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

To appoint the Insurance Commissioner of Connecticut with the power of attorney in any action or proceeding against you as a non-resident conducting individual reinsurance business 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 Individual Reinsurance Intermediary Power Of Attorney Step 1: On the first blank line, enter your name.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 2: On the second blank line, enter the city or town where you live.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 3: On the third blank line, enter the state in which you live.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 4: On the fourth blank line, enter your name.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 5: On the fifth blank line, enter your name.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 6: On the sixth blank line, enter the date on which you are completing this form.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 7: On the seventh blank line, enter the month during which you are completing this form.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 8: On the eighth blank line, enter the last two digits of the year in which you are completing this form.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 9: On the ninth blank line, enter your signature.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 10: On the tenth blank line, print your name.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 11: The form must then be signed by a notary public or a commissioner of the Superior Court in your state. On the first three blank lines, they will enter the day, month and year of the date on which you appeared before them.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 12: On the next blank line, the notary public or commissioner will enter their state.

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 13: On the next blank line, the notary public or commissioner will enter your name. They will then enter their signature and the date on which their commission expires.