Consent to Rate

Consent to Rate Procedures

For information regarding a Consent to Rate Application Reference:

• Regulation I-2010-03
• Bulletin 51
• Bulletin 111

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
• 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:
Nikki M Garand AINS, AIS, API, CPIW, ACSR
Telephone: (802) 828-4840
Nicole.Garand@state.vt.us

Mail the completed Consent to Rate Application to:
Department of Financial Regulation
Insurance Rates & Forms
89 Main Street
Montpelier, VT 05620-3101