Schedule A

Control Number_____________________
(Treasury use)

Schedule A
TERRORISM RISK INSURANCE PROGRAM
DECLARATION OF “DIRECT EARNED PREMIUM” AND
CALCULATION OF “INSURER DEDUCTIBLE” UNDER
TERRORISM RISK INSURANCE ACT (TRIA)
Insurer or Insurer Group Name: __________________________________________
NAIC Insurer (or Group) Number (or TIN if no NAIC #): __________
Program (calendar) Year: __________
Calendar Year of Direct Earned Premium (see instructions for guidance): _________
List all affiliated insurers with premium subject to Terrorism Risk Insurance Act:
Name

NAIC # (or TIN if no NAIC #)

_________________________________________

__________________________

_________________________________________

__________________________

_________________________________________

__________________________

_________________________________________

__________________________

_________________________________________

__________________________

_________________________________________

__________________________

_________________________________________

__________________________

(insurers may add more lines as needed)
STEP 1:
Direct Earned Premiums from the Annual Statement Exhibit of Premiums and Losses (Statutory Page 14),
Column 2 for commercial lines of business, or from another appropriate reporting mechanism. See
instructions for guidance.
Annual Statement Line of Business
Line 1 – Fire
Line 2.1 – Allied Lines
Line 5.1 – Commercial Multiple Peril
(non-liability portion)
Line 5.2 – Commercial Multiple Peril (liability portion)

Direct Earned Premium
(Column 2 - Statutory Pg. 14)
$____________________________
$____________________________
$____________________________
$____________________________

OMB No. 1505-0200 Expiration: September 30, 2007
TRIP 02A (revised 04/2006)

Control Number_____________________
(Treasury use)
Direct Earned Premium
(Column 2 - Statutory Pg. 14)
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________
$____________________________

Annual Statement Line of Business
Line 8 – Ocean Marine
Line 9 – Inland Marine
Line 16 – Workers’ Compensation
Line 17 – Other Liability
Line 18 – Products Liability
Line 22 – Aircraft (all perils)
Line 27 – Boiler and Machinery
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
(insurers may add more lines as needed)

STEP 1 TOTAL $___________________
STEP 2:
Direct Earned Premiums included in the numbers reported under Step 1 that are for insurance coverage
not to be included for purposes of TRIA. See instructions for guidance.
Annual Statement
Line of Business

Direct Earned Premium
Not to be Included per TRIA

Reason for Exclusion of Premium

______________

$__________________

___________________________

______________

$__________________

___________________________

______________

$__________________

___________________________

______________

$__________________

___________________________

______________

$__________________

___________________________

______________

$__________________

___________________________

(insurers may add more lines as needed)
STEP 2 TOTAL $____________________

OMB No. 1505-0200 Expiration: September 30, 2007
TRIP 02A (revised 04/2006)

Control Number_____________________
(Treasury use)
STEP 3:
Direct Earned Premium, for lines of business included for purposes of TRIA, that were included in the
numbers reported under Step 1 and were ceded to a state residual market under a servicing carrier
arrangement. See instructions for guidance.
Annual
Statement
Line of Business

Direct Earned
Premium Ceded
to Residual Market

Name of Residual
Market for Which Insurer
Serves as Servicing Carrier

State of
Residual Market

_______________

$___________________

___________________________

_____________

_______________

$___________________

___________________________

_____________

_______________

$___________________

___________________________

_____________

_______________

$___________________

___________________________

_____________

_______________

$___________________

___________________________

_____________

_______________

$___________________

___________________________

_____________

_______________

$___________________

___________________________

_____________

(insurers may add more lines as needed)
STEP 3 TOTAL $______________
STEP 4:
Direct Earned Premiums for lines of business subject to TRIA that were NOT included in the numbers
reported under Step 1 and were distributed to the insurer by commercial lines state residual market
entities.
Annual
Statement
Line of Business

Earned Premium
Received From
Residual Markets

Name of Residual
Market Entity

State of
Residual Market

______________

$____________________

___________________________

_____________

______________

$____________________

___________________________

_____________

______________

$____________________

___________________________

_____________

______________

$____________________

___________________________

_____________

______________

$____________________

___________________________

_____________

______________

$____________________

___________________________

_____________

______________

$____________________

___________________________

_____________

______________

$____________________

___________________________

_____________

(insurers may add more lines as needed)
STEP 4 TOTAL $_________________

OMB No. 1505-0200 Expiration: September 30, 2007
TRIP 02A (revised 04/2006)

Control Number_____________________
(Treasury use)
STEP 5:
Complete the following formula in order to determine the insurer’s Program Year deductible.
(STEP 1 TOTAL $_________________ plus STEP 4 TOTAL $________________ )
SUBTRACT
(STEP 2 TOTAL $_________________ plus STEP 3 TOTAL $________________ )
EQUALS
Direct Earned Premium $________________
MULTIPLY

X _______________ Deductible Factor (2006 = 0.175; 2007 = 0.2)

EQUALS

$________________ Insurer Deductible under TRIA

Certification
I hereby certify that the direct earned premium data, calculations, and supporting documentation used to
determine the insurer deductible are accurate and complete to the best of my information, knowledge and
belief. Any false or fraudulent statements or claims may subject the insurer or signatory to criminal, civil,
or administrative penalties.
______________________________
Name

_____________________________ ____________________
Officer Title

Date

_____________________________
Signature

Notice Under the Paperwork Reduction Act
We estimate it will take you about 6.5 hours to complete this form. However, you are not required to
provide information requested unless a valid OMB control number is displayed on the form. Any
comments or suggestions regarding this form should be sent to the Terrorism Risk Insurance Program
Office, 1425 New York Avenue, NW, Washington, DC 20220. Do not send completed form to this
address.
Submit forms according to instructions provided at www.treas.gov/trip.

OMB No. 1505-0200 Expiration: September 30, 2007
TRIP 02A (revised 04/2006)

Schedule A
Direct Earned Premium and Insurer Deductible
1

General Instructions

1.1

Filing of Form
This form is required in order to determine each insurer’s Program Year deductible under the
Terrorism Risk Insurance Act (“TRIA”). It must be completed, certified by an officer of the
insurer, and submitted to Treasury with an Initial Certification of Loss or at the insurer’s option,
with the Initial Notice of Loss.
Reported data must be consolidated for all affiliates. Do NOT report separately for individual
companies in a group of affiliated insurers. For guidance on definitions of affiliates and issues of
corporate control, please visit the TRIP website at www.treas.gov/trip.
Insurers should maintain all worksheets and other documentation for the purposes of later auditing
by the Terrorism Risk Insurance Program (see 31 C.F.R. Part 50 Subpart G for guidance). This
includes such materials for the individual insurers within an affiliated group.

1.2

Lines of Business Subject to TRIA
Commercial property and casualty lines of business included in the Program (including excess
insurance, workers' compensation insurance, and directors and officers liability insurance), means
only the following lines of business from the NAIC's Exhibit of Premiums and Losses (commonly
known as Statutory Page 14): Line 1 -- Fire; Line 2.1 -- Allied Lines; Line 5.1 -- Commercial
Multiple Peril (non-liability portion); Line 5.2 -- Commercial Multiple Peril (liability portion); Line
8 -- Ocean Marine; Line 9 -- Inland Marine; Line 16 -- Workers' Compensation; Line 17 -- Other
Liability; Line 18 -- Products Liability; Line 22 -- Aircraft (all perils); and Line 27 -- Boiler and
Machinery. Insurance coverage that is written on a dwelling policy form, but for which premiums
are reported under the above lines of business (e.g., 1-4 family rental dwelling), is still included in
the Program.
Other lines of business from Statutory Page 14 are not included in the Program. Insurance
coverages specifically not included in the Program are: Federal crop insurance issued or reinsured
under the Federal Crop Insurance Act; any other type of crop or livestock insurance that is
privately issued or reinsured (including crop insurance reported on either Line 2.1 – Allied Lines or
Line 2.2. – Multiple Peril Crop); Line 3 – Farmowners Multiple Peril; Line 19.3 -- Commercial
Auto No-Fault (personal injury protection); Line 19.4 – Other Commercial Auto Liability; Line
21.2 –Commercial Auto Physical Damage; Line 24 – Surety; Line 26 – Burglary and Theft;
Professional Liability insurance as defined in 31 CFR 50.5(j)1; private mortgage insurance; title
insurance; financial guaranty insurance when issued by a monoline financial guaranty insurance
corporation; medical malpractice insurance; health or life insurance, including group life insurance;
Federal flood insurance; earthquake insurance reported under Line 12 of Statutory Page 14; and
reinsurance or retrocessional reinsurance. Workers’ compensation insurance provided directly to
qualified self-insureds is not reinsurance for purposes of the Program.

