Fs 1 Form Nc PDF Details

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QuestionAnswer
Form NameFs 1 Form Nc
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namesfs1 form nc, nc fs 4 forms, fs1 form, fillable fs1 form for nc

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STATE OF NORTH CAROLINA

DEPARTMENT OF TRANSPORTATION

BEVERLY EAVES PERDUE

GOVERNOR

DIVISION OF MOTOR VEHICLES

April 2011

EUGENE A. CONTI, JR.

SECRETARY

TO:

NC LICENSED INSURANCE COMPANIES

FROM:

Kathy Brannan, Manager

 

Liability Insurance Unit

RE:

North Carolina Filing Requirements regarding FS-1’s and FS-4’s Forms

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.

*

DOT Contacts

Page 2

*

Company contact information to be returned to NCDMV, if applicable

Page 2

*

Regulations for filing Forms FS-4 and FS-1 in the State of North Carolina

Pages 3 - 4

*

Media / Field Requirements for Forms FS-4 and FS-1, All Media

Pages 4 - 7

*

File Layouts of Forms FS-4 and FS-1, All Media

Pages 7 - 9

North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

SUBJECT

CONTACT

CONTACT INFORMATION

EDI/GXS

LITES Project Team

E-Mail:

litesprojectteam@ncdot.gov

Connect:Direct

 

 

 

FTP with SSL

 

 

 

RACF ID and ITS Billing Code

Traffic Records

Phone:

(919) 861-3062

STARS Inquiry

 

Fax:

(919) 715-9099

NC Filing Requirements

Liability Insurance Unit

Phone:

(919) 861-3832

Electronic & Tape Transfer

 

Fax:

(919) 861-3617

Test Planning

 

E-Mail:

insuranceinfo@ncdot.gov

*************************************************************************************

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.

Date:

_________________________________________________________________

Contact Name/Title:

_________________________________________________________________

Contact Telephone:

(______________) _________________________________________________

Contact Fax:

(______________) _________________________________________________

Contact Email:

_________________________________________________________________

Contact Address:

_________________________________________________________________

 

_________________________________________________________________

Insurance Group:

_________________________________________________________________

(if applicable)

 

Insurance Company & Assigned Company Code Used on FS-1 and FS-4 Forms

Writes in

NC

(Yes/No)

If yes, your transmission will be: (Paper, Tape, or Electronic)

If yes, your transmission will occur: (Daily, Weekly, Monthly, etc.)

2

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.

3

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‟.

4

North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

4.

Insurance Company Name:

Enter company name.

5.

Insurance Company Code:

Enter code assigned at the time company is licensed in state.

6.

Policy Number:

Enter policy number.

7.

Registered Owner (optional):

Personal: Enter first, middle, and last name along with any

 

 

suffix in the appropriate fields.

 

 

Business: Enter name of business.

8.

Drivers License Number (optional):

Personal: Enter drivers license of registered owner of vehicle.

 

 

Business: Enter customer ID assigned to business at time of

 

 

N.C. registration.

9.

Date of Birth (optional):

Personal: Enter date of birth of registered owner of vehicle.

 

 

Business: Leave blank.

10.

Street Address (optional):

Enter for registered owner of vehicle.

11.

City, State, Zip (optional):

Enter for registered owner of vehicle.

12.

Termination Date:

Form FS-4: Enter date policy was terminated (mmddyyyy).

 

 

Form FS-1: Leave blank.

13.

Effective Date:

Form FS-4: Enter date policy went into effect (mmddyyyy).

 

 

Form FS-1: Enter date policy was renewed (mmddyyyy).

14.

Preparation Date:

Enter today‟s date or when form was prepared (mmddyyyy).

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”.

5

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)

1.

Transaction ID:

Hard code „003395‟

2.

Operation Code:

Hard code „I‟

3.

Documentation Type Code:

Hard code „01‟ for FS-1

 

 

Hard code „02‟ for FS-4

4.

