QUARTERLY FILING CHECKLIST
CERTIFIED COMPANIES
THE FOLLOWING CHECKLIST IS PROVIDED TO AID YOUR COMPANY IN
ELECTRONICALLY SUBMITTING A QUARTERLY FILING TO THIS
DEPARTMENT (COPY OF THIS CHECKLIST IS TO BE SUBMITTED WITH FILING)
REPORTING COMPANY NAME:
CONTACT PERSON NAME AND TITLE:
CONTACT PHONE NO. AND E-MAIL:
SUBMITTED
ITEMS TO BE SUBMITTED YES
NO
1. Quarterly Financial Data Requirements:
a. NAIC Upload File (s.txt file only) of Reporting Company
b. Signed and Notarized Quarterly Statement (JURAT PAGE ONLY)
2. a. Schedule of Excess Risks – signed and notarized (form provided on-line)*
b. Reinsurance Agreement Forms for All Bonds Written with U.S.
Government the Obligee (SF 273, 274, 275) (forms provided on-line)*
c. Powers of Attorney for all Attorneys-In Fact on Reins. Agrmt. Forms
3. Updated Biographical Affidavits of New Officers and Directors (use
NAIC format)
4. Documents Describing Changes in the Company (i.e., name change,
Ownership change, change in state of incorporation, change in CPA audit firms,
etc.)
5. Copies of Changes to Charter or Articles of Incorporation or Bylaws Which
Occurred During the Quarter
6. Report of Federal Business Written/or Assumed and Outstanding (form provided
on-line)*
*ALL OF OUR FORMS ARE AVAILABLE ON-LINE AT
http://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/surety_home.htm
THE SURETY BOND PROGRAM ONLY ACCEPTS ELECTRONIC SUBMISSIONS
OF DOCUMENTS
Rev. 12/2019
