R.C.S.A. § 38a-88 APPENDIX D
Appendix D
Cite as Conn. Agencies Regs. § 38a-88 APPENDIX D
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