Fs 1 Form Nc – Fill Out and Use This PDF

STATE OF NORTH CAROLINA

DEPARTMENT OF TRANSPORTATION

The Department of Insurance has informed NCDOT of your authority to write automobile liability insurance coverage in the State of North Carolina. The Department of Transportation, Division of Motor Vehicles implemented a new computer system on August 2, 1999. This system is called LITES (Liability Insurance Tracking & Enforcement System). In an effort to assist you, the attached information has been designed to indicate our reporting specifications. Amendment to General Statute 20-309 requires notification to the Division on new policies written. The amendment also requires electronic notification if your company has $25,000,000 or more in annual vehicle insurance premium.

The individual declared as the liaison between the insurance companies and the Division of Motor Vehicles will need to complete our contact sheet (page 2) and return. Upon request, a hard copy of General Statutes, policy and procedure implementations will be forwarded to the designated contact person in your corporate, district or regional office. An e-mail address incorporates an additional way to receive Rejection/Random Sampling Reports other than by mail. Group name, if applicable, should be shown as the parent name of all associated companies authorized to write North Carolina automobile liability coverage. If you are not currently writing automobile liability coverage in our State, we would appreciate a response back. Upon your response, our records will be updated accordingly. Should you need further information, refer to the chart on Page 2.

North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

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If you are responding for more than one parent insurance company, please list all of the North Carolina companies you represent, including the unique three (3) digit insurance company code. Also, in order to reduce the volume of future communications, advise the Division if a company is NOT currently writing automobile liability insurance policies in North Carolina. Provide this information in the table provided below. You may fax this sheet or send via e-mail to the Liability Insurance Unit as referenced in the contact information above.

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North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

FORMS FS-4 and FS-1: Regulations for Filing

I.Liability Insurance Certification

A.If the financial responsibility for a vehicle is a liability insurance policy, the owner of the vehicle

must certify to the existence of the policy and furnish sufficient information on forms provided by the Division of Motor Vehicles to enable verification of the policy‟s existence.

B.Certification shall be made at original registration and at such times as a motor vehicle registration transaction is made between the owner and the Division of Motor Vehicles.

II.Termination Notices

A.North Carolina Notice of Termination Form FS-4 shall be used to notify the Commissioner of the Division of Motor Vehicles of termination of motor vehicle liability insurance. The form shall be supplied by the insurer and must include the items in Section C below. A notice of termination for a policy covering multiple listed vehicles also requires a Form FS-4. For data transmitted by tape or electronically, a separate record for each vehicle is required; for paper submissions, please refer to page 4.

B.Insurers shall also notify the Commissioner of the North Carolina Division of Motor Vehicles immediately upon effective date of cancellation or deletion of a motor vehicle from a motor vehicle liability insurance policy. Notification to the Commissioner is NOT necessary if a vehicle is deleted from a policy and replaced with another vehicle or is insured under a fleet policy by the same insurer. A fleet policy is defined, as a policy with five or more vehicles not listed individually by year, make, model or identification number.

C.The North Carolina Notice of Termination Form FS-4 has been approved by the Commissioner of the North Carolina Division of Motor Vehicles. The form shall contain the following fields.

Name and address of the registered owner Name of insurance company and code number

Date of birth of registered owner, if available (non-fleet policies) Drivers license number of registered owner, if available

Year, make, and identification number of vehicle Termination date

Effective date of policy Date prepared

Signature of facsimile signature of authorized representative of insurance company (may be pre-printed or stamped)

III.Reinstatement and Renewal Notices

A.If a termination of liability insurance (FS-4) was issued to the North Carolina Division of Motor Vehicles and the insured was subsequently reinstated or renewed, the insurer must inform the Division with an FS-1, certificate of insurance, provided such reinstatement or renewal has occurred without any lapse in coverage.

B.FS-1‟s shall be issued upon request from the insured, request from the Division of Motor Vehicles or to reinstate with no lapse in coverage.

C.When an insurance company terminates a policy and issues another policy, without a lapse, no FS-4 is necessary. The insurance company shall issue an FS-1 showing continuous coverage. Continuous coverage for a policy covering multiple listed vehicles also requires a Form FS-1. For data transmitted by tape or electronically, a separate record for each vehicle is required, for paper submissions, please refer to page 4.

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North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

D.The certificate of insurance shall be on a form approved by the Commissioner of the North Carolina Division of Motor Vehicles. The form shall be designated an FS-1 and shall reflect the following:

Name and address of the registered owner

Name of the insurance company and code number

Date of birth of registered owner, if available (non-fleet policies) Drivers license number of registered owner, if available

Year, make, and identification number of vehicle Effective date of policy

Date prepared

Signature of facsimile signature of authorized representative of insurance company (may be pre-printed or stamped)

IV. Authorization

A.An agent representing an insurance company may issue the FS-4 or FS-1 if authorized to do so by the company.

