Report of Commercial Risk Insurance Writings and Experience Required by Conn. Gen. Stat. §38a-696

APPENDIX 1 Report of Commercial Risk Insurance Writings and Experience required by Section 38a-696 of the Connecticut General Statutes. This report is due on or before JUNE 1, of each year for the preceding calendar year experience. Line or Subline of Business _____________________________________ Company or Company Group _____________________________________ Item (Direct Basis) Connecticut Countrywide 1) Premiums written __________ __________ 2) Premiums earned __________ __________ 3) Incurred losses __________ __________ 4) Loss adjustment expense __________ __________ 5) Incurred expense __________ __________ 6) Policyholder dividends __________ __________