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 | OMB No. 1505-0208 Expiration: November 30, 2015 | 
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 | TRIP 05 | 
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 | TERRORISM RISK INSURANCE PROGRAM | 
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 | DATA CALL | 
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 | INSURER NAME: _________________________________________ | 
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 | INSURER (Group) NAIC#: _______________ | 
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 | INSURER TIN: ________________ | 
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 | DATE: ___________ | 
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 | PROGRAM YEAR:__________ | 
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 | SUBMITTING INSURER DEDUCTIBLE ESTIMATE____________________________ | 
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		| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 
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		| CAT | LINE OF | TOTAL CUMULATIVE | ALAE | LOSS | ALAE CASE | LOSS | ALAE | TOTAL | 
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 | 1.0  Fire | 
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 | 2.1  Allied Lines | 
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 | 5.1 Commercial Multi-Peril (non-liability) | 
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 | 5.2 Commercial Multi-Peril (liability) | 
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 | 8.0  Ocean Marine | 
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 | 9.0  Inland Marine | 
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 | 16.0 Workers’ Compensation | 
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 | 17.0 Other Liability | 
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 | 18.0 Products Liability | 
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 | 22.0 Aircraft (all perils) | 
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 | 27.0 Boiler and Machinery | 
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 | 50.0 Energy | 
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 | 51.0 All Other Property Risks | 
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 | 52.0 All Other Casualty Risks | 
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 | 80.0 Residual Market (Multiple Coverages) | 
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		| SUMMARY INFORMATION | 
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