N.M. Admin. Code § 13.18.3.21

Current through Register Vol. 35, No. 21, November 5, 2024

Section 13.18.3.21 - FORM A SUMMARY EXPERIENCE REPORT

SUMMARY EXPERIENCE REPORT

Name of Insurer: __________________________________________ NAIC Code: _____________________

Contact Person: ___________________________________________ Telephone Number: _______________

Calendar Year: ________________

CREDITOR-PLACED INSURANCE

NEW MEXICO				COUNTRYWIDE
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)
TYPE OF DATA	Real Property	Motor Vehicles	Mobile Homes	All Other Personal Property	Total	Real Property	Motor Vehicles	Mobile Homes	All Other Personal Property	Total
A. Gross Written Premium
B. Refunds on Terminations
C. Net Written Premium (A)-(B)
D. Beginning Premium Reserve
E. Ending Premium Reserve
F. Net Earned Premium (C)+(D)-(E)
G. Other Income Less Other Expense
H. Policyholder Dividends
I. Incurred Losses
J. LAE Incurred
K. Commissions Incurred
L. Service Fees Incurred
M. Other Incurred Compensation
N. Other Acquisition Expenses
O. Other Underwriting Expense
P. Total Loss and Expense Sum of (H) to (O)
Q. Underwriting Profit (F)+(G)(P)

Instructions:

1. This form applies to creditor-placed insurance only.

2. Provide all data direct as to reinsurance.

3. LAE means loss adjustment expense.

4. Other underwriting expenses means the sum of taxes, licenses, fees, and general expenses.

5. The experience reported should be consistent with the insurance expense exhibit of the insurer's annual statement.

N.M. Admin. Code § 13.18.3.21

1/1/99; Recompiled 11/30/01