Sec.38a-88-appendix e. Appendix E  


Latest version.
  • Form CR-S – PART 1 – SECTION 1

    Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsured Company as of December 31, Current Year

    1

    Company Code or

    ID

    Number

    2

    3

    Effective

    Date

    4

    Name

    of

    Reinsured

    5

    Location

    6

    Type of

    Reinsurance

    Assumed

    7

    Amount of

    In Force at

    End of Year

    8

    Reserve

    9

    Premiums

    10

    Reinsurance

    Payable on

    Paid and

    Unpaid

    Losses

    11

    Modified

    Coinsurance

    Reserve

    12

    Funds

    Withheld

    Under

    Coinsurance

    Totals

    Form CR-S – PART 1 – SECTION 2

    Reinsurance Assumed Accident and Health Insurance Listed by Reinsured Company as of December 31, Current Year

    1

    Company

    Code or

    ID

    Number

    2

    3

    Effective

    Date

    4

    Name

    of

    Reinsured

    5

    Domiciliary

    Jurisdiction

    6

    Type

    of

    Reinsurance

    Assumed

    7

    Premiums

    8

    Unearned

    Premiums

    9

    Reserve

    Liability

    Other Than

    For

    Unearned

    Premiums

    10

    Reinsurance

    Payable on

    Paid and

    Unpaid Losses

    11

    Modified

    Coinsurance

    Reserve

    12

    Funds

    Withheld

    Under

    Coinsurance

    Totals

    Form CR-S – PART 2

    Reinsurance Recoverable on Paid and Unpaid Losses Listed by Reinsuring Company as of December 31, Current Year

    1

    Company

    Code or

    ID Number

    2

    3

    Effective

    Date

    4

    Name

    of

    Company

    5

    Location

    6

    Paid

    Losses

    7

    Unpaid

    Losses

    Totals—Life, Annuity and Accident and Health

    Form CR-S – PART 3 – SECTION 1

    Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December 31, Current Year

    1

    Company

    Code or

    ID

    Number

    2

    3

    Effective

    Date

    4

    Name

    of

    Company

    5

    Location

    6

    Type of

    Reinsurance

    Ceded

    7

    Reserve Credit

    Taken

    10

    Outstanding Surplus Relief

    13

    Modified

    Coinsurance

    Reserve

    14

    Funds

    Withheld

    Under

    Coinsurance

    Amount in

    Force at

    End of Year

    8

    Current

    Year

    9

    Prior

    Year

    Premiums

    11

    Current

    Year

    12

    Prior

    Year

    Totals

    Form CR-S – PART 3 – SECTION 2

    Reinsurance Ceded Accident and Health Insurance Listed by Reinsuring Company as of December 31, Current Year

    1

    Company

    Code or

    ID

    Number

    2

    3

    Effective

    Date

    4

    Name

    of

    Company

    5

    Location

    6

    Type

    7

    Premiums

    8

    Unearned

    Premiums

    (Estimated)

    9

    Reserve Credit

    Taken Other

    than for

    Unearned Premiums

    Outstanding Surplus Relief

    12

    Modified

    Coinsurance

    Reserve

    13

    Funds

    Withheld

    Under

    Coinsurance

    10

    Current

    Year

    11

    Prior

    Year

    Totals

(Effective May 11, 2022)