Form E-Mrr.plr - Annual Report Of Policy And Loss Reserves For Domestic Mechanical Reimbursement Reinsurers Pursuant

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Department of Insurance
State of Arizona
Financial Affairs Division
2910 North 44th Street, Second Floor
Phoenix, Arizona 85018-7256
Telephone: (602) 912-8420/Fax: (602) 912-8421
CALENDAR YEAR 2002
ANNUAL REPORT OF POLICY AND LOSS RESERVES FOR
DOMESTIC MECHANICAL REIMBