Fillable Form Crs (Commonwealth of Massachusetts)

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Form Crs (Commonwealth of Massachusetts)

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Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Form CR-S Adopted by EX-Plenary 11-06-11
© 1994-2011 National Association of Insurance Commissioners
Form CR-S – PART 1 – SECTION 1
Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities
Without Life or Disability Contingencies, and Related Benefits Listed by Reinsured Company as
of December 31, ________
1
Company Code
or ID Number
2
Effective Date
3
Name of Reinsured
4
Location
5
Type of
Reinsurance
Assumed
6
Amount of In
Force at End of
Year
7
Reserve
8
Premiums
9
Reinsurance Payable
on Paid and Unpaid
Losses
10
Modified
Coinsurance Reserve
11
Funds Withheld Under
Coinsurance
Totals
0
0
0
0
0
0
Form CR-S Adopted by EX-Plenary 11-06-11
© 1994-2011 National Association of Insurance Commissioners
Form CR-S – PART 1 – SECTION 2
Reinsurance Assumed Accident and Health Insurance Listed by Reinsured Company as of December 31, ________
1
Company Code
or ID Number
2
Effective Date
3
Name of Reinsured
4
Domiciliary Jurisdiction
5
Type of
Reinsurance
Assumed
6
Premiums
Unearned
8
Reserve Liability
Other Than For
Unearned Premiums
9
Reinsurance Payable
on Paid and Unpaid
Losses
10
Modified
Coinsurance Reserve
11
Funds Withheld Under
Coinsurance
Totals
0
0
0
0
0
0
Form CR-S Adopted by EX-Plenary 11-06-11
© 1994-2011 National Association of Insurance Commissioners
Form CR-S – PART 2
Reinsurance Recoverable on Paid and Unpaid Losses Listed by Reinsuring Company as of December 31, ________
1
Company Code
or ID Number
2
Effective Date
3
Name of Company
4
Location
5
Paid Losses
6
Unpaid Losses
Totals – Life, Annuity and Accident and Health
0
0
Form CR-S Adopted by EX-Plenary 11-06-11
© 1994-2011 National Association of Insurance Commissioners
Form CR-S – PART 3 SECTION 1
Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities
Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December 31, ________
1
2
3
4
5
6
Reserve Credit Taken
9
Outstanding Surplus Relief
12
13
Company
Code or ID
Number
Effective Date
Name of Company
Location
Type of
Reinsurance
Cededs
Amount in Force at
End of Year
7
Current Year
Prior Year
Premiums
10
Current Year
11
Prior Year
Modified
Coinsurance
Reserve
Funds Withheld
Under
Coinsurance.
Totals
0
0
0
0
0
0
0
0
Form CR-S Adopted by EX-Plenary 11-06-11
© 1994-2011 National Association of Insurance Commissioners
Form CR-S – PART 3 SECTION 2
Reinsurance Ceded Accident and Health Insurance Listed by Reinsuring Company as of December 31, ________
1
2
3
4
5
6
7
8
Outstanding Surplus Relief
11
12
Company
Code or ID
Number
Effective Date
Name of Company
Location
Type
Premiums
Unearned
Premium
(Estimated)
Reserve Credit Taken
Other than for Unearned
Premium
9
Current Year
10
Prior Year
Modified
Coinsurance Reserve
Funds Withheld Under
Coinsurance.
Totals
0
0
0
0
0
0
0
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Form Crs (Commonwealth of Massachusetts)

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Completed 26 July 2020

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