Form FEMA Form 129-1 FEMA Form 129-1 Financial Statement Exhibits

							OMB No. 1660-0020
							Expiration Date: December 31, 2011
Department of Homeland Security
Federal Emergency Management Agency
OMB Control Number: 1660-0020
Title: Write Your Own (WYO) Program
FEMA Form Number 129-1
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FSBLKFiscal2011				KEY IN GRAY SHADED AREAS ONLY																			CO	.PRN
Effective 10/1/2010																							#VALUE!	#VALUE!
					EXHIBIT I
					INCOME STATEMENT
																							OCT	1	OCTOBER	31
		COMPANY NAME :		x: Please do not make any formatting changes to this diskette. (ie. Do not add or delete rows or columns). Type in name in all caps, left justified. YOUR COMPANY NAME																			NOV	2	NOVEMBER	30
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED																			DEC	3	DECEMBER	31
		PERIOD ENDING :		x: Type in month and year only. Type month in words, in capital letters. Do not abbreviate or use punctuation marks. MONTH (ALL CAPITAL LETTERS) AND YEAR																			JAN	4	JANUARY	31
																							FEB	5	FEBRUARY	29
					CURRENT				FISCAL														MAR	6	MARCH	31
		REVENUE			MONTH				YEAR-TO-DATE														APR	7	APRIL	30
																							MAY	8	MAY	31
	100.	WRITTEN PREMIUM		$	0			$	0				0										JUN	9	JUNE	30
													0										JUL	10	JULY	31
	105.	CHANGE IN UNEARNED PREMIUM			0				0				0										AUG	11	AUGUST	31
													0										SEP	12	SEPTEMBER	30
	110.	EARNED PREMIUM		$	0			$	0
		EXPENSES
	115.	NET PAID LOSSES			0				0
	120.	ALLOCATED LAE (LINE 500)			0				0
	125.	OTHER LOSS & LAE ITEMS
		(LINE 660)			0				0
	130.	CHANGE IN LOSS & LAE
		RESERVES (LINES 325 THRU
		340 COL.C)			0				0
	135.	NET LOSS & LAE INCURRED			0			$	0
	140.	EXPENSE ALLOWANCE
		(LINE 430)			0				0
	150.	MISCELLANEOUS EXPENSE			0				0
	155.	TOTAL EXPENSES		$	0			$	0
	160.	OPERATING INCOME (LOSS)			0				0
	165.	INTEREST INCOME (LINE 710)			0				0
	170.	NET POLICY SERVICE FEES			0				0
	175.	NET INCOME (LOSS)		$	0			$	0
		PREPARER'S NAME:
		PHONE NUMBER:
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B
					EXHIBIT II
				RECONCILIATION OF PAYABLE/RECEIVABLE BALANCE
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
					CURRENT				FISCAL
					MONTH				YEAR-TO-DATE
	200.	BEGINNING PAYABLE/REC.
		BALANCE(LINE315,COL.B)			0				0
	205.	NET INCOME (LOSS)
		(LINE 175)			0				0
	210.	LOC FUNDS RECEIVED
		(LINE 800)			0				0
	215.	DISBURSEMENT TO NFIP
		(LINE 805)			0				0
	220.	ENDING PAYABLE/RECEIVABLE			0				0
		BALANCE (LINE 315, COL.A)
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B
					EXHIBIT III
					BALANCE SHEET ITEMS
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
				A	B		C		D
							INCREASE
				CURRENT	PRIOR		(DECREASE)		BEGINNING OF
				MONTH	MONTH		(COLS.A-B)		FISCAL YEAR
	300.	CASH		0	0		0		0
	305.	CASH - NOT
		TRANSFERRED TO
		RESTRICTED ACCT.**		0	0		0		0
	310.	CASH - NOT
		TRANSFERRED FROM
		RESTRICTED ACCT.**		0	0		0		0
	312.	CLAIMS PAYABLE**		0	0		0		0
	315.	PAYABLE TO
		(RECEIVABLE
		FROM) NFIP		0	0		0		0
	320.	UNEARNED PREMIUM
		RESERVES		0	0		0		0
	325.	LOSS RESERVES
		(CASE)		0	0		0		0
	330.	LOSS RESERVES
		(IBNR)		0	0		0		0
	335.	LAE RESERVES-CASE
		(ALLOCATED)		0	0		0		0
	336.	LAE RESERVES-IBNR
		(ALLOCATED)		0	0		0		0
	340.	LAE RESERVES
		(UNALLOCATED)		0	0		0		0
	345.	PREMIUM SUSPENSE
		(UNDER 60 DAYS)		0	0		0		0
	346.	PREMIUM SUSPENSE
		(60 DAYS OR OVER)		0	0		0		0
		TOTALS		0	0		0		0
		PLEASE SHOW DEBITS AS POSITIVE NUMBERS & BRACKET ALL CREDITS.
