TBD Terrorism Risk Insurance Program: Small Insurers

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Overview

Affiliations
Premium (Juris.)
Standalone Terrorism (US)
Cyber (US)
Exposure Bases (Juris.)
Places of Worship (US)
Reinsurance (US)
PRA Notice

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Sheet 1: Affiliations

B		C			G		H
3	NAIC Group Code	Insurer Group Name			3	Total 2020 Policyholder Surplus
4					4	Total 2020 TRIP-Eligible DEP (all lines)
B		C	D
8	NAIC Company Code	Insurance Company Name	Type of Insurer
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

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Sheet 2: Premium (Juris.)

Jurisdiction:
2
B		C	D	E	F	G	H
5	TRIP-Eligible Line of Coverage	NAIC Line (Commercial Only)	Total 2021 TRIP-Eligible DEP (all policies)	Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Declined)	Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Provided for Disclosed $0 Charge)	Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Provided with a Premium Charged)	Total 2021 DEP Charged for Terrorism Risk Coverage
6	Fire	1	$-
7	Allied Lines	2.1	$-
8	Commercial Multiple Peril (non-liability portion)	5.1	$-
9	Commercial Multiple Peril (liability portion)	5.2	$-
10	Ocean Marine	8	$-
11	Inland Marine	9	$-
12	Workers' Compensation	16	$-
13	Excess Workers' Compensation	17.3	$-
14	Other Liability	17	$-
15	Products Liability	18	$-
16	Aircraft (all perils)	22	$-
17	Boiler and Machinery	27	$-
18	TOTALS		$-	$-	$-	$-	$-

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Sheet 3: Standalone Terrorism (US)

B		C
2	Element	Amount
3	2021 DEP for Standalone Terrorism Policies
4	Portion of 2021 DEP Providing Coverage for Losses for Certified Acts of Terrorism under TRIP
5	Portion of 2021 DEP Providing Coverage for Losses Arising from Other (Non-Certified) Acts of Terrorism
6	2021 Number of Standalone Terrorism Policies Issued
7	2021 Number of Standalone Terrorism Policies Issued Providing Coverage for Losses for Certified Acts of Terrorism Under TRIP
8	2021 Property Insurance Exposure for Standalone Terrorism Policies Providing Coverage for Losses for Certified Acts of Terrorism Under TRIP
9	Total 2021 Limits of Liability for Standalone Terrorism Policies Providing Coverage for Losses for Certified Acts of Terrorism Under TRIP

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Sheet 4: Cyber (US)

B		C	D	E
2	Element	Standalone Cyber	Cyber Coverage provided as part of a Package Policy	Totals
3	Total 2021 TRIP-Eligible DEP (All Cyber Policies)			$-
4	Total 2021 Cyber DEP in TRIP-Eligible Lines of Insurance (Terrorism Risk Coverage Declined)			$-
5	Total 2021 Cyber DEP in TRIP-Eligible Lines of Insurance (Terrorism Risk Coverage Provided)			$-
6	Total 2021 TRIP-Eligible DEP Charged for Terrorism Risk Coverage Under Cyber Policies			$-
7	Total 2021 Non-TRIP-Eligible DEP (All Cyber Policies)			$-
8	Total 2021 Number of Cyber Policies Issued in TRIP-Eligible Lines of Insurance			0
9	Total 2021 Number of Cyber Policies Issued (Terrorism Risk Coverage Provided)			0
10	Total 2021 Number of Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance			0
11	Total 2021 Number of all Cyber Policies Issued			0
12	Total 2021 Number of all Cyber Policies Issued to Small Policyholders (100 or fewer employees)			0
13	Total 2021 Number of all Cyber Policies Issued to Medium Policyholders (101-500 employees)			0
14	Total 2021 Number of all Cyber Policies Issued to Large Policyholders (501 or more employees)			0
15	Total 2021 DEP of all Cyber Policies Issued to Small Policyholders (100 or fewer employees)			$-
16	Total 2021 DEP of all Cyber Policies Issued to Medium Policyholders (101-500 employees)			$-
17	Total 2021 DEP of all Cyber Policies Issued to Small Policyholders (501 or more employees)			$-
18	Total 2021 Limits of Liability for Cyber Policies Issued in TRIP-Eligible Lines of Insurance			$-
19	Total 2021 Limits of Liability for Cyber Policies Issued in TRIP-Eligible Lines of Insurance Providing Coverage for Losses for Certified Acts of Terrorism Under TRIP			$-
20	Total 2021 Limits of Liability for Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance			$-
21	Total 2021 Limits of Liability for Cyber Extortion under Cyber Policies Issued in TRIP-Eligible Lines of Insurance			$-
22	Total 2021 Limits of Liability for Ransom Payments for Cyber Extortion under Cyber Policies Issued in TRIP-Eligible Lines of Insurance			$-
23	Total 2021 Limits of Liability for Cyber Extortion under Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance			$-
24	Total 2021 Limits of Liability for Ransom Payments for Cyber Extortion under Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance			$-
25	Total 2021 Direct Losses Paid for Cyber Extortion under all Cyber Policies Issued			$-
26	Total 2021 Direct Losses Incurred for Cyber Extortion under all Cyber Policies Issued			$-
27	Total 2021 Direct Losses Paid for Cyber Extortion (Ransom Payment or Reimbursement Only) under all Cyber Policies Issued			$-
28	Total 2021 Number of Claims Associated with Payments reported in Line 27			0
29	Total 2021 Direct Defense and Loss Containment Amounts Paid for Cyber Extortion under all Cyber Policies Issued			$-
30	Total 2021 Direct Defense and Loss Containment Amounts Incurred for Cyber Extortion under all Cyber Policies Issued			$-

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Sheet 5: Exposure Bases (Juris.)

