Va. Admin. Code tit. 14, agency 5, ch. 200, form FORMS (14VAC5-200) - FORMS (14VAC5-200)

Rescission Reporting Form, Form A (eff. 2/2002)

Long-Term Care Insurance Personal Worksheet, Form B (rev. 4/2015)

Things You Should Know Before You Buy Long-Term Care Insurance, Form C (rev. 9/2007)

Long-Term Care Insurance Suitability Letter, Form D (rev. 2/2002)

Claims Denial Reporting Form, Form E (rev. 4/2015)

Potential Rate Increase Disclosure Form, Form F (rev. 12/2015)

Replacement and Lapse Reporting Form, Form G (eff. 9/2007)

Partnership Program Notice, Form 200-A (eff. 9/2007)

Partnership Disclosure Notice, Form 200-B (eff. 9/2007)

Long-Term Care Partnership Certification Form, Form 200-C (rev. 4/2015)

Notes

Va. Admin. Code tit. 14, agency 5, ch. 200, form FORMS (14VAC5-200)

Amended, Virginia Register Volume 31, Issue 18, eff. 9/1/2015.

Statutory Authority: §§ 12.1-13, 38.2-223, and 38.2-5202 of the Code of Virginia.