A Property and Casualty Reporting Form

Section 936 Section 936.EXHIBIT A   Property and Casualty Reporting Form Cumulative paid loss development history at successive quarterly evaluations for most recent four (4) accident years (Include paid ALAE) Development Quarter (in months) Accident Year 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 XXX xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx Cumulative paid + case loss development history (excluding bulk & IBNR) at successive quarterly evaluations for most recent 4 accident yrs. (This is referred to as "reported") (Including paid ALAE) Development Quarter (in months) Accident Year 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 XXX xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx Bulk and incurred but not reported reserves on losses and ALAE at successive quarterly evaluations for most recent four (4)  accident years (Pure bulk and IBNR as well as future development on reported claims) Development Quarter (in months) Accident Year 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 XXX xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx xxx xxx xxx xxx XXX xxx xxx xxx xxx Earned premium by accident quarter Accident Quarter Earned Prem. xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx