[For insurance companies]----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Column A Column B Column C Column D Column E Column F Column G Column H Column I Column J Column K----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Future policy Benefits, claims,
Deferred policy benefits, losses, Other policy Net investment losses, and Amortization of
Segment \1\ acquisition cost claims and loss Unearned premiums claims and Premium revenue income (caption 2) settlement deferred policy Other operating Premiums written
(caption 7) expenses (caption (caption 13-a-2) benefits payable (caption 1) \3\ expenses (caption acquisition costs expenses \3 4\ \2\
13-a-1) (caption 13-a-3) 5) \4\----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Total \5\.....................----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------\1\ Segments shown should be the same as those presented in the footnote disclosures called for by generally accepted accounting principles.\2\ Does not apply to life insurance or title insurance. This amount should include premiums from reinsurance assumed, and be net of premiums on reinsurance ceded.\3\ State the basis for allocation of net investment income and, where applicable, other operating expenses.
\4\ The total of columns I and J should agree with the amount shown for income statement caption 7.\5\ Totals should agree with the indicated balance sheet and income statement caption amounts, where a caption number is shown. [46 FR 54338, Nov. 2, 1981, as amended at 57 FR 45293, Oct. 1, 1992; 64 FR 1734, Jan. 12, 1999]