memo

• STATE OF HAWAII INSURANCE DIVISION • DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS P. 0. Box 3614 Honolulu, HI 96811-3614 335 Merchant St., 2nd Floor Honolulu, HI 96813 December 29, 2003 Memorandum 2003-13E TO: FOREIGN RISK RETENTION GROUPS SUBJECT: ANNUAL FILING REQUIREMENTS IN 2004 A. GENERAL INFORMATION All filings must be POSTMARKED no later than the indicated date. If the due date falls on a weekend or holiday, then the deadline is extended to the next business day. B. DOCUMENTS AND FILING DEADLINES DOCUMENT (FILE ONE COPY EACH UNLESS OTHERWISE STATED) 1. 2. 3. 4. 5. ANNUAL STATEMENT (Size 8W' x 14") for year 2003, verified by oaths of at least two officers. Facsimile signatures or reproductions of original signatures may be used (per the NAIC's Annual Statement Instructions). TAX STATEMENT (Annual Statement of Premiums Received for Taxation Purposes) for year 2003 signed on insurer's behalf by some duly authorized person and notarized. LOSS RESERVE CERTIFICATION (Documentation of liabilities shall be accompanied by a Statement of Actuarial Opinion and signed by a qualified actuary or specialist.) AUDITED FINANCIAL STATEMENT FOR year 2003. CERTIFICATE OF COMPLIANCE issued by state of domicile. 2004 FILING DEADLINE March 1 March 1 March 1 June 1 As soon as available • • Memorandum 2003-13E Page 2 DOCUMENT (FILE ONE COPY EACH UNLESS OTHERWISE STATED) 6. 7. LATEST REPORT OF EXAMINATION (if not previously filed) bearing an original certification by the insurance supervisory official of the state of domicile. AMENDMENTS TO CHARTER OR ARTICLES OF INCORPORATION, CONSTITUTION AND BYLAWS, made during year, bearing an original certification by the proper officer of the state of domicile. Constitution and Bylaws should be certified by proper officer of the society and notarized C. REMARKS 2004 FILING DEADLINE As soon as available Within 90 days after enactment Checks should be made payable to "DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS, STATE OF HAWAII" Your cancelled check is your receipt; an official receipt will be issued only upon written request. A service charge of $15.00 will be assessed for each dishonored check received. Your Risk Retention Group Registration will be administratively withdrawn if documents are not submitted by the filing deadline. QUESTIONS REGARDING FILING REQUIREMENTS: Please contact Albert Yamane@ (808) 586-8150 or via fax@ (808) 586-3873.