These 4 pages are informational only and do not need to be submitted with your filings

These 3 pages are informational only and do not need to be submitted with your filings! Louisiana Department of Insurance Property & Casualty Transmittal Document Form Filing Schedule Rate/Rule Filing Schedule INSTRUCTIONS PROPERTY AND CASUALTY TRANSMITTAL DOCUMENT 1. Reserved for Insurance Department Use Only 2. Insurance Department Use Only: This box includes the following information: a. Date the filing is received - by the Louisiana Department of Insurance b. Examiner - analyst who reviews the filing and assigns final disposition c. Date Assigned - date the filing is assigned to the Examiner d. Disposition - this is the disposition that the Department assigns—approved, acknowledged, withdrawn, disapproved, etc. e. Date of Disposition of the Filing- date the filing is closed f. State Filling Number: the number the LA DOI assigns to the filing g. SERFF Filing Number: SERFF assigned number 3. Group Name and Group NAIC Number- This number is assigned by NAIC. 4. Company Name(s), State of Domicile, NAIC Number and FEIN Number: Each company to which this filing applies must be listed and the company information must be supplied. A filing that lists a group without supplying company info will be disapproved as incomplete. 5. Company Tracking Number: The filing number, assigned by the insurance company, if any. 6. Contact Info of Filer or Corporate Officer: Supply information on the person the Examiner should contact if there is ...