Document
Write Your Own (WYO) Program
ICR 201109-1660-002 · OMB 1660-0020 · Object 29343001.
This document may belong to an older filing. More recent activity for OMB 1660-0020:
Document Viewer [xlsx]
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | Write Your Own (WYO) Program |
| Author | FEMA Employee |
| Last Modified By | Calc |
| File Modified | 2011-12-19 |
| File Created | 2026-08-24 |
| Conversion State | complete |
Extracted Text
OMB No. 1660-0020 Expiration Date: December 31, 2011 Department of Homeland Security Federal Emergency Management Agency OMB Control Number: 1660-0020 Title: Write Your Own (WYO) Program FEMA Form Number 129-1 Public reporting burden for this form is estimated to average 35 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. You are not required to respond to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0020) NOTE: Do not send your completed form to this address. KEY IN GRAY SHADED AREAS ONLY FSBLKFiscal2011 Effective 10/1/2010 EXHIBIT I INCOME STATEMENT COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR CURRENT MONTH REVENUE 100. WRITTEN PREMIUM $ 0 105. CHANGE IN UNEARNED PREMI 0 110. EARNED PREMIUM 0 $ FISCAL YEAR-TO-DATE $ 0 0 $ 0 EXPENSES 115. NET PAID LOSSES 0 0 120. ALLOCATED LAE (LINE 500) 0 0 125. OTHER LOSS & LAE ITEMS (LINE 660) 0 0 CHANGE IN LOSS & LAE RESERVES (LINES 325 THRU 340 COL.C) NET LOSS & LAE INCURRED 0 0 EXPENSE ALLOWANCE (LINE 430) 0 130. 135. 140. 0 0 $ 0 150. 155. MISCELLANEOUS EXPENSE TOTAL EXPENSES $ 0 0 0 0 160. OPERATING INCOME (LOSS) 0 0 165. INTEREST INCOME (LINE 71 0 0 170. 175. NET POLICY SERVICE FEES NET INCOME (LOSS $ 0 0 $ 0 0 $ PREPARER'S NAME: PHONE NUMBER: WYO ACCOUNTING PROCEDURES (MANUAL) PART B EFFECTIVE : 10/1/2010 EXHIBIT II RECONCILIATION OF PAYABLE/RECEIVABLE BALANCE COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR CURRENT MONTH 200. 205. 210. FISCAL YEAR-TO-DATE BEGINNING PAYABLE/REC. BALANCE(LINE315,COL.B) 0 0 NET INCOME (LOSS) (LINE 175) 0 0 LOC FUNDS RECEIVED 215. 220. (LINE 800) 0 0 DISBURSEMENT TO NFIP (LINE 805) 0 0 0 0 ENDING PAYABLE/RECEIVABL BALANCE (LINE 315, COL.A) WYO ACCOUNTING PROCEDURES (MANUAL) PART B EFFECTIVE : 10/1/2010 EXHIBIT III BALANCE SHEET ITEMS COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR 300. CASH 305. CASH - NOT TRANSFERRED TO RESTRICTED ACCT. A B CURRENT MONTH 0 PRIOR MONTH 0 0 0 C INCREASE (DECREASE) (COLS.A-B) 0 0 D BEGINNING OF FISCAL YEAR 0 0 310. CASH - NOT TRANSFERRED FROM RESTRICTED ACCT. 0 0 0 0 312. CLAIMS PAYABLE** 0 0 0 0 315. PAYABLE TO (RECEIVABLE FROM) NFIP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LAE RESERVES-CASE (ALLOCATED) 0 0 0 0 LAE RESERVES-IBNR (ALLOCATED) 0 0 0 0 LAE RESERVES (UNALLOCATED) 0 0 0 0 PREMIUM SUSPENSE (UNDER 60 DAYS) 0 0 0 0 PREMIUM SUSPENSE (60 DAYS OR OVER TOTALS 0 0 0 0 0 0 0 0 320. 325. 330. 335. 336. 340. 345. 346. UNEARNED PREMIUM RESERVES LOSS RESERVES (CASE) LOSS RESERVES (IBNR) PLEASE SHOW DEBITS AS POSITIVE NUMBERS & BRACKET ALL CREDITS. THE COLUMNS MUST ADD TO ZERO (-0-). * UPON TREASURY DEPARTMENT'S REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING AGED DETAIL FOR THE REPORTED BALANCE. COMPANIES WILL BE NOTIFIED WHEN SUCH A REQUEST IS MADE. EXHIBIT IV EXPENSE ALLOWANCE CALCULATION COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR CURRENT MONTH EXPENSE ALLOWANCE 400. WRITTEN PREMIUM (Do Not Use for Premium) 405. EXPENSE ALLOWANCE % A 410. EXPENSE ALLOWANCE FOR WRITTEN PREMIUM * 411. WRITTEN PREMIUM (Use 10/1/2008 data month and later) 412. EXPENSE ALLOWANCE % B 413. EXPENSE ALLOWANCE FOR WRITTEN PREMIUM B 414. SUBTOTAL EXPENSE ALLOWAN FISCAL YEAR-TO-DATE 0 0 0.0% 0.0% 0 0 0 30.2% 0 30.2% 0 0 0 0 0 0 415. CANCELLATION PREMIUM REFUND ADJUSTMENT BASE 420. 