31.07.01.08

.08 Forms.

A. Reference Filing Adoption Form.

  Date _________________
Space Reserved for Insurance
Department Use
Insurer Rate Filing Adoption
of Rating Organization Prospective
 Loss Costs Reference
Filing Adoption Form
State of Maryland
1. Insurer Name ____________________________
    Address ____________________________
____________________________
____________________________
____________________________
   Person Responsible for Filing ____________________________
    Title ___________________________ Telephone # __________________
2. Insurer NAIC # ____________________________
3. Line of Insurance ____________________________
4. Rating Organization ____________________________
5. Rating Organization Reference Filing # ____________________________
6. The above insurer hereby declares that it is a member, subscriber or service
purchaser of the named rating organization for this line of insurance. The insurer
hereby files to be deemed to have independently submitted as its own filing the
prospective loss costs in the captioned Reference Filing. The insurer's rates will
be the combination of the prospective loss costs and the loss cost multipliers and,
if utilized, the expense constants specified in the attachments.
7. Proposed Rate Level
   Change ____________ % Effective Date _________________
8. Prior Rate Level
   Change ____________ % Effective Date _________________
9. Attach "Summary of Supporting Information Form"
   (Use a separate Summary for each insurer-selected loss cost multiplier.)
10. Check one of the following:
      ( ) The insurer hereby files to have its loss cost multipliers and, if utilized,
           expense constants be applicable to future revisions of the rating
           organization's prospective loss costs for this line of insurance. The
           insurer's rates will be the combination of the rating organization's
           prospective loss costs and the insurer's loss cost multipliers and, if
           utilized, expense constants specified in the attachments.  The rates
           will apply to policies effective on or after the effective date of the rating
          organization's prospective loss costs. This authorization is effective
           until disapproved by the Commissioner, or amended or withdrawn
           by the insurer.
      ( ) The insurer hereby files to have its loss cost multipliers and, if utilized,
           expense constants be applicable only to the above Rating Organization
           Reference Filing.
B. Summary of Supporting Information Form.
Insurer Name: ____________________ Date: _______________________
NAIC Number: ___________________

State of Maryland
Insurer Rate Filing
Adoption of Rating Organization Prospective Loss Costs
Summary of Supporting Information Form
Calculation of Company Loss Cost Multiplier

1. Line, Subline, Coverage, Territory, Class, etc. combination to which this page applies:

________________________________________________________

2. Loss Cost Modification:

A. The insurer hereby files to adopt the prospective loss costs in the captioned reference filing: (CHECK ONE)

( ) Without modification. (factor = 1.000)

( ) With the following modification(s). (Cite the nature and percent modification, and attach supporting data and/or rationale for the modification.)

________________________________________________________
             ________________________________________________________

B. LOSS COST MODIFICATION Expressed as a Factor: _______
                (See examples below.)

NOTE: If expense constants are utilized, attach "Expense Constant Supplement", §C, below, or other supporting information. Do not complete items 3—7, below.

3. Development of Expected Loss Ratio. (Attach exhibit detailing insurer expense data and/or other supporting information.)

Selected Provisions
A. Total Production Expense ________________ %
B. General Expense ________________ %
C. Taxes, Licenses, and Fees ________________ %
D. Underwriting Profit and Contingencies ________________ %
E. Other (explain) ________________ %
F. TOTAL ________________ %
4A. Expected Loss Ratio: ELR =
       100% - 3F = ________________ %
4B. ELR in decimal form = ________________
5. Company Formula Loss Cost
       Multiplier: (2B/4B)= ________________
6. Company Selected Loss Cost
       Multiplier = ________________
       Explain any differences between 5 and 6:
       ________________________________________________
       ________________________________________________
7. Rate level change for the coverages to
     which this page applies: ________________ %
      ________________________________________________
      ________________________________________________
Example 1: Loss cost modification factor: If your company's
             loss cost modification is -10%, a factor of .90
             (1.000 - .100) should be used.
Example 2: Loss cost modification factor: If your company's
             loss cost modification is +15%, a factor of 1.15
             (1.000 + .150) should be used.
C. Expense Constant Supplement Form.
Insurer Name: _____________________ Date: ____________
NAIC Number: __________________________________________

State of Maryland
Expense Constant Supplement
Calculation of Company Loss Cost Multiplier
With Expense Constants

1. Development of Expected Loss Ratio. (Attach exhibit detailing insurer expense data and/or other supporting information.

Overall Selected
Provisions
Variable
Fixed
A. Total Production
     Expense
_______ ________ ________
B. General Expense _______ ________ ________
C. Taxes, Licenses,
     and Fees
_______ ________ ________
D. Underwriting Profit
     and Contingencies
_______ ________ ________
E. Other (explain) _______ ________ ________
F. TOTAL _______ ________ ________
2.A. Expected Loss
        Ratio: ELR =
        100% -
        Overall 1F =
_______
B. ELR expressed in
     decimal form =
_______
C. Variable Expected
      Loss Ratio VELR =
     100% - Variable 1F =
________
D. VELR in decimal
      form =
________
_________________________________________________________ _________________________________________________________
3. Formula Expense Constant:
    ((1.00+2B) - (1.00+2D)) x
                      Average Underlying Loss Cost =        ________
Formula Variable Loss Cost Multiplier: (2B+2D) =  ________
4. Selected Expense Constant =                                  ________
    Selected Variable Loss Cost Multiplier                  ________
5. Explain any differences between 3 and 4:
   _____________________________________________
   _____________________________________________
6. Rate level change for the coverages
    to which this page applies:                                     _______%