40-5209. Same; required forms; contents.

      40-5209.   Same; required forms; contents.A notice of transfer and form for response by an insured tosuch anotice shall bedeemed to be sufficient for the purposes of this act if it substantiallyconforms with the followingform:

NOTICE OF TRANSFER

IMPORTANT: THIS NOTICE AFFECTS YOUR CONTRACT RIGHTS.PLEASE READ IT CAREFULLY.

Transfer of Policy

      The [ABC Insurance Company] has agreed to replace us as your insurerunder[insertpolicy/certificate name and number] effective [insert date]. The[ABCInsurance Company's]principal place of business is [insert address] and certain financialinformation concerning bothcompanies is attached, including (1) ratings for the last five years, ifavailable, or for such lesserperiod as is available from two nationally recognized insurance ratingservices; (2) balance sheetsfor the previous three years, if available, or for such lesser period as isavailable and as of thedate of the most recent quarterly statement; (3) a copy of the Management'sDiscussion andAnalysis that was filed as a supplement to the previous year's annualstatement; and (4) anexplanation of the reason for the transfer. You may obtain additionalinformation concerning[ABC Insurance Company] from reference materials in your local library orbycontacting yourInsurance Commissioner at [insert address and phone number].

      The [ABC Insurance Company] is licensed to write this coverage in yourstate. TheCommissioner of Insurance in your state has reviewed the potential effect ofthe proposedtransaction, and has approved the transaction.

Your Rights

      You may choose to consent to or reject the transfer of your policy to [ABCInsuranceCompany]. If you want your policy transferred, you may notify us in writingbysigning andreturning the enclosed pre-addressed, postage-paid card or by writing to us at:

      [Insert name, address and facsimile number of contact person.]

      Payment of your premium to the assuming company will also constitute acceptanceof the transaction. However, a method will be provided to allow you to pay thepremium whilereserving the right to reject the transfer.

      If you reject the transfer, you may keep your policy with us or exercise anyoption underyour policy. If we do not receive a written rejection you will, as a matter oflaw, have consentedto the transfer. However, before this consent is final you will be provided asecond notice of thetransfer 24 months from now. After the second notice is provided, youwill have onemonth to reply. If you have paid your premium to the [ABC InsuranceCompany],withoutreserving your right to reject the transfer, you will not receive a secondnotice.

Effect of Transfer

      If you accept this transfer, [ABC Insurance Company] will be yourinsurer. Itwill havedirect responsibility to you for the payment of all claims, benefits and forall other policyobligations. We will no longer have any obligations to you.

      If you accept this transfer, you should make all premium payments and claimssubmissions to [ABC Insurance Company] and direct all questions to[ABCInsuranceCompany].

      If you have any further questions about this agreement, you may contact [XYZInsurance]or [ABC Insurance].

                              Sincerely,                                                                                                  ________________________[XYZ Insurance Company        [ABC Insurance Company   111 No Street                 222 No Street           Smithville, USA               Jonesville, USA         555/555-5555]                 333/333-3333]        

     
For your convenience, we have enclosed a pre-addressed postage-paid responsecard. Please take time now to read the enclosed notice and complete and returnthe response card to us.

[Notice Date]

RESPONSE CARD

_____________________