GENERAL INFORMATION - CONFIDENTIAL

TO COMPLETE SECOND YEAR OF TWO-YEAR TERM AS A CONSUMER REPRESENTATIVE AT NAIC MEETINGS AND TO RECEIVE REIMBURSEMENT FOR EXPENSES FROM NAIC FOR THE YEAR 2018

Please note: NAIC Consumer Representatives are expected to attend NAIC meetings and to participate on NAIC committee, working group, task force and consumer representative planning calls.

* 1. NAME:

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