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REINSURANCE COMPANY NAME: NAIC Company Code: …

2014 National Association of Insurance Commissioners REINSURANCE COMPANY NAME: NAIC COMPANY Code: Contact: Telephone: REQUIRED FILINGS IN THE STATE OF: Filings Made During the Year _____ (1) Check-list (2) Line # (3) REQUIRED FILINGS FOR THE ABOVE STATE (4) NUMBER OF COPIES* (5) DUE DATE (6) FORM SOURCE** (7) APPLICABLE NOTES Domestic Foreign State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 x 14 ) 1 EO xxx 3/30 NAIC Please, read Notes A to K and the general instructions within the form.

© 2014 National Association of Insurance Commissioners 5 details. R Report of Reinsurance Assumed from PR Domestic Insurers Specify the name of the insurer and the

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