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On-line Insurer Corporate Designee Form: Regulation 64 (11 NYCRR216.4)

The Department requires each insurer to designate one individual per insurer as corporate officer responsible for its internal consumer services department. This is the Designee Form used to confirm or update the existing information in our records including the fax number used to fax out complaint files as stipulated in Circular Letter No. 14 (2000). The Department must be informed immediately whenever there is a change in any information.

Select the following Link to access this Form:
Insurer Corporate Designee Form