AppendixD. Appendix D

Form CR-F – PART 1

Assumed Reinsurance as of December 31, Current Year (000 Omitted)

1	2	3	4	5	Reinsurance On			9	10	11	12	13	14	15
Company Code or ID Number		Name of Reinsured	Domiciliary Jurisdiction	Assumed Premium	6 Paid Losses and Loss Adjustment Expenses	7 Known Case Losses and LAE	8 Cols. 6 + 7	Contingent Commissions Payable	Assumed Premiums Receivable	Unearned Premium	Funds Held By or Deposited With Reinsured Companies	Letters of Credit Posted	Amount of Assets Pledged or Compensating Balances to Secure Letters of Credit	Amount of Assets Pledged or Collateral Held in Trust
9999999 Totals

Form CR-F – PART 2

Ceded Reinsurance as of December 31, Current Year (000 Omitted)

1

2

3

4

5

6

Reinsurance Recoverable On

Reinsurance Payable

18

19

Company Code or ID Number

Name of Reinsurer

Domiciliary Jurisdiction

Reinsurance Contracts Ceding 75% or More of Direct Premiums Written

Reinsurance Premiums Ceded

7 Paid Losses

8 Paid LAE

9 Known Case Loss Reserves

10 Known Case LAE Reserves

11 IBNR Loss Reserves

12 IBNR LAE Reserves

13 Unearned Premiums

14 Contingent Commissions

15 Cols. 7 through 14 Totals

16 Ceded Balances Payable

17 Other Amounts Due to Reinsurers

Net Amount Recoverable From Reinsurers Cols. 15 –

Funds Held by Company Under Reinsurance Treaties

9999999 Totals

(Effective August 6, 2013; Amended May 11, 2022)