Jurisdiction:
2
B		C	D	E	F	G	H	I	J	K	L	M	N
5	TRIP-Eligible Line of Coverage	NAIC Line (Commercial Only)	Total 2021 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Provided)	Total 2021 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Provided and NBCR Risks Not Excluded)	Total 2021 Policyholder Deductibles for TRIP-Eligible Property Policies (Terrorism Risk Coverage Provided)	Total 2021 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Declined)	Total 2021 Policyholder Deductibles for TRIP-Eligible Property Policies (Terrorism Risk Coverage Declined)	Total 2021 Limits of Liability for TRIP-Eligible Policies (Terrorism Risk Coverage Provided)	Total 2021 TRIP-Eligible Limits of Liability (Terrorism Risk Coverage Provided and NBCR Risks Not Excluded)	Total 2021 Policyholder Deductibles for TRIP-Eligible Liability Policies (Terrorism Risk Coverage Provided)	Total 2021 Liability for TRIP-Eligible Policies (Terrorism Risk Coverage Declined)	Total 2021 Policyholder Deductibles for TRIP-Eligible Liability Policies (Terrorism Risk Coverage Declined)	Total 2021 Payroll for TRIP-Eligible Policies (Terrorism Risk Coverage Provided)
6	Fire	1
7	Allied Lines	2.1
8	Commercial Multiple Peril (non-liability portion)	5.1
9	Commercial Multiple Peril (liability portion)	5.2
10	Ocean Marine	8
11	Inland Marine	9
12	Workers' Compensation	16
13	Excess Workers' Compensation	17.3
14	Other Liability	17
15	Products Liability	18
16	Aircraft (all perils)	22
17	Boiler and Machinery	27
18	TOTALS		$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-

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Sheet 6: Places of Worship (US)

C			D	E	F	G	H	I	J	K	L	M	N	O
				Property				Liability				Workers' Compensation		All Categories
3	Code		Description	Total 2021 DEP Charged for Terrorism Risk Coverage	Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Declined)	Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Provided)	Total 2021 TRIP-Eligible DEP	Total 2021 DEP Charged for Terrorism Risk Coverage	Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Declined)	Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Provided)	Total 2021 TRIP-Eligible DEP	Total 2021 DEP Charged for Terrorism Risk Coverage	Total 2021 TRIP-Eligible DEP	Total 2021 TRIP-Eligible DEP
4	NAICS	813110	Religious Organizations				$-				$-			$-
5	SIC	8661	Religious Organizations				$-				$-			$-
6	ISO	0900 (Property) 41650 (Liablity)	Religious Organizations				$-				$-			$-
7	Other		Places of Worship				$-				$-			$-
8			TOTALS:	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-

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Sheet 7: Reinsurance (US)

B		C	D
2	Element	Response	Description or Explanation (if any)
3	Size of TRIP 2021 Deductible (Cell H4 of Insurer Group Affiliations Chart x 20%)
4	Total 2021 Limits Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss
5	Total 2021 Aggregate Limits of Purchased Treaty Reinsurance Covering TRIP Loss
6	2021 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss
7	2020 Co-Participation Share of Purchased Treaty Reinsurance Covering TRIP Loss
8	Total 2021 Limits Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophe Loss
9	Total 2021 Aggregate Limits of Purchased Treaty Reinsurance Covering Natural Catastrophe Loss
10	2021 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophe Loss
11	2021 Co-Participation Share Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophe Loss
12	Any Reinsurance Exclusions for TRIP Certified Foreign Acts of Terrorism?
13	Any Reinsurance Exclusions for TRIP Certified Domestic Acts of Terrorism?
14	Reinsurance for NBCR WC Exposures Resulting from Certified Acts of Terrorism?
15	If Yes, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss
16	If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss
17	If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance For Certified Acts of Terrorism involving WC Loss
18	Reinsurance for NBCR Property Loss Resulting from Certified Acts of Terrorism?
19	If Yes, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss
20	If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss
21	If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss
22	Reinsurance for NBCR Liability Loss Resulting from Certified Acts of Terrorism?
23	If Yes, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss
24	If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss
25	If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss
26	Any Other Reinsurance Exclusions Specifically Applicable to Certified Acts of Terrorism Under TRIP?
27	ZIP Code Associated with Largest Probable Maximum Loss (PML)
28	Largest PML at a Single Location (Amount)

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Sheet 8: PRA Notice

Notice under the Paperwork Reduction Act

We estimate it will take you about 32 hours to complete this form. However, you are not required to provide the 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, Department of the Treasury, 1500 Pennsylvania Avenue NW, Room 1410 MT, Washington, DC 20220. Do not send completed forms to this address. Submit forms according to instructions provided at www.tripsection111data.com.