Form Not Assigned Not Assigned Annual Checklist for Admitted Reinsurers

ANNUAL FILING CHECKLIST
ADMITTED REINSURERS
THE FOLLOWING CHECKLIST IS PROVIDED TO AID YOUR COMPANY IN
ELECTRONICALLY SUBMITTING A COMPLETE FILING TO THIS DEPARTMENT
(COPY OF THIS CHECKLIST IS TO BE SUBMITTED WITH FILING)

REPORTING COMPANY NAME:

CONTACT PERSON NAME AND TITLE:

CONTACT PERSON PHONE NO. AND E-MAIL ADDRESS:

ITEMS TO BE SUBMITTED

1. Copy Renewal Fee Receipt (pay on-line at
http://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/surety_home.htm)
2. Signed and Notarized Jurat Page for Annual Financial Statement of Reporting
3. NAIC UPLOAD FILE (s.txt file only)
4. For Subsidiaries Shown on Schedule D:
a. NAIC UPLOAD FILE (s.txt file only)
5. Treasury Schedule F (form provided on-line)*
6. Copies of LOC’s and Trust Agreements for Largest Recoverable Amounts
Reported on Sch. F, Part 2, Columns 4a and 4b
7. NAIC IRIS Ratios and explanation(s) of IRIS Ratios with Unusual Results
8. Current State Exam Report (if not previously provided) and copy of
correspondence responding to Examiner’s recommendations
9. Updated Biographical Affidavits of New Officers and Directors (use NAIC
Format)
10. Description of Miscellaneous Assets Reported on Page 1 of the Annual
Financial Statement
11. Current Appraisals for Mortgage Loans and Real Estate Acquired During this
Past Year

SUBMITTED
YES
NO

12. Insurance Dept. Certificates:
- verifying large infusions of capital or surplus
- verifying approval of extraordinary dividend
13. Documents Describing Changes in the Company (i.e., name change, ownership
change, change in state of incorporation, change in CPA audit firms, etc...)
14. Copies of Change to Charter or Articles of Incorporation or Bylaws Which
Occurred this Past Year

*ALL OF OUR FORMS ARE AVAILABLE ON-LINE AT

http://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/surety_home.htm
**NOTE: IT IS NOT NECESSARY TO SUBMIT INSURANCE EXPENSE EXHIBITS**

*** THE SURETY BOND PROGRAM ONLY ACCEPTS ELECTRONIC SUBMISSIONS
OF DOCUMENTS (FACSIMILE SIGNATURES ARE ACCEPTABLE) ***
Annual Filing Checklist Admitted
Reinsurers Rev. 8/2017
OMB No. 1530-0061