER INSURANCE
				  COMPANIES:
Has this New Fund ever been qualified for use in California
				  as an investment for variable products? If yes, please provide the names of the
				  insurance companies you know are qualified to offer this fund.
5.
DISCIPLINARY ACTIONS:
Has
				  this New Fund, its investment advisor or its broker-dealer been subject to any
				  disciplinary action by the Securities and Exchange Commission, the California
				  Department of Corporations or any other State securities regulator, the
				  National Association of Securities Dealers or any other self-regulatory
				  organizations, or the Commodities Futures Trading Commission within the past
				  ten years? If yes, attach a copy of each action.
6.
FUND PROSPECTUS AND STATEMENT OF
				  ADDITIONAL INFORMATION:
Does this New Fund require a filing with the
				  Securities and Exchange Commission? If yes, attach a copy of the effective fund
				  prospectus and statement of additional information. The fund prospectus and
				  statement of additional information must be effective before the application
				  for amended variable qualification will be accepted for filing.
7.
PLAN DOCUMENTS:
If the New
				  Fund is not subject to filing with the Securities and Exchange Commission,
				  attach a copy of the Plan Documents or other documentation which provides
				  information about the New Fund.
(5) New Subaccount Form:
NEW SUBACCOUNT FORM
1.
SUBACCOUNT NAME:
What is the
				  name of the New Subaccount?
2.
INVESTMENT OBJECTIVE:
What is the principal investment objective
				  of the New Subaccount?
3.
SUBACCOUNT MANAGER:
Who is the Subaccount manager for the New
				  Subaccount?
4.
FEES:
Are any fees charged by the New Subaccount? If yes, identify each
				  charge.
5.
DISCIPLINARY
				  ACTIONS:
Has the New Subaccount or its portfolio manager been subject to
				  any disciplinary action by the Securities and Exchange Commission, the
				  California Department of Corporations or any other State securities regulator,
				  the National Association of Securities Dealers or any other self-regulatory
				  organizations, or the Commodities Futures Trading Commission within the past
				  ten years? If yes, attach a copy of the action.
6.
PROSPECTUS AND STATEMENT OF
				  ADDITIONAL INFORMATION:
Does the New Subaccount require a filing with
				  the Securities and Exchange Commission? If yes, attach a copy of the effective
				  product and/or fund prospectus and statement of additional information relating
				  to the addition of this New Subaccount. The product and/or fund prospectus must
				  be effective before the application for amended variable qualification will be
				  accepted for filing.
7.
PLAN
				  DOCUMENTS OR OTHER INFORMATIONAL MATERIAL:
If the New Subaccount is not
				  subject to Securities and Exchange Commission filing, attach a copy of the Plan
				  Documents or other informational material which provides information about the
				  subaccount/portfolio.
(6)
				  Other Material Changes Form:
OTHER MATERIAL CHANGES
1.
OTHER MATERIAL CHANGES:
Identify any material changes to the applicant's current variable
				  qualification.
(Examples of material changes are as follows:
1) change of custodian;
2) change of administrator;
3) change of broker/dealer;
4) change of investment advisor;
5) change of portfolio manager;
6) change in fund or portfolio
				  name;
7) change in fund or
				  portfolio investment objective;
8)
				  disciplinary action taken by the Securities and Exchange Commission, the
				  California Department of Corporations or any other State securities regulator,
				  the National Association of Securities Dealers or any other self-regulatory
				  organizations, or the Commodities Futures Trading Commission against fund,
				  investment advisor, portfolio manager or broker/dealer;
9) regulatory action against the insurer
				  arising out of its variable annuity or variable life business;
10) amendments to:
a) the Board of Directors
				  resolutions,
b) the agreement
				  establishing the separate account,
c) the variable contract, or
d) registration statement or prospectus; and
				  11) any substantial change in management of the Separate
				  Account).
2.
PROSPECTUS AND STATEMENT OF ADDITIONAL INFORMATION:
If filing with
				  the Securities and Exchange Commission is required for any of the changes
				  listed above, attach a copy of the effective prospectus and statement of
				  additional information which reflects these changes.
3.
PLAN DOCUMENTS:
If filing
				  with the Securities and Exchange Commission for any of the changes identified
				  above is not required, attach a copy of the Plan Documents or other
				  documentation which provides information about these
				  changes.