IMPORTANT: THIS NOTICE AFFECTS YOUR CONTRACT RIGHTS. PLEASE READ IT CAREFULLY. 

The AB Insurance company has agreed to replace us as your insurer under (insert policy/certificate name and number) effective (insert date). The AB Insurance Company's principal place of business is (insert address). Financial  information concerning both companies is attached, including (1) ratings for the last five years, if available, or for such lesser period as is available from two nationally recognized insurance rating services; (2) balance sheets for the previous three years, if available, or for such lesser period as is available and as of the date of the most recent quarterly statement; (3) a copy of the Management's Discussion and Analysis that was filed as a supplement to the previous year's annual statement; and (4) an explanation of the reason for the transfer. You may obtain additional information concerning AB Insurance Company from reference materials in your local library or by contacting your Insurance Commissioner at (insert address and phone number).

The AB Insurance Company is licensed to write this coverage in your state. The Commissioner of Insurance in your state has reviewed the potential effect of the proposed transaction, and has approved the transaction (if the commissioner has approved the transaction). 

You may choose to consent to or reject the transfer of your policy to AB Insurance Company. If you want your policy transferred, you may notify us in writing by signing and returning the enclosed pre-addressed, postage-paid card.

Payment of your premium to the AB Insurance Company will also constitute consent to the transfer of your policy unless you reject or reserve the right to reject the transfer when you make your payment. Your next premium notice will tell you how to pay the premium and keep your policy in force while reserving your right to reject the transfer.

If you do not want your policy transferred, you must notify us in writing that  you reject the transfer. You may use the enclosed pre-addressed, postage-paid card to notify us that you reject the transfer.

If you reject the transfer, you may keep your policy with us or exercise any option under your policy. If we do not receive notice of rejection, you will, as a matter of law, be deemed to have consented to the transfer effective (insert date). However, before this consent is final you will be provided a second notice of the transfer 12 months from now. After the second notice is provided, you will have two months to reply. If you pay your premium to the AB Insurance Company without reserving your right to reject the transfer, you will not receive a second notice.

You may also notify us of your consent to or rejection of the transfer of your policy by writing to us at:

Insert name, address and facsimile number of contact person. 

If you accept this transfer, AB Insurance Company will be your insurer.

If you accept this transfer, you should make all premium payments and claims submissions to AB Insurance Company and direct all questions to AB Insurance Company.

If you have any further questions about this agreement, you may contact XY Insurance (the transferring insurer) or AB Insurance Company.

For your convenience, we have enclosed a pre-addressed postage-paid response card. Please take time now to read the enclosed notice and complete and return the response card to us.