1

(j) Professional liability insurance means insurance coverage for liability arising out of the performance
of professional or business duties related to a specific occupation, with coverage being tailored to the needs
of the specific occupation. Examples include abstracters, accountants, insurance adjusters, architects,
engineers, insurance agents and brokers, lawyers, real estate agents, stockbrokers and veterinarians. For
purposes of this definition, professional liability insurance does not include directors and officers liability
insurance.
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TRIP 02A (revised 04/2006)

1.3

Direct Earned Premium
Direct earned premium to be reported on this form includes premium for all commercial property
and casualty lines of insurance listed above issued by any insurer for insurance against all losses.
Generally, direct earned premium amounts are to be included in the reporting on this form as they
were reported to the NAIC or through an equivalent reporting requirement for the immediately
prior calendar year. However, certain adjustments may be necessary as described below.
Direct earned premium should be included in the calculations only to the extent that commercial
property and casualty coverage is issued for losses occurring at the following locations:
1. Within the United States;
2. In the case of an air carrier (as defined in section 40102 of title 49, United States Code), or
a United States flag vessel (or a vessel based principally in the United States, on which
United States income tax is paid and whose insurance coverage is subject to regulation in
the United States), losses occurring anywhere; and
3. At the premises of any United States mission.
Premiums for personal property and casualty insurance coverage (coverage primarily designed to
cover personal, family or household risk exposures), or premiums for any other insurance coverage
that does not meet the definition of commercial property and casualty insurance, should not be
included in the calculation of direct earned premiums for purposes of the Program.
If a property and casualty insurance policy covers both commercial and personal risk exposures,
insurers may either treat the entire premium as commercial or allocate the premium in accordance
with the proportion of risk between commercial and personal components in order to ascertain
direct earned premium for Program purposes. If a policy includes insurance coverage that meets the
definition of commercial property and casualty insurance for losses occurring at the locations
specified above, but also includes coverage for losses outside the geographic scope of TRIA or
coverage otherwise outside the scope of TRIA, insurers may likewise allocate premiums in
accordance with the proportion of risk attributable to the components of coverage subject to TRIA
in order to ascertain direct earned premium for Program purposes.
Premiums for personal property and casualty insurance coverages, premiums for other insurance
coverages excluded from the scope of TRIA, or premiums for risks located outside the geographic
scope of TRIA may be fully excluded by an insurer from the calculation of direct earned premium
if such coverages include only incidental TRIA qualifying commercial property and casualty
insurance coverage. For purposes of the Program, commercial coverage is incidental if less than 25
percent of the total direct earned premium is attributable to that coverage or combination of
qualifying TRIA coverages. If an insurer elects to fully exclude premiums for insurance policies
with incidental commercial coverage, it must do so for all policies within a particular category (e.g.
policy form, risk classification, underwriting rule) and not on a policy by policy basis. It should be
noted that if premiums for the commercial coverages are excluded, then insured losses under those
coverages will not be compensated under the Program and do not count towards satisfying an
insurer’s deductible.

1.4

Affiliated Insurers
Direct earned premium of affiliated insurers is to be consolidated for reporting on this form. The
affiliated group is based on the corporate structure of affiliations on the date of occurrence of the
act of terrorism that is the first act of terrorism in a Program Year to be certified by the Secretary
and determined to be a Program Trigger Event. The amount of direct earned premium for each
individual insurer within the affiliated group is based on that individual insurer’s earned premium
reported to the NAIC (or the equivalent) for the prior year.
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1.5

Insurers Without a Full Year of Operations
If an insurer, or an insurer entity within an affiliated group, did not have a full year of operations in
the prior calendar year, then that insurer’s or insurer entity’s direct earned premium to be used in
calculating the insurer deductible is the direct premium earned in the Program Year for which the
Certification of Loss is being submitted. Estimated amounts for such insurers are permitted in
submitting Schedule A with a Certification of Loss. Final calculations of direct earned premium
and deductible are to be submitted when available at the end of the Program Year on an updated
Schedule A. If the insurer has not had a full year of operations during the applicable Program
Year, the direct earned premiums are to be annualized to a full year basis.

2

Special Instructions

2.1

State Licensed or Admitted Insurers that Report to the NAIC via Statutory Page 14.
For a State licensed or admitted insurer that reports to the NAIC, direct earned premium is the
premium information for commercial property and casualty insurance coverage reported by the
insurer on column 2 of the NAIC Exhibit of Premiums and Losses of the NAIC Annual Statement
(commonly known as Statutory Page 14). (See instruction 1.2 above.)