425. COMMISSION ALLOWANCE % CANCELLATION COMMISSION RETENTION 15% 15% 0 0 426. EXPENSE ALLOWANCE ADJUST FOR BONUS COMMISSION RATING ORGANIZATION EXPE 0 0 0 0 0 0 427. 428. 429. 430. STATE SALES TAX ON INSURANCE SERVICES PRIOR TERM REFUND EXPENSE ALLOWANCE DUE THE NFIP TOTAL EXPENSE ALLOWANCE 0 0 WYO ACCOUNTING PROCEDURES (MANUAL) PART B 0 0 $ EFFECTIVE : 10/1/2010 UPDATED: 6/1/2008 EXHIBIT V-A FEE SCHEDULE - ALLOCATED LAE (USE FOR CLAIMS WITH DATE OF LOSS OF 9/30/90 AND PRIOR) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR A B C D ENTRY VALUE RANGE ERRONEOUS ASSIGNMENT CWP 0.01200.00 200.01400.00 400.01600.00 600.01800.00 800.01- 1000.00 1000.01- 1500.00 1500.01- 2000.00 2000.01- 2500.00 2500.01- 3000.00 3000.01- 3500.00 3500.01- 4000.00 4000.01- 4500.00 4500.01- 5000.00 5000.01- 6000.00 6000.01- 7000.00 7000.01- 8000.00 8000.01- 9000.00 9000.01- 10000.00 10000.01- 15000.00 15000.01- 20000.00 20000.01- 25000.00 25000.01- 30000.00 30000.01- 35000.00 35000.01- 40000.00 40000.01- 45000.00 45000.01- 50000.00 50000.01- 75000.00 75000.01-100000.00 100000.01-125000.00 125000.01-150000.00 150000.01-175000.00 175000.01-200000.00 200000.01- LIMITS 500-A. NUMBER CLOSED FEE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40.00 70.00 70.00 90.00 110.00 130.00 150.00 180.00 200.00 220.00 240.00 260.00 280.00 300.00 320.00 350.00 370.00 380.00 400.00 420.00 460.00 490.00 520.00 550.00 580.00 610.00 640.00 670.00 800.00 950.00 1100.00 1250.00 1400.00 1550.00 1700.00 **TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-A FEE PD (BxC) $ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $ 0 **UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPE WYO ACCOUNTING PROCEDURES (MANUAL) EFFECTIVE : 10/1/2010 PART B EXHIBIT V-B FEE SCHEDULE - ALLOCATED LAE (USE FOR CLAIMS WITH DATE OF LOSS OF 10/1/90 THROUGH 10/31/96) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR A ENTRY VALUE RANGE B NUMBER CLOSED C FEE D FEE PD (BxC) ERRONEOUS ASSIGNMENT CWP MINIMUM FOR UPTON-JONES 0 0 0 40.00 125.00 800.00 $ $ 0.01- $600.00 0 150.00 0 600.01- 1000.00 0 175.00 0 1000.01- 2000.00 0 225.00 0 2000.01- 3500.00 0 275.00 0 3500.01- 5000.00 0 350.00 0 5000.01- 7000.00 0 425.00 0 7000.01- 10000.00 0 500.00 0 10000.01- 15000.00 0 550.00 0 15000.01- 25000.00 0 600.00 0 25000.01- 35000.00 0 675.00 0 35000.01- 50000.00 0 750.00 0 50000.01-100000.00 0 1000.00 0 100000.01-150000.00 0 1300.00 0 150000.01-200000.00 0 1600.00 0 200000.01- LIMITS 0 2000.00 0 0 EXCESS MILEAGE 500-B. 0 0 0 **TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-B $ 0 **UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPE EXHIBIT V-C FEE SCHEDULE - ALLOCATED LAE (USE FOR CLAIMS WITH DATE OF LOSS OF 11/01/96 THROUGH 04/30/97) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR A ENTRY VALUE RANGE B NUMBER ERRONEOUS ASSIGNMENT CWP $ C FEE 0 0 40.00 125.00 D FEE PAID $ 0.01- $600.00 0 150.00 0 600.01- 1000.00 0 175.00 0 1000.01- 2000.00 0 225.00 0 2000.01- 3500.00 0 275.00 0 3500.01- 5000.00 0 350.00 0 5000.01- 7000.00 0 425.00 0 7000.01- 10000.00 0 500.00 0 10000.01- 