Vehicle Identification Number (VIN):

For both personal and business operating a single vehicle:

 

 

Enter vehicle identification number obtained from vehicle

 

 

registration card or from dashboard of vehicle.

5.

Insurance Company Code:

Enter code assigned at the time company is licensed in state.

6.

Policy Number:

Enter policy number.

7.

Termination Date:

Form FS-4: Enter date policy was terminated (mmddyyyy).

 

 

Form FS-1: Leave blank.

8.

Effective Date:

Form FS-4: Enter date policy went into effect (mmddyyyy).

 

 

Form FS-1: Enter date policy was renewed (mmddyyyy).

9.

Preparation Date:

Enter today‟s date or when form was prepared (mmddyyyy).

10.

Vehicle Make:

Enter first 4 letters of vehicle make (Ex. “Chev”, “Buic”)

6

North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

11.

Vehicle Year:

Enter 4 digit year of manufacture (yyyy)

12.

Drivers License Number (optional):

Personal: Enter drivers license of registered owner of vehicle.

 

 

Business: Enter customer ID assigned to business at time of

 

 

N.C. registration.

13.

Date of Birth (optional):

Personal: Enter date of birth of registered owner of vehicle.

 

 

Business: Leave blank.

14.

Registered Owner (optional):

Personal: Enter first, middle, and last name along with any

 

 

suffix in the appropriate fields.

 

 

Business: Enter name of business.

15.

Address 1 and Address 2 (optional):

Enter for registered owner of vehicle.

16.

City, State, Zip (optional):

Enter for registered owner of vehicle.

FORMS FS-4 and FS-1: Record Layout

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

 

NCDOT SYSTEM:

 

Liability Insurance Tracking and Enforcement System (LITES)

 

 

BLOCKSIZE:

27,740

 

 

 

 

RECORD LENGTH:

 

380 Bytes

 

 

 

 

 

 

 

 

 

Field Name

Position Start

 

Position End

Type

Notes

Transaction ID

1

 

6

X (6): (constant)

„003395‟

Operation Code

7

 

7

X (1): (constant)

„I‟

Documentation Type

8

 

9

X (2): „01‟ or „02‟

FS-1: „01‟

Code

 

 

 

 

FS-4: „02‟

Vehicle Identification

10

 

34

X (25)

Obtained from vehicle registration

Number

 

 

 

 

card or from the dashboard of the

 

 

 

 

 

 

vehicle

Insurance Company

35

 

37

X (3)

N. C. code assigned to company by

Code

 

 

 

 

the state

Policy Number

38

 

67

X (30)

Policy number of insured

Termination Date

68

 

75

X (8): (mmddyyyy)

FS-4: Policy termination date

 

 

 

 

 

 

FS-1: Blank

Effective Date

76

 

83

X (8): (mmddyyyy)

FS-4: Policy effective date

 

 

 

 

 

 

FS-1: Policy

 

 

 

 

 

 

reinstatement/renewal date

Preparation Date

84

 

91

X (8): (mmddyyyy)

Today‟s date or date form prepared

Vehicle Make

92

 

95

X (4)

First 4 letters of vehicle make (ex.

 

 

 

 

 

 

„Chev‟, „Buic‟)

Vehicle Year

96

 

99

X (4): (yyyy)

Year of Manufacture

Drivers License

100

 

111

X (12)

Personal: Driver license number

Number (if available)

 

 

 

 

of the registered owner of the

 

 

 

 

 

 

vehicle

 

 

 

 

 

 

Business: N. C. number assigned

 

 

 

 

 

 

to business at time of vehicle

 

 

 

 

 

 

registration – obtained from

 

 

 

 

 

 

vehicle registration card

Date of Birth (if

112

 

119

X (8): (mmddyyyy)

Personal: DOB of insured

available)

 

 

 

 

Business: Blank

Registered Owner‟s

120

 

139

X (20)

