Not Assigned Annual Checklist for Certified Companies

ANNUAL FILING CHECKLIST
ADMITTED REINSURERS
•
•
•
•
•

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. Copy of Renewal Fee Receipt (pay online at
https://www.fiscal.treasury.gov/surety-bonds/)
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. Treasury Schedule F (form provided online)
6. Copies of LOC’s and Trust Agreements for Largest Recoverable
Amounts Reported on Sch. F, Part 2, Columns 2b and 2c
7. NAIC IRIS Ratios and explanation(s) of IRIS Ratios with Unusual Results
8. Current State Exam Report (if not previously provided) and copy of
correspondence responding to Examiner’s recommendations

SUBMITTED
YES
N/A

9. Biographical Affidavits of New Officers and Directors marked with #
on Jurat, if not provided in a previous quarterly filing (use NAIC Format)
10. Description of Miscellaneous Assets Reported on Page 1 of the Annual
Financial Statement
11. Insurance Dept. Certificates:
- verifying large infusions of capital or surplus
- verifying approval of extraordinary dividend
12. Documents Describing Changes in the Company (i.e., name Change,

ownership change, change in state of incorporation, change in CPA audit
firms, etc.)
13. Copies of Change to Charter or Articles of Incorporation or Bylaws

which occurred this past year, if not sent in previous quarters

Annual Filing Checklist
Admitted Reinsurers Rev.
12/2020
OMB No. 1530-0061