2001-2002 Auto Insurance Rate Guide Information Form

(Due Date: June 20, 2001) Company Name: _______________________________ NAIC Group and Company Number: _______________________________ Consumer Information Telephone Number: _______________________________ Company Contact Person: _______________________________ Company Contact Telephone Number: _______________________________ Company Contact E-mail Address: _______________________________ If you return the survey by FAX, please type your responses. Region Auto Territory Driver A Driver B Driver C Class A Key Rate: .06 Driver D Class B Key Rate: .50 BI+PD (20/40/15), 1B, 1 year Driver A BI+PD (20/40/15), 2C-1, 1 year Driver B BI+PD (20/40/15), 2D, 1 year Driver C BI+PD (20/40/15), 6A, 1 year Driver D Amarillo & Lubbock 10 Amarillo & Lubbock 14 Amarillo & Lubbock 62 Coastal Texas 7 Coastal Texas 54 Coastal Texas 55 Dallas Metro 2 Dallas Metro 27 Dallas Metro 28 East Texas 47 East Texas 63 East Texas 66 Far West & Panhandle 5 Far West & Panhandle 58 Far West & Panhandle 65 Ft. Worth Metro 4 Ft. Worth Metro 34 Ft. Worth Metro 46 Golden Triangle 6 Golden Triangle 21 Golden Triangle 48 Harris County 1 Harris County 38 Harris County 39 Harris County 40 Heart of Texas 24 Heart of Texas 51 Heart of Texas 52 Lower Valley 12 Lower Valley 56 Lower Valley 57 Northeast Texas 41 Northeast Texas 42 Northeast Texas 43 Northeast Texas 44 Outer Dallas/Ft. Worth Metro Area 13 Outer Dallas/Ft. Worth Metro Area 31 Outer Dallas/Ft. Worth Metro Area 32 Outer Dallas/Ft. Worth Metro Area 45 Permian Basin 59 Permian Basin 60 Permian Basin 61 San Angelo, Abilene, Wichita Falls 11 San Angelo, Abilene, Wichita Falls 16 San Angelo, Abilene, Wichita Falls 20 South Central 3 South Central 23 South Central 53 South Central 64 Upper Coast 22 Upper Coast 37 Upper Coast 49