Personal

7

North Carolina Department of Transportation

Division of Motor Vehicles

Liability Insurance Unit

First Name

 

 

 

 

Registered Owner‟s

140

159

X (20)

Personal

Middle Name

 

 

 

 

Registered Owner‟s

160

184

X (25)

Personal

Last name

 

 

 

 

Registered Owner‟s

185

187

X (3)

Personal

Suffix

 

 

 

 

Registered Owner‟s

188

259

X (72)

Business

Name

 

 

 

 

Address – 1

260

284

X (25)

Personal or business

Address – 2

285

309

X (25)

Personal or business

City

310

331

X (22)

Personal or business

State

332

333

X (2)

Personal or business

Zip Code

334

342

X (9)

Personal or business (can be 5 or 9

 

 

 

 

digit zip code)

Filler

343

380

X (38)

Reserved for DMV use

8

NOTICE OF TERMINATION OF LIABILITY INSURANCE

FS-4

 

YEAR

MAKE

 

 

 

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURANCE COMPANY NAME

 

 

 

 

 

 

 

COMPANY CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGISTERED OWNER NAME

 

 

 

 

 

 

TERMINATION DATE

 

 

 

 

 

 

 

MM DD YYYY

 

 

 

 

 

MM

 

DD

 

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVERS LICENSE

 

 

DATE OF BIRTH

 

 

 

 

 

 

 

EFFECTIVE DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

 

PREPARATION DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOWN OR CITY

 

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUTHORIZED SIGNATURE

 

 

NORTH CAROLINA CERTIFICATE OF LIABILITY INSURANCE

FS-1

YEAR

MAKE

 

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURANCE COMPANY NAME

 

 

 

COMPANY CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGISTERED OWNER NAME

 

EFFECTIVE DATE

 

 

 

 

MM DD YYYY

 

MM

DD

 

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVERS LICENSE

 

DATE OF BIRTH

 

 

 

PREPARATION DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

TOWN OR CITY

STATE

ZIP CODE

AUTHORIZED SIGNATURE

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Fill in the following areas to create the form:

stage 1 to writing nc fs 1 form

Complete the Contact Address, Insurance Group if applicable, Insurance Company Assigned, Writes in NC YesNo, If yes your transmission will be, and If yes your transmission will areas with any particulars which may be asked by the system.

part 2 to filling out nc fs 1 form

Write down the important data in First Name Registered Owners, Filler, X X X X X, Personal, Personal, Personal, Business, and Personal or business Personal or area.

step 3 to filling out nc fs 1 form

The NOTICE OF TERMINATION OF LIABILITY, YEAR MAKE VEHICLE IDENTIFICATION, INSURANCE COMPANY NAME COMPANY CODE, POLICY NUMBER MM DD YYYY, REGISTERED OWNER NAME TERMINATION, MM DD YYYY MM DD YYYY, DRIVERS LICENSE DATE OF BIRTH, MM DD YYYY, STREET ADDRESS PREPARATION DATE, and TOWN OR CITY STATE ZIP CODE section is the place where each party can place their rights and responsibilities.

Finishing nc fs 1 form step 4

Finalize by looking at these areas and preparing them as required: NORTH CAROLINA CERTIFICATE OF, YEAR MAKE VEHICLE IDENTIFICATION, INSURANCE COMPANY NAME COMPANY CODE, POLICY NUMBER MM DD YYYY, REGISTERED OWNER NAME EFFECTIVE, MM DD YYYY MM DD YYYY, DRIVERS LICENSE DATE OF BIRTH, STREET ADDRESS, and TOWN OR CITY STATE ZIP CODE.

Entering details in nc fs 1 form part 5

Step 3: Once you click the Done button, your completed file is conveniently transferable to any of your devices. Or alternatively, you can easily deliver it using mail.

Step 4: It is better to prepare duplicates of your file. You can be sure that we won't disclose or see your particulars.

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