FORMS FS-4 and FS-1: Media / Field Requirements (Paper)

Media Requirements for Paper Forms

Paper forms will no longer be scanned with the AEG PFL 6150 Form Reader. Please disregard previous requirements regarding paper, opacity, mechanical properties, paper edges, cut size and ink. Paper forms are to

conform to the design for Forms FS-4 and FS-1 included in this packet (page 8), including the size requirement of 7”w x 4 ¼”h per form. Certain items of text that appeared on the previous forms have been eliminated from the

new layout – this text may be included at your discretion but must not affect the 7 x 4 ¼ size requirement. The new forms have been designed so that 2 forms will fit on one 8 ½”w x 11”h sheet of paper for the purpose of faxing.

Any forms not computer-generated must be typed.

See the end of the document for an example of each form.

Field Requirements for Paper Forms

1.Vehicle Year:

a.For both personal and business operating a single vehicle: Enter 4 digit year of manufacture (yyyy).

b.For business operating a schedule of vehicles: Leave blank and enter each vehicle year separately on an attached schedule, along with the corresponding VIN and vehicle make.

c.For dealership, transporter, or drive-away: Leave blank.

2.Vehicle Make:

a.For both personal and business operating a single vehicle: Enter first 4 letters of vehicle make (Ex.

“Chev”, “Buic”).

b.For business operating a schedule of vehicles: Leave blank and enter each vehicle year separately on an attached schedule, along with the corresponding VIN and vehicle year.

c.For dealership, transporter, or drive-away: Leave blank.

3.Vehicle Identification Number (VIN):

a.For both personal and business operating a single vehicle: Enter vehicle identification number obtained from vehicle registration card or from dashboard of vehicle.

b.For business operating a schedule of vehicles: Enter „See Attached Schedule‟ and enter each VIN separately on the attached schedule.

c.For dealership, transporter, or drive-away: Enter „Garage Liability Policy‟.

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North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

FORMS FS-4 and FS-1: Media Requirements (Electronic)

EDI/GXS

GXS Information Exchange provides companies the ability to establish secure connections to one another by providing written permission outlining the connectivity desired by each company. Many insurance companies are currently processing forms FS-1 and FS-4 with the State of North Carolina using the product Expedite offered by GXS Information Exchange. Expedite is a mailbox-based product that allows companies with dissimilar systems to exchange files. Expedite supports OS/390, AS/400 PC/DOS, OS/2 and Windows platforms.

GXS Information Exchange can be contacted at 1-877-326-6426.

File Transfer Protocol with SSL (FTPS)

FTP is a transfer protocol that is fairly common throughout information technology companies. FTP with SSL is an extension of this that adds transport layer security (TLS) and secure socket layer (SSL) cryptographic algorithms. This ensures that the data being transmitted from one company to another is protected from any unauthorized viewing while in transit, which is critical for the sensitive nature of the FS-1 and FS-4 data.

When dealing with FTPS, it is understood that the FTP client software is very platform specific and not all software supports encryption. Because of the variety of software packages available, we require for the State of North Carolina that any company looking to utilize FTPS use the full capabilities of the encryption algorithms available. As such, the following requirements will be enforced:

1.Client software must support explicit mode FTPS by sending the command “AUTH TLS”.

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North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

2.Client software must support passive mode FTP.

3.Client software must be able to accept “well-known” digital certificates transmitted by the state mainframe as self-signed certificates are not permitted on these state resources.

4.Client software must be able to process Port Command Format 2 or have the ability to ignore the IP address that is provided in Port Command Format 1.

5.Client software must be able to transmit data in a file structure compatible with MVS formats as the mainframe is not setup to accept any other file structure at this time.

6.Clients must be able to open TCP Ports 50000 – 50040 on their firewall in order to process the data connection from the state mainframe.

7.In order to guarantee encryption for all data transmitted via FTPS, clients will only be authorized certain TCP ports that are designed for these types of transactions. The client will be notified of the approved TCP ports once the account for the client has been set up.

To help streamline the implementation of these requirements, the Office of Information Technology Services (ITS) for the State of North Carolina is prepared to assist you with establishing an FTPS account and ensure that the communication protocols are in place.

Other Electronic Media Formats

The State of North Carolina also permits the use of Connect:Direct to electronically submit insurance records. This is a mainframe to mainframe application that is available for use but requires technical effort on both ends to get set up properly. This is the only other electronic protocol that will be accepted at the NCDOT until further notice. It is anticipated that other protocols may be accepted in the future as they prove themselves to be reliable and secure.

FORMS FS-4 and FS-1: Field Requirements (Electronic)

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North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

FORMS FS-4 and FS-1: Record Layout

Record Layout for Submission of FS-4 and FS-1 Data by Electronic Media

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North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

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