Appendix D

38a-88-appendixd Sec. 38a-88-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