Consent to Rate

Consent to Rate Procedures

All Consent to Rate applications must be submitted via SERFF. The SERFF Project Name should only state "Consent to Rate". The SERFF Filing Description should only state the name of the insured's.

For information regarding a Consent to Rate Application please reference:

The completed application must have the following information:

  • Name and address of the Insurance Company
  • NAIC Code
  • Name and Address of the Insured
  • Description and location of the risk
  • Policy Number
  • Policy type
  • Effective date of the Endorsement
  • Manual Premium (if applicable)
  • Higher Premium Charged (if applicable)
  • Reason for Non-Standard coverage
  • Description of exposure or coverage eliminated

When filing a Consent to Rate form seeking to attach a pollution exclusion to liability coverage, please remember to attach a copy of all policy forms you are requesting to exclude.

  • Signature of Insured
  • Signature of the Broker or Insurance company representative

The application must be signed by all named insureds.  If the named insured is a Corporation, then only one signature is needed.  If the application is submitted by U.S mail, a stamped self addressed envelope must be provided to receive an acknowledgement.

If you have any quesitons regarding the Consent to Rate Application contact:

Kevin Gaffney


PDF icon form-consent-rate-application.pdf15.95 KB