Form Not Assigned Not Assigned Annual Checklist for Admitted Reinsurers

ANNUAL FILING CHECKLIST
CERTIFIED COMPANIES
•
•
•
•
•
•
•

THE FOLLOWING CHECKLIST IS PROVIDED TO AID YOUR COMPANY IN
ELECTRONICALLY SUBMITTING A COMPLETE FILING TO THIS DEPARTMENT
A COPY OF THIS CHECKLIST IS TO BE SUBMITTED WITH YOUR COMPANY FILING
PLEASE MARK EVERY ITEM ON THE CHECKLIST Y OR N/A
IF N/A IS CHECKED, PLEASE INCLUDE AN EXPLANATION AS TO WHY THE DOCUMENT IS
NOT INCLUDED
ALL OF OUR FORMS ARE AVAILABLE ONLINE AT https://www.fiscal.treasury.gov/surety-bonds/
downloads.html

NOTE: IT IS NOT NECESSARY TO SUBMIT INSURANCE EXPENSE EXHIBITS
THE SURETY BOND PROGRAM ONLY ACCEPTS ELECTRONIC SUBMISSIONS OF
DOCUMENTS

REPORTING COMPANY NAME:
CONTACT PERSON NAME AND TITLE:
CONTACT PERSON PHONE NO.:
AND EMAIL ADDRESS:
ITEMS TO BE SUBMITTED

FORMS SUBMITTED ARE THE MOST RECENT VERSIONS
FROM THE SURETY BONDS WEBSITE
1. Renewal Fee (pay online at https://www.fiscal.treasury.gov/suretybonds/)
2. Signed and Notarized Jurat Page for Annual Financial Statement of Reporting
3. NAIC UPLOAD FILE (s.txt file only)
4. For Subsidiaries shown on schedule D: NAIC UPLOAD FILE (s.txt file only)
5. Surety License Form (form provided online) – Provide all current information
6. Treasury Schedule F (form provided online)
7. Copies of LOC’s and Trust Agreements for Largest Recoverable Amounts
Reported on Sch. F, Part 2, Columns 2b and 2c
8a. Schedule of Excess Risks (form provided online)

SUBMITTED
YES
N/A

b. Reinsurance Agreement Forms for All Bonds Written with U.S. Government as
the Obligee (SF 273, 274, 275) (Available online)
c. Powers of Attorney for all Attorneys-In-Fact on Reins. Agreement Forms
9. NAIC IRIS Ratios and explanation(s) of IRIS Ratios with Unusual Results
10. Current State Exam Report (if not previously provided) and copy of
correspondence responding to Examiner’s recommendations
11. Biographical Affidavits of New Officers and Directors marked with # on
Jurat, if not provided in a previous quarterly filing (use NAIC Format)
12. Bail Bond Reserve Schedule (if applicable)
13. Description of Miscellaneous Assets Reported on Page 1 of the Annual
Financial Statement
14. Current Appraisals for Mortgage Loans and Real Estate Acquired During this
Past Year
15. Insurance Dept. Certificates:
- verifying large infusions of capital or surplus
- verifying approval of extraordinary dividend
16. Documents Describing Changes in the Company (i.e., name change, ownership
change, change in state of incorporation, change in CPA audit firms, etc.)
17. Copies of Change to Charter or Articles of Incorporation or Bylaws which
Occurred this Past Year
18. Report on Federal Business Written, Assumed and/or Outstanding (form
provided online)

Annual Filing Checklist
Certified Companies Rev. 12/2020
OMB No. 1530-0061