2.2

Insurers that do not Report to the NAIC via Statutory Page 14.
An insurer that does not report to the NAIC via Statutory Page 14 should only report direct earned
premium in Step 1 for classes or lines of business that include, at a minimum, the equivalent of one
or more lines of business specified in General Instruction 1.2. Thus, regardless of the description
of the premium on another reporting form, all direct earned premium in Step 1 must include the
functional equivalent of a commercial line of business as specified in General Instruction 1.2.
Insurers that may be required to extract direct earned premium information from other reporting
forms include alien surplus lines insurers, farm mutual insurers, county mutual insurers, captive
insurers and federally-approved insurers.
If such an insurer reports to its State regulator only on a written premium basis, then the accrual
method must be applied to calculate direct earned premium.
An eligible surplus line insurer listed on the NAIC Quarterly Listing of Alien Insurers that does not
currently report earned premium, may use its current reporting basis for purposes of calculating the
insurer deductible provided that 1) it reports to the NAIC on an equivalent basis satisfactory to the
NAIC, and 2) it is in transition to reporting on an earned premium basis. Permission is only
granted for the duration of this transition period.
Other types of payments that compensate the insurer for risk of loss (such as contributions,
assessments, etc. for certain farm and county mutual insurers) must also be considered as part of
direct earned premium.
An insurer approved by a Federal agency for the purpose of offering property and casualty
insurance in connection with maritime, energy or aviation activity should adjust its premium to
reflect the limitations on scope of insurance coverage under the Program (i.e. to the extent of
federal approval of commercial property and casualty insurance in connection with maritime,
energy or aviation activities).

3

Step by Step Calculations

3.1

Step One
List Direct Earned Premiums (consolidated for all affiliated insurers) from the Annual Statement
Exhibit of Premiums and Losses (Statutory Page 14), Column 2 for all lines of business included in
the Program.

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List premiums by line for all lines not reported via Statutory Page 14, but reported on a separate
state form as discussed in Special Instruction 2.2. Use the blank lines at the end of the section.
Include all premiums reported for any State of the United States, the District of Columbia, the
Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, American
Samoa, Guam, each of the U.S. Virgin Islands, and any other territory or possession of the United
States.
Include all surplus lines written by affiliates and reported for any State of the United States, the
District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern
Mariana Islands, American Samoa, Guam, each of the U.S. Virgin Islands, and any other territory
or possession of the United States.
If a line of business reported in this section includes direct earned premiums both for lines of
business or coverage included and not included in the Program, include the full amount of
premiums reported on Statutory Page 14 or another reporting mechanism in Step 1. The premiums
from lines or coverages not included in the Program will be reported in Step 2 and subtracted later.
3.2

Step Two
List Direct Earned Premiums included in the numbers reported under Step 1 that are not included
in the Program. “Reasons for Exclusion of Premium” include:
1. Incidental personal lines coverage within hybrid policies,
2. Cross-border (Locations not covered by TRIA),
3. Incidental non-commercial lines coverage (other than personal lines) within hybrid
policies,
4. Coverages within an included line but specifically excluded from the Program (e.g., Crop
reported on Line 2.1 or Professional Liability reported on Line 17),
5. Other (explain).

3.3

Step Three
This step only applies to those insurers who act as servicing carriers for one or more state residual
markets that write commercial lines of business included in the Program. For applicable lines of
business included in the Program, list all direct earned premium amounts that were included in the
numbers reported under Step 1, but not excluded under Step 2, and that were ceded to a state
residual market under a servicing carrier arrangement.

3.4

Step Four
List all earned premiums for lines of business included in the Program that were not otherwise
included in the data reported under Step 1 and were distributed to the insurer by state residual
market mechanisms (note: this includes premiums received from state residual markets that were
reported as assumed reinsurance).

3.5

Step Five
Complete the formula in order to determine the insurer’s Direct Earned Premium for purposes of
TRIA and the resultant insurer deductible based on the Deductible Factor for the relevant Program
Year.

3.6

Step Six
An appropriate executive officer of the insurer (e.g., an officer listed on the NAIC Annual
Statement) must certify the data and calculations used to determine the Direct Earned Premium and
resulting insurer deductible.

OMB No. 1505-0200 Expiration: September 30, 2007
TRIP 02A (revised 04/2006)