The following form and filing instruction of the California Earthquake Liability Questionnaire as of December 31, 2012, are now available in Microsoft Excel and Adobe's Portable Document Format (PDF). The Excel document may be downloaded to your computer. For the documents in PDF format, you will need Adobe Acrobat Reader 3.0 or higher to view it or download a copy of the software by visiting our Free Document Readers
For companies that have data to report on Form A or Form B, we ask that you download the Excel files of the forms. If you have any problems downloading the files, please feel free to call my staff at (213) 346-6731. Fill out the form using the downloaded file, and e-mail it to firstname.lastname@example.org. For the Signature Page, please have it signed and saved/scanned back to a pdf file. If you are unable to scan it back to a pdf, please mail it to:
California Department of Insurance
Rate Specialist Bureau - 14th Floor
300 South Spring Street
Los Angeles, CA 90013
Earthquake Liability Questionnaire 2012
Please note that the printing of the FORM in both PDF and MS Word requires legal size paper.
For furthur assistance, please call the Rate Specialist Bureau at (213) 346-6731 or e-mail us at RSBeqpml@insurance.ca.gov. Please include your name, company name, telephone number, and e-mail address in all correspondence with the CDI.
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