Asset Adequacy Tested Amounts Reserves and Liabilities | |||||
Statement Item | Formula Reserves (1) | Additional Actuarial Reserves (a) (2) | Analysis Method (b) | Other Amount (3) | Total Amount (1) + (2) + (3) (4) |
Exhibit 8 A. Life Insurance | |||||
B. Annuities | |||||
C. Supplementary Contracts Involving Life Contingencies | |||||
D. Accidental Death Benefit | |||||
E. Disability - Active | |||||
F. Disability - Disabled | |||||
G. Miscellaneous | |||||
Total (Exhibit 8 Item 1, pg. 3) | |||||
Exhibit 9 A. Active Life Reserve | |||||
B. Claim Reserve | |||||
Total (Exhibit 9 Item 2, pg. 3) | |||||
Exhibit 10 Premiums and other Deposit funds (Column 5, Line 14) | |||||
Guaranteed Interest Contracts (Column 2, Line 14 | |||||
Other (Column 6, Line 14) | |||||
Supplementary Contracts and Annuities Certain (Column 3, Line 14) | |||||
Divided Accumulations or Refunds (Column 4, Line 14) Total Exhibit 10 (Column 1, Line 14) | |||||
Exhibit 11, Part 1 1. Life (Page 3, Line 4.1) | |||||
2. Health (Page 3, Line 4.2) | |||||
Total Exhibit 11, Part 1 | |||||
Separate Accounts (pg. 3 of the Annual Statement of the Separate Accounts, Lines 1,2,3.1,3.2, 3.3) | |||||
Total Reserves |
IMR (General Account, Page _____ Line ______ |
Separate Accounts (Page _____ Line ______ |
AVR (Page _____ Line_____ | (c) |
Net Deferred and Uncollected Premium |
____________________________ |
Signature of Appointed Actuary |
____________________________ |
Address of Appointed Actuary |
____________________________ |
Telephone Number of Appointed Actuary |
____________________________ |
Date |
(1) Product Type | (2) Death Benefit or Account Value | (3) Reserves Held | (4) Codification Reserves | (5) Codification Standard |
230 R.I. Code R. 230-RICR-20-45-9.6