Section 3.21.186. Preacquisition notification; potential competitive impact; Form E.

    A domestic insurer including any person controlling a domestic insurer required to file notice under AS 21.22.010, and a nondomiciliary insurer licensed to do business in this state required to file notice under AS 21.22.065 of a proposed merger or acquisition shall furnish the required preacquisition notification information on Form E, made a part of this section in substantially the following form: 
 FORM E 
 PRE-ACQUISITION NOTIFICATION FORM REGARDING THE 
POTENTIAL COMPETITIVE IMPACT OF A PROPOSED 
MERGER OR ACQUISITION BY A NON-DOMICILIARY 
INSURER DOING BUSINESS IN THIS STATE 
OR BY A DOMESTIC INSURER 
 __________________ 
			(Name of Applicant) 
________________________
 (Name of Other Person Involved in Merger or Acquisition) 
Filed with the Division/Department of Insurance of the State of ____________ 
Date: _____________, 20____  
Name, Title, Address, Electronic Mail Address, and Telephone Number of Individual Completing This Statement: 
________________________
________________________
________________________
________________________
ITEM 1. NAME AND ADDRESS 
    State the name and address of each person identified above who is providing notice of the person's involvement in a pending acquisition or change in corporate control. 
ITEM 2. NAME AND ADDRESS OF AFFILIATED COMPANIES 
    State the name and address of each person affiliated with those listed in Item 1. Describe their affiliations. "Affiliated" has the meaning given in AS 21.22.200. 
ITEM 3. NATURE AND PURPOSE OF THE PROPOSED MERGER OR ACQUISITION 
    State the nature and purpose of the proposed merger or acquisition. 
ITEM 4. NATURE OF BUSINESS 
    State the nature of the business performed by each person identified in response to Items 1 and 2. 
ITEM 5. MARKET AND MARKET SHARE 
    State specifically what market and market share in each relevant insurance market each person identified in Items 1 and 2 currently experiences in this state. Provide historical market and market share data for each person identified in Items 1 and 2 for the past five years and identify the source of the data. Provide a determination as to whether the proposed acquisition or merger, if consummated, would violate the competitive standards of the state under AS 21.22.065(d). If the proposed acquisition or merger would violate competitive standards, provide justification of why the acquisition or merger would not substantially lessen competition or create a monopoly in the state. "Insurance market" has the meaning given in AS 21.22.200. 
    Furnish the data and calculations necessary for the director to make a determination under AS 21.22.065(d). Furnish calculations, discussion, or other information that would constitute "other substantial evidence" under AS 2 l .22.065(f) or would provide information supportive of AS 21.22.065(g). 
    Furnish other information pertinent to the approval or pre-approval sought. If a Form A, an application for certificate of authority, or another filing for the company or affiliate of the company is pending before the director, identify and describe the associated filing. Note: The division may additionally choose to make additional calculations under AS 21.22.065 using the division's own data or data provided by the National Association oflnsurance Commissioners.. 
ITEM 6. EXEMPTION FROM AS 21.22.065 
    If a company is claiming an exemption from the requirements of AS 21.22.065 under the provisions of AS 21.22.065(j)(3), (5), or (7), furnish the relevant data, calculations, discussion, or other information necessary for the director to determine the appropriateness of the exemption. 
    If a company is claiming an exemption under the provisions of AS 21.22.065(j)(5)(A), a letter of pre-notification of acquisition may be submitted in lieu of a completed Form E. 
ITEM 7. SIGNATURE AND CERTIFICATION 
    Signature and certification are required as follows: 
 SIGNATURE 
________________________
                    (SEAL) 
________________________
                    (Name of Applicant) 
________________________
                    (Name)                                            (Title) 
Attest: 
________________________
(Signature of Officer) 
________________________
     (Title)                                                                  
 CERTIFICATION 
________________________
                 (Signature)                                                  
________________________
                 (Type or print name below)                                   
________________________

Authorities

21.06.090;21.22.065;21.22.130;21.22.200

Notes

Reference

3 AAC 21.187

Authority

AS 21.06.090 AS 21.22.065 AS 21.22.130 AS 21.22.200

History

Eff. 1/12/95, Register 133; am 11/26/2015, Register 216