15000.00 0 550.00 0 15000.01- 25000.00 0 600.00 0 25000.01- 35000.00 0 675.00 0 35000.01- 50000.00 0 750.00 0 50000.01-100000.00 0 3.0% 0 100000.01-250000.00 0 250000.01- LIMITS 0 2.3% BUT NOT LESS THAN $3,000.00 2.1% BUT NOT LESS THAN $5,750.00 OTHER FEMA-AUTHORIZED LAE* 500-C. 0 0 TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-C $ 0 0 0 0 *UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPEN EXHIBIT V-D FEE SCHEDULE - ALLOCATED LAE (USE FOR CLAIMS WITH DATE OF LOSS OF 05/01/97 THROUGH 08/31/04) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR A ENTRY VALUE RANGE B NUMBER ERRONEOUS ASSIGNMENT CWP $ 500-D. C FEE 0 0 40.00 125.00 D FEE PAID $ 0 0 0.01- $600.00 0 150.00 0 600.01- 1000.00 0 175.00 0 1000.01- 2000.00 0 225.00 0 2000.01- 3500.00 0 275.00 0 3500.01- 5000.00 0 350.00 0 5000.01- 7000.00 0 425.00 0 7000.01- 10000.00 0 500.00 0 10000.01- 15000.00 0 600.00 0 15000.01- 25000.00 0 750.00 0 25000.01- 35000.00 0 900.00 0 35000.01- 50000.00 0 1200.00 0 50000.01-100000.00 0 3.0% 0 100000.01-250000.00 0 250000.01- LIMITS 0 2.3% BUT NOT LESS THAN $3,000.00 2.1% BUT NOT LESS THAN $5,750.00 TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-D $ 0 0 0 *UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPEN EXHIBIT V-E INCREASED COST OF COMPLIANCE (ICC) FEE SCHEDULE - ALLOCATED LAE (USE FOR ICC CLAIMS WITH DATE OF LOSS OF 06/01/97 THROUGH 08/31/04) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR A ENTRY VALUE RANGE B NUMBER ERRONEOUS ASSIGNMENT CWP $ C FEE 0 0 40.00 125.00 D FEE PAID $ 0 0 0.01- $600.00 0 150.00 0 600.01- 1000.00 0 175.00 0 1000.01- 2000.00 0 225.00 0 2000.01- 3500.00 0 275.00 0 3500.01- 5000.00 0 350.00 0 5000.01- 7000.00 0 425.00 0 7000.01- 10000.00 0 500.00 0 10000.01- 15000.00 0 600.00 0 (Use the following Entry Range only for ICC total claims payments greater than $15,000 but not more than $20,000, and with a Loss Date of 05/01/00 and later). 15000.01- 20000.00 0 750.00 0 (Use the following Entry Range only for ICC total claims payments greater than $15,000 but not more than $30,000, and with a Loss Date of 05/01/2003 and later). 15000.01- 20000.00 25000.01- 30000.00 500-E. 0 0 TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-E 750.00 900.00 0 0 $ 0 *UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPEN REVISED EXHIBIT V-F FEE SCHEDULE - ALLOCATED LAE (USE FOR CLAIMS WITH DATE OF LOSS OF 09/01/2004 THROUGH 8/31/2008) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR A ENTRY VALUE RANGE B NUMBER ERRONEOUS ASSIGNMENT CWP $ C FEE 0 0 60.00 225.00 D FEE PAID $ 0 0 0.01- 1000.00 0 300.00 0 1000.01- 2500.00 0 425.00 0 2500.01- 5000.00 0 500.00 0 5000.01- 7500.00 0 575.00 0 7500.01- 10000.00 0 650.00 0 10000.01- 15000.00 0 750.00 0 15000.01- 25000.00 0 850.00 0 25000.01- 35000.00 0 1000.00 0 35000.01- 50000.00 0 1250.00 0 50000.01- 100000.00 0 3.0% 0 0 2.3% BUT NOT LESS THAN $3,000.00 250,000.01 and up 0 0 2.1% BUT NOT LESS THAN $5,750.00 Use the following Allocated LAE Fees for Expedited Claim Handling for Hurricanes Katrina and Rita with dates of loss beginning August 24, 2005. 100000.01- 250000.00 0 500-F1 500-F1S Process 1 Process 1 Site Visit 0 0 750.00 400.00 0 0 500-F2 500-F2S Process 2 Process 2 Site Visit 0 0 750.00 400.00 0 0 500-F4 Special Adjusting Proc 0 0 (FEMA Approval Required) 500-F. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-F $ 0 *UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPEN EXHIBIT V-G INCREASED COST OF COMPLIANCE (ICC) FEE SCHEDULE - ALLOCATED LAE (USE FOR ICC CLAIMS WITH DATE OF LOSS OF 9/01/04 AND LATER) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR A ENTRY VALUE RANGE B NUMBER C FEE D FEE PAID ERRONEOUS ASSIGNMENT CWP 0 0 60.00 225.00 $ 0 300.00 0 500-H. 500-G. 500-F. 500-E. 500-D. 500-C. 500-B. 500-A. 500. 0.01- $1000.00 $ 0 0 1000.01- 2500.00 0 425.00 0 2500.01- 5000.00 0 500.00 0 5000.01- 7500.00 0 575.00 0 7500.01- 10000.00 0 650.00 0 10000.01- 15000.00 0 750.00 0 15000.01- 25000.00 0 850.00 0 25000.01- 30000.00 0 1000.00 0 TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-H TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-G TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-F TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-E TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-D TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-C TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-B TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-A **TOTAL ALLOCATED LAE FEES PAID $ $ 0 0 0 0 0 0 0 0 0 *UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPEN UPDATED: 9/1/2008 EXHIBIT V-H FEE SCHEDULE - ALLOCATED LAE (USE FOR CLAIMS WITH DATE OF LOSS OF 09/01/2008 AND LATER) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR A ENTRY VALUE RANGE B NUMBER C FEE ERRONEOUS ASSIGNMENT CLOSED WITHOUT PAYMENT (CWOP) 0 0 70.00 275.00 $ D FEE PAID $ 0 0 0.01- 1000.00 0 375.00 0 1000.01- 5000.00 0 600.00 0 5000.01- 10000.00 0 800.00 0 10000.01- 15000.00 0 925.00 0 15000.01- 25000.00 0 1025.00 0 25000.01- 35000.00 0 1175.00 0 35000.01- 50000.00 0 1400.00 0 0 3% BUT NOT LESS THAN $1,600.00 100000.01- 250000.00 0 0 2.3% BUT NOT LESS THAN $3,000.00 250,000.01 and up 0 0 2.1% BUT NOT LESS THAN $5,750.00 500-H. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-H $ 0 *UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPEN 50000.01- 100000.00 0 UPDATED: 9/1/2008 EXHIBIT VI OTHER LOSS & LAE CALCULATION COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR UNALLOCATED L.A.E.PAID * 600A. NET PAID LOSSES(LINE 115 (Use 10/1/2008 data month and later) CURRENT MONTH 0 FISCAL YEAR-TO-DATE 0 * 605A. CHANGE IN CASE RESERVES(LINE 325,COL C) (Use 10/1/2008 data month and later) 0 610. CASE INCURRED LOSSES 0 611. ULAE INCURRED LOSS % 1.5% 612. SUBTOTAL ULAE INCURRED L 0 613 ULAE NET WRITTEN PREMIUM 1.0% SUBTOTAL ULAE NET WRITTE 0 614. 620A. UNALLOCATED LAE(6/1/08th 0 UNALLOCATED LAE(10/1/07t 0 620. * TOTAL UNALLOCATED LAE 0 620B. SALVAGE & SUBROGATION 625. NET SALVAGE RECEIVED 0 0 0 1.5% 0 1.0% 0 0 0 0 0 630. 635. SALVAGE ALLOWANCE % SALVAGE CREDIT 10% 0 10% 0 640. NET SUBROGATION RECEIVED 0 0 645. 650. SUBROGATION ALLOWANCE % SUBROGATION CREDIT 25% 0 25% 0 RECOVERY OF LOSSES PAID Enter Recovery as a Debit SPECIAL ALLOCATED LAE ________________________ 0 0 0 0 652. 655. 660. SPECIAL ALLOCATED LOSS ADJUSTMENT EXPENSE TOTAL OTHER LOSS & LAE ITEMS (SUM OF LINES 620B, 635,650,655) $ 0 WYO ACCOUNTING PROCEDURES (MANUAL) PART B $ 0 EFFECTIVE : 10/1/2010 UPDATED: 6/1/2008 EXHIBIT VII INTEREST INCOME COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR CURRENT FISCAL MONTH YEAR-TO-DATE TOTAL INTEREST RECEIVED 0 0 RESTRICTED ACCOUNT CHARG Enter Charges as a Debit 710. TOTAL INTEREST INCOME 0 0 700. 705. 0 WYO ACCOUNTING PROCEDURES (MANUAL) PART B $ EFFECTIVE : 10/1/2010 0 EXHIBIT VIII-A LETTER OF CREDIT DRAWDOWNS COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR 0 LOC DRAWDOWNS AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST 800. DATE 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL $ $ EXHIBIT VIII-B AMOUNT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CASH PAYMENTS TO THE NFIP COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR PAYMENTS TO NFIP AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST DATE 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 805. B 805. C 805. D 805. E 805 TOTAL CREDIT CARD PAYMENTS INTERNET PAYMENTS WIRE TRANSFER PAYMENTS TOTAL PAYMENTS TO NFIP WYO ACCOUNTING PROCEDURES (MANUAL) PART B AMOUNT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $ 0 0 0 0 0 EFFECTIVE : 10/1/2010 EXHIBIT VIII-C CREDIT CARD PAYMENTS TO NFIP COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST DATE 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 $ AMOUNT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 800-C TOTAL CREDIT CARD PAYMEN $ 0 EXHIBIT VIII-D INTERNET PAYMENTS TO NFIP COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST DATE 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 $ AMOUNT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 800-D TOTAL INTERNET PAYMENTS $ WYO ACCOUNTING PROCEDURES (MANUAL) PART B 0 EFFECTIVE : 10/1/2010 EXHIBIT VIII-E WIRE TRANSFER TO NFIP (GREATER THAN $ 100,000) COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST DATE 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 $ AMOUNT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 800-E TOTAL WIRE TRANSFER PAYM WYO ACCOUNTING PROCEDURES (MANUAL) PART B $ 0 EFFECTIVE : 10/1/2010 EXHIBIT IX RESTRICTED ACCOUNT DEPOSITS SUMMARY COMPANY NAME : YOUR COMPANY NAME COMPANY NUMBER :YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED PERIOD ENDING : MONTH (ALL CAPITAL LETTERS) AND YEAR AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST AUGUST DATE 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 AMOUNT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 900 TOTAL 0 WYO ACCOUNTING PROCEDURES (MANUAL) PART B EFFECTIVE : 10/1/2010 "DISKETTE CONTROL FORM" ------- ---------- WYO COMPANY NAME: FILE NAME: YOUR COMPANY NAME ------- ------DATE SENT: ------- ---------- --------- -- REPORTING MONTH/YEAR: MONTH (ALL CAPITAL LETTERS) AND YEAR ------- ------- PREPARER'S NAME: 0 ------- ------- TELEPHONE NUMBER: 0 ------- ------CURRENT MTH. NET INCOME (LOSS) FOR REPORTING MONTH: (EXH. I, INCOME STATEMENT, LINE 175) PAYABLE TO (RECEIVABLE FROM) NFIP: EXHIBIT III, BALANCE SHEET, LINE 315, COLUMN A) 0 0 ======= ========= FYTD 0 ======= 0 ======= cember 31, 2011 EAR-TO-DATE 0 0 0 0 YEAR-TO-DATE BEGINNING OF FISCAL YEAR VIDE SUPPORTING NOTIFIED WHEN YEAR-TO-DATE EE PD (BxC) FOR THE REPORTED EXPENSE. EE PD (BxC) FOR THE REPORTED EXPENSE. FEE PAID OR THE REPORTED EXPENSE. FEE PAID OR THE REPORTED EXPENSE. FEE PAID s greater than /00 and later). s greater than /2003 and later). OR THE REPORTED EXPENSE. H 8/31/2008) FEE PAID g for Hurricanes OR THE REPORTED EXPENSE. FEE PAID OR THE REPORTED EXPENSE. FEE PAID OR THE REPORTED EXPENSE. YEAR-TO-DATE EAR-TO-DATE CO .PRN #VALUE! #VALUE! OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP 1 OCTOBER 2 NOVEMBE 3 DECEMBE 4 JANUARY 5 FEBRUAR 6 MARCH 7 APRIL 8 MAY 9 JUNE 10 JULY 11 AUGUST 12 SEPTEMB 31 30 31 31 29 31 30 31 30 31 31 30