INSTRUCTIONS: CONNECTICUT NON-RESIDENT CORPORATION REINSURANCE INTERMEDIARY POWER OF ATTORNEY

To designate the state Insurance Commissioner with power of attorney to receive actions or proceedings against a non-resident corporation performing reinsurance intermediary in Connecticut, use the form discussed in this article. This document can be obtained from the website maintained by the government of the state of Connecticut.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 1: Enter the name of the non-resident corporation on the first blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 2: Enter the state of the non-resident corporation on the second blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 3: Enter the street address, city and state of the non-resident corporation's principal place of business on the third blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 4: Enter the name of the non-resident corporation on the fourth blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 5: Enter the date on which your board passed a resolution authorizing this decision on the fifth blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 6: Enter the month during which the resolution was passed on the sixth blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 7: Enter the last two digits of the year in which the resolution was passed on the seventh blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 8: Enter the date on which you are signing this form on the eighth blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 9: Enter the month in which you are signing this form on the ninth blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 10: Enter the last two digits of the year in which you are signing this form on the tenth blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 11: The president of the company should enter their signature on the eleventh blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 12: The president of the company should print their name on the twelfth blank line.

Connecticut Non-Resident Corporation Reinsurance Intermediary Power Of Attorney Step 13: The secretary of the company should sign and print their name on the last two blank lines.