		THE COLUMNS MUST ADD TO ZERO (-0-).
	*	UPON TREASURY DEPARTMENT'S REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING
		AGED DETAIL FOR THE REPORTED BALANCE. COMPANIES WILL BE NOTIFIED WHEN
		SUCH A REQUEST IS MADE.
				EXHIBIT IV
				EXPENSE ALLOWANCE CALCULATION
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
					CURRENT				FISCAL
	EXPENSE ALLOWANCE				MONTH				YEAR-TO-DATE
	400.	WRITTEN PREMIUM			0				0
(Do Not Use for Premium)
	405.	EXPENSE ALLOWANCE % A			0.0%				0.0%
	410.	EXPENSE ALLOWANCE FOR
		WRITTEN PREMIUM A			0				0
*	411.	WRITTEN PREMIUM
(Use 10/1/2008 data month and later)					0				0
	412.	EXPENSE ALLOWANCE % B			30.2%				30.2%
	413.	EXPENSE ALLOWANCE FOR
		WRITTEN PREMIUM B			0				0
	414.	SUBTOTAL EXPENSE ALLOWANCE			0				0
	415.	CANCELLATION PREMIUM
		REFUND ADJUSTMENT BASE			0				0
	420.	COMMISSION ALLOWANCE %			15%				15%
	425.	CANCELLATION COMMISSION
		RETENTION			0				0
	426.	EXPENSE ALLOWANCE ADJUSTMENT			0				0
		FOR BONUS COMMISSION
	427.	RATING ORGANIZATION EXPENSE			0				0
	428.	STATE SALES TAX
		ON INSURANCE SERVICES			0				0
	429.	PRIOR TERM REFUND EXPENSE
		ALLOWANCE DUE THE NFIP			0				0
	430.	TOTAL EXPENSE ALLOWANCE $			0			$	0
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B					UPDATED: 6/1/2008
				EXHIBIT V-A
				FEE SCHEDULE - ALLOCATED LAE
		(USE FOR CLAIMS WITH DATE OF LOSS OF 9/30/90 AND PRIOR)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
		A			B		C		D
	ENTRY VALUE RANGE				NUMBER CLOSED		FEE		FEE PD (BxC)
	ERRONEOUS ASSIGNMENT				0		40.00	$	0
	CWP				0		70.00		0
		0.01- 200.00			0		70.00		0
		200.01- 400.00			0		90.00		0
		400.01- 600.00			0		110.00		0
		600.01- 800.00			0		130.00		0
		800.01- 1000.00			0		150.00		0
		1000.01- 1500.00			0		180.00		0
		1500.01- 2000.00			0		200.00		0
		2000.01- 2500.00			0		220.00		0
		2500.01- 3000.00			0		240.00		0
		3000.01- 3500.00			0		260.00		0
		3500.01- 4000.00			0		280.00		0
		4000.01- 4500.00			0		300.00		0
		4500.01- 5000.00			0		320.00		0
		5000.01- 6000.00			0		350.00		0
		6000.01- 7000.00			0		370.00		0
		7000.01- 8000.00			0		380.00		0
		8000.01- 9000.00			0		400.00		0
		9000.01- 10000.00			0		420.00		0
		10000.01- 15000.00			0		460.00		0
		15000.01- 20000.00			0		490.00		0
		20000.01- 25000.00			0		520.00		0
		25000.01- 30000.00			0		550.00		0
		30000.01- 35000.00			0		580.00		0
		35000.01- 40000.00			0		610.00		0
		40000.01- 45000.00			0		640.00		0
		45000.01- 50000.00			0		670.00		0
		50000.01- 75000.00			0		800.00		0
		75000.01-100000.00			0		950.00		0
		100000.01-125000.00			0		1100.00		0
		125000.01-150000.00			0		1250.00		0
		150000.01-175000.00			0		1400.00		0
		175000.01-200000.00			0		1550.00		0
		200000.01- LIMITS			0		1700.00		0
	500-A. **TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-A							$	0
	**UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPENSE.
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B
				EXHIBIT V-B
				FEE SCHEDULE - ALLOCATED LAE
		(USE FOR CLAIMS WITH DATE OF LOSS OF 10/1/90 THROUGH 10/31/96)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
		A			B		C		D
	ENTRY VALUE RANGE				NUMBER CLOSED		FEE		FEE PD (BxC)
	ERRONEOUS ASSIGNMENT				0		40.00	$	0
	CWP				0		125.00		0
	MINIMUM FOR UPTON-JONES				0		800.00		0
	$	0.01- $600.00			0		150.00		0
		600.01- 1000.00			0		175.00		0
		1000.01- 2000.00			0		225.00		0
		2000.01- 3500.00			0		275.00		0
		3500.01- 5000.00			0		350.00		0
		5000.01- 7000.00			0		425.00		0
		7000.01- 10000.00			0		500.00		0
		10000.01- 15000.00			0		550.00		0
		15000.01- 25000.00			0		600.00		0
		25000.01- 35000.00			0		675.00		0
		35000.01- 50000.00			0		750.00		0
		50000.01-100000.00			0		1000.00		0
		100000.01-150000.00			0		1300.00		0
		150000.01-200000.00			0		1600.00		0
		200000.01- LIMITS			0		2000.00		0
		EXCESS MILEAGE							0
	500-B. **TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-B							$	0
	**UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPENSE.
				EXHIBIT V-C
				FEE SCHEDULE - ALLOCATED LAE
		(USE FOR CLAIMS WITH DATE OF LOSS OF 11/01/96 THROUGH 04/30/97)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
		A			B		C		D
	ENTRY VALUE RANGE				NUMBER		FEE		FEE PAID
	ERRONEOUS ASSIGNMENT				0		40.00	$	0
	CWP				0		125.00		0
	$	0.01- $600.00			0		150.00		0
		600.01- 1000.00			0		175.00		0
		1000.01- 2000.00			0		225.00		0
		2000.01- 3500.00			0		275.00		0
		3500.01- 5000.00			0		350.00		0
		5000.01- 7000.00			0		425.00		0
		7000.01- 10000.00			0		500.00		0
		10000.01- 15000.00			0		550.00		0
		15000.01- 25000.00			0		600.00		0
		25000.01- 35000.00			0		675.00		0
		35000.01- 50000.00			0		750.00		0
		50000.01-100000.00			0		3.0%		0
		100000.01-250000.00			0		2.3% BUT NOT LESS		0
							THAN $3,000.00
		250000.01- LIMITS			0		2.1% BUT NOT LESS		0
							THAN $5,750.00
	OTHER FEMA-AUTHORIZED LAE*								0
	500-C. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-C							$	0
	*UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPENSE.
				EXHIBIT V-D
				FEE SCHEDULE - ALLOCATED LAE
		(USE FOR CLAIMS WITH DATE OF LOSS OF 05/01/97 THROUGH 08/31/04)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
		A			B		C		D
	ENTRY VALUE RANGE				NUMBER		FEE		FEE PAID
	ERRONEOUS ASSIGNMENT				0		40.00	$	0
	CWP				0		125.00		0
	$	0.01- $600.00			0		150.00		0
		600.01- 1000.00			0		175.00		0
		1000.01- 2000.00			0		225.00		0
		2000.01- 3500.00			0		275.00		0
		3500.01- 5000.00			0		350.00		0
		5000.01- 7000.00			0		425.00		0
		7000.01- 10000.00			0		500.00		0
		10000.01- 15000.00			0		600.00		0
		15000.01- 25000.00			0		750.00		0
		25000.01- 35000.00			0		900.00		0
		35000.01- 50000.00			0		1200.00		0
		50000.01-100000.00			0		3.0%		0
		100000.01-250000.00			0		2.3% BUT NOT LESS		0
							THAN $3,000.00
		250000.01- LIMITS			0		2.1% BUT NOT LESS		0
							THAN $5,750.00
	500-D. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-D							$	0
	*UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPENSE.
				EXHIBIT V-E
	INCREASED COST OF COMPLIANCE (ICC) FEE SCHEDULE - ALLOCATED LAE
	(USE FOR ICC CLAIMS WITH DATE OF LOSS OF 06/01/97 THROUGH 08/31/04)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
		A			B		C		D
	ENTRY VALUE RANGE				NUMBER		FEE		FEE PAID
	ERRONEOUS ASSIGNMENT				0		40.00	$	0
	CWP				0		125.00		0
	$	0.01- $600.00			0		150.00		0
		600.01- 1000.00			0		175.00		0
		1000.01- 2000.00			0		225.00		0
		2000.01- 3500.00			0		275.00		0
		3500.01- 5000.00			0		350.00		0
		5000.01- 7000.00			0		425.00		0
		7000.01- 10000.00			0		500.00		0
		10000.01- 15000.00			0		600.00		0
	(Use the following Entry Range only for ICC total claims payments greater than
	$15,000 but not more than $20,000, and with a Loss Date of 05/01/00 and later).
		15000.01- 20000.00			0		750.00		0
	(Use the following Entry Range only for ICC total claims payments greater than
	$15,000 but not more than $30,000, and with a Loss Date of 05/01/2003 and later).
		15000.01- 20000.00			0		750.00		0
		25000.01- 30000.00			0		900.00		0
	500-E. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-E							$	0
	*UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPENSE.
				REVISED EXHIBIT V-F
				FEE SCHEDULE - ALLOCATED LAE
		(USE FOR CLAIMS WITH DATE OF LOSS OF 09/01/2004 THROUGH 8/31/2008)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
		A			B		C		D
	ENTRY VALUE RANGE				NUMBER		FEE		FEE PAID
	ERRONEOUS ASSIGNMENT				0		60.00	$	0
	CWP				0		225.00		0
	$	0.01- 1000.00			0		300.00		0
		1000.01- 2500.00			0		425.00		0
		2500.01- 5000.00			0		500.00		0
		5000.01- 7500.00			0		575.00		0
		7500.01- 10000.00			0		650.00		0
		10000.01- 15000.00			0		750.00		0
		15000.01- 25000.00			0		850.00		0
		25000.01- 35000.00			0		1000.00		0
		35000.01- 50000.00			0		1250.00		0
		50000.01- 100000.00			0		3.0%		0
		100000.01- 250000.00			0		2.3% BUT NOT LESS		0
							THAN $3,000.00
		250,000.01 and up			0		2.1% BUT NOT LESS		0
							THAN $5,750.00
	Use the following Allocated LAE Fees for Expedited Claim Handling for Hurricanes
	Katrina and Rita with dates of loss beginning August 24, 2005.
	500-F1	Process 1			0		750.00		0
	500-F1S	Process 1 Site Visit			0		400.00		0
	500-F2	Process 2			0		750.00		0
	500-F2S	Process 2 Site Visit			0		400.00		0
	500-F4	Special Adjusting Process			0				0
		(FEMA Approval Required)
	500-F. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-F							$	0
	*UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPENSE.
				EXHIBIT V-G
	INCREASED COST OF COMPLIANCE (ICC) FEE SCHEDULE - ALLOCATED LAE
	(USE FOR ICC CLAIMS WITH DATE OF LOSS OF 9/01/04 AND LATER)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
		A			B		C		D
	ENTRY VALUE RANGE				NUMBER		FEE		FEE PAID
	ERRONEOUS ASSIGNMENT				0		60.00	$	0
	CWP				0		225.00		0
	$	0.01- $1000.00			0		300.00		0
		1000.01- 2500.00			0		425.00		0
		2500.01- 5000.00			0		500.00		0
		5000.01- 7500.00			0		575.00		0
		7500.01- 10000.00			0		650.00		0
		10000.01- 15000.00			0		750.00		0
		15000.01- 25000.00			0		850.00		0
		25000.01- 30000.00			0		1000.00		0
	500-H. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-H							$	0
	500-G. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-G								0
	500-F. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-F								0
	500-E. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-E								0
	500-D. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-D								0
	500-C. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-C								0
	500-B. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-B								0
	500-A. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-A								0
	500.	**TOTAL ALLOCATED LAE FEES PAID						$	0
	*UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPENSE.
							UPDATED: 9/1/2008
				EXHIBIT V-H
				FEE SCHEDULE - ALLOCATED LAE
		(USE FOR CLAIMS WITH DATE OF LOSS OF 09/01/2008 AND LATER)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
		A			B		C		D
	ENTRY VALUE RANGE				NUMBER		FEE		FEE PAID
	ERRONEOUS ASSIGNMENT				0		70.00	$	0
	CLOSED WITHOUT PAYMENT (CWOP)				0		275.00		0
	$	0.01- 1000.00			0		375.00		0
		1000.01- 5000.00			0		600.00		0
		5000.01- 10000.00			0		800.00		0
		10000.01- 15000.00			0		925.00		0
		15000.01- 25000.00			0		1025.00		0
		25000.01- 35000.00			0		1175.00		0
		35000.01- 50000.00			0		1400.00		0
		50000.01- 100000.00			0		3% BUT NOT LESS		0
							THAN $1,600.00
		100000.01- 250000.00			0		2.3% BUT NOT LESS		0
							THAN $3,000.00
		250,000.01 and up			0		2.1% BUT NOT LESS		0
							THAN $5,750.00
	500-H. TOTAL ALLOCATED LAE FEES PAID-EXHIBIT V-H							$	0
	*UPON FEMA REQUEST, WYO COMPANY MUST PROVIDE SUPPORTING DETAIL FOR THE REPORTED EXPENSE.
							UPDATED: 9/1/2008
				EXHIBIT VI
				OTHER LOSS & LAE CALCULATION
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
					CURRENT				FISCAL
					MONTH				YEAR-TO-DATE
	UNALLOCATED L.A.E.PAID
*	600A.	NET PAID LOSSES(LINE 115 CUR MONTH)			0				0
(Use 10/1/2008 data month and later)
*	605A.	CHANGE IN CASE RESERVES(LINE 325,COL C)
(Use 10/1/2008 data month and later)					0				0
	610.	CASE INCURRED LOSSES			0				0
	611.	ULAE INCURRED LOSS %			1.5%				1.5%
	612.	SUBTOTAL ULAE INCURRED LOSS			0				0
	613	ULAE NET WRITTEN PREMIUM %			1.0%				1.0%
	614.	SUBTOTAL ULAE NET WRITTEN PREMIUM			0				0
	620A.	UNALLOCATED LAE(6/1/08thru9/30/08)			0				0
	620.	UNALLOCATED LAE(10/1/07thru5/31/08)			0				0
*	620B.	TOTAL UNALLOCATED LAE			0				0
	SALVAGE & SUBROGATION
	625.	NET SALVAGE RECEIVED			0				0
	630.	SALVAGE ALLOWANCE %			10%				10%
	635.	SALVAGE CREDIT			0				0
	640.	NET SUBROGATION RECEIVED			0				0
	645.	SUBROGATION ALLOWANCE %			25%				25%
	650.	SUBROGATION CREDIT			0				0
	652.	RECOVERY OF LOSSES PAID			0				0
	Enter Recovery as a Debit
	SPECIAL ALLOCATED LAE
	________________________
	655.	SPECIAL ALLOCATED LOSS
		ADJUSTMENT EXPENSE			0				0
	660.	TOTAL OTHER LOSS & LAE
		ITEMS (SUM OF LINES 620B,
		635,650,655)		$	0			$	0
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B					UPDATED: 6/1/2008
					EXHIBIT VII
					INTEREST INCOME
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
					CURRENT				FISCAL
					MONTH				YEAR-TO-DATE
	700.	TOTAL INTEREST RECEIVED			0				0
	705.	RESTRICTED ACCOUNT CHARGES			0				0
	Enter Charges as a Debit
	710.	TOTAL INTEREST INCOME $			0			$	0
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B					0
				EXHIBIT VIII-A
			LETTER OF CREDIT DRAWDOWNS
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
				LOC DRAWDOWNS
			DATE				AMOUNT
		AUGUST	01			$	0
		AUGUST	02				0
		AUGUST	03				0
		AUGUST	04				0
		AUGUST	05				0
		AUGUST	06				0
		AUGUST	07				0
		AUGUST	08				0
		AUGUST	09				0
		AUGUST	10				0
		AUGUST	11				0
		AUGUST	12				0
		AUGUST	13				0
		AUGUST	14				0
		AUGUST	15				0
		AUGUST	16				0
		AUGUST	17				0
		AUGUST	18				0
		AUGUST	19				0
		AUGUST	20				0
		AUGUST	21				0
		AUGUST	22				0
		AUGUST	23				0
		AUGUST	24				0
		AUGUST	25				0
		AUGUST	26				0
		AUGUST	27				0
		AUGUST	28				0
		AUGUST	29				0
		AUGUST	30				0
		AUGUST	31				0
		800.	TOTAL			$	0
				EXHIBIT VIII-B
			CASH PAYMENTS TO THE NFIP
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
				PAYMENTS TO NFIP
			DATE				AMOUNT
		AUGUST	01				0
		AUGUST	02				0
		AUGUST	03				0
		AUGUST	04				0
		AUGUST	05				0
		AUGUST	06				0
		AUGUST	07				0
		AUGUST	08				0
		AUGUST	09				0
		AUGUST	10				0
		AUGUST	11				0
		AUGUST	12				0
		AUGUST	13				0
		AUGUST	14				0
		AUGUST	15				0
		AUGUST	16				0
		AUGUST	17				0
		AUGUST	18				0
		AUGUST	19				0
		AUGUST	20				0
		AUGUST	21				0
		AUGUST	22				0
		AUGUST	23				0
		AUGUST	24				0
		AUGUST	25				0
		AUGUST	26				0
		AUGUST	27				0
		AUGUST	28				0
		AUGUST	29				0
		AUGUST	30				0
		AUGUST	31				0
		805. B	TOTAL			$	0
		805. C	CREDIT CARD PAYMENTS				0
		805. D	INTERNET PAYMENTS				0
		805. E	WIRE TRANSFER PAYMENTS				0
		805	TOTAL PAYMENTS TO NFIP				0
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B
				EXHIBIT VIII-C
				CREDIT CARD PAYMENTS TO NFIP
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
			DATE				AMOUNT
		AUGUST	01			$	0
		AUGUST	02				0
		AUGUST	03				0
		AUGUST	04				0
		AUGUST	05				0
		AUGUST	06				0
		AUGUST	07				0
		AUGUST	08				0
		AUGUST	09				0
		AUGUST	10				0
		AUGUST	11				0
		AUGUST	12				0
		AUGUST	13				0
		AUGUST	14				0
		AUGUST	15				0
		AUGUST	16				0
		AUGUST	17				0
		AUGUST	18				0
		AUGUST	19				0
		AUGUST	20				0
		AUGUST	21				0
		AUGUST	22				0
		AUGUST	23				0
		AUGUST	24				0
		AUGUST	25				0
		AUGUST	26				0
		AUGUST	27				0
		AUGUST	28				0
		AUGUST	29				0
		AUGUST	30				0
		AUGUST	31				0
		800-C	TOTAL CREDIT CARD PAYMENTS			$	0
				EXHIBIT VIII-D
				INTERNET PAYMENTS TO NFIP
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
			DATE				AMOUNT
		AUGUST	01			$	0
		AUGUST	02				0
		AUGUST	03				0
		AUGUST	04				0
		AUGUST	05				0
		AUGUST	06				0
		AUGUST	07				0
		AUGUST	08				0
		AUGUST	09				0
		AUGUST	10				0
		AUGUST	11				0
		AUGUST	12				0
		AUGUST	13				0
		AUGUST	14				0
		AUGUST	15				0
		AUGUST	16				0
		AUGUST	17				0
		AUGUST	18				0
		AUGUST	19				0
		AUGUST	20				0
		AUGUST	21				0
		AUGUST	22				0
		AUGUST	23				0
		AUGUST	24				0
		AUGUST	25				0
		AUGUST	26				0
		AUGUST	27				0
		AUGUST	28				0
		AUGUST	29				0
		AUGUST	30				0
		AUGUST	31				0
		800-D	TOTAL INTERNET PAYMENTS			$	0
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B
				EXHIBIT VIII-E
				WIRE TRANSFER TO NFIP (GREATER THAN $ 100,000)
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
			DATE				AMOUNT
		AUGUST	01			$	0
		AUGUST	02				0
		AUGUST	03				0
		AUGUST	04				0
		AUGUST	05				0
		AUGUST	06				0
		AUGUST	07				0
		AUGUST	08				0
		AUGUST	09				0
		AUGUST	10				0
		AUGUST	11				0
		AUGUST	12				0
		AUGUST	13				0
		AUGUST	14				0
		AUGUST	15				0
		AUGUST	16				0
		AUGUST	17				0
		AUGUST	18				0
		AUGUST	19				0
		AUGUST	20				0
		AUGUST	21				0
		AUGUST	22				0
		AUGUST	23				0
		AUGUST	24				0
		AUGUST	25				0
		AUGUST	26				0
		AUGUST	27				0
		AUGUST	28				0
		AUGUST	29				0
		AUGUST	30				0
		AUGUST	31				0
		800-E	TOTAL WIRE TRANSFER PAYMENTS			$	0
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B
				EXHIBIT IX
			RESTRICTED ACCOUNT DEPOSITS SUMMARY
		COMPANY NAME :		YOUR COMPANY NAME
		COMPANY NUMBER :		YOUR COMPANY NAIC NUMBER LEFT JUSTIFIED
		PERIOD ENDING :		MONTH (ALL CAPITAL LETTERS) AND YEAR
			DATE				AMOUNT
		AUGUST	01				0
		AUGUST	02				0
		AUGUST	03				0
		AUGUST	04				0
		AUGUST	05				0
		AUGUST	06				0
		AUGUST	07				0
		AUGUST	08				0
		AUGUST	09				0
		AUGUST	10				0
		AUGUST	11				0
		AUGUST	12				0
		AUGUST	13				0
		AUGUST	14				0
		AUGUST	15				0
		AUGUST	16				0
		AUGUST	17				0
		AUGUST	18				0
		AUGUST	19				0
		AUGUST	20				0
		AUGUST	21				0
		AUGUST	22				0
		AUGUST	23				0
		AUGUST	24				0
		AUGUST	25				0
		AUGUST	26				0
		AUGUST	27				0
		AUGUST	28				0
		AUGUST	29				0
		AUGUST	30				0
		AUGUST	31				0
		900	TOTAL				0
		WYO ACCOUNTING PROCEDURES (MANUAL)					EFFECTIVE : 10/1/2010
		PART B
				"DISKETTE CONTROL FORM"
				-	----------
WYO COMPANY NAME:				YOUR COMPANY NAME
				-	-
FILE NAME:					DATE SENT:
			-	----------			-	--
REPORTING MONTH/YEAR:				MONTH (ALL CAPITAL LETTERS) AND YEAR
				-	-
PREPARER'S NAME:				0
				-	-
TELEPHONE NUMBER:				0
				-	-
							CURRENT MTH.		FYTD
NET INCOME (LOSS) FOR REPORTING MONTH:
(EXH. I, INCOME STATEMENT, LINE 175)							0		0
						=	=		=
PAYABLE TO (RECEIVABLE FROM) NFIP:
EXHIBIT III, BALANCE SHEET, LINE 315, COLUMN A)									0
					0				=