Insurance Company Termination "FOR CAUSE" Notice Individual & Business Entity Form for an Insurance Company to report a statutory termination for cause R.I. Gen. Laws § 27-2.4-16 requires a separate notification to the Insurance Commissioner when an insurance producer is terminated for cause. “For cause” terminations are defined by R.I. Gen. Laws § 27-2.4-14. All such terminations are required to be reported using this form. Notification MUST be submitted to the Insurance Commissioner within thirty (30) days of the “for cause” termination. R.I. Gen. Laws § 27-2.4-16(a) A copy of the notification MUST be provided to the insurance producer within fifteen (15) days of termination. R.I. Gen. Laws § 27-2.4-16(a) Person submitting this form Full Name Title Email Compliance contact if different from the person submitting this form Full Name Title Email Insurance Underwriting Company NAIC CoCode Terminated insurance producer Full Name Rhode Island insurance license number NPN Termination details Effective date of termination Date appointment was terminated in NIPR Were there any Rhode Island consumers identified as affected by the insurance producer’s actions that lead to the termination for cause? Yes No If there were any Rhode Island consumer affected, has the company made those consumers whole? Yes No Which statute(s) under R.I. Gen. Laws § 27-2.4-14 has been violated. (check all that apply) Providing incorrect, misleading, incomplete or materially untrue information in the license application; Violating any insurance laws, or violating any regulation, subpoena or order of the insurance commissioner or of another state’s insurance commissioner; Obtaining or attempting to obtain a license through misrepresentation or fraud; Improperly withholding, misappropriating or converting any monies or properties received in the course of doing insurance business; Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance; Having been convicted of a felony; Having admitted or been found to have committed any insurance unfair trade practice or fraud; Using fraudulent, coercive, or dishonest practices or demonstrating incompetence, untrustworthiness or financial irresponsibility in this state or in another place; Having an insurance producer license, or its equivalent, denied, suspended or revoked in any other state, province, district or territory or administrative action under this section; Forging another’s name to an application for insurance or to any document related to an insurance transaction; Cheating on an examination for an insurance license; Knowingly accepting insurance business from an individual who is not licensed; Failing to comply with an administrative or court order imposing a child support obligation; Failing to pay state income tax or comply with any administrative or court order directing payment of state income tax. In addition to the submission of this form, the following supporting documentation is required: A summary narrative of the investigation. If the licensee is a Rhode Island resident, provide a copy of the investigation. If there are Rhode Island consumers who were identified as affected by the insurance producer’s actions that lead to the termination for cause, provide a copy of the investigation. A summary narrative of the investigation. ? Copy of Investigation? CAPTCHA Get new captcha! What code is in the image? Enter the characters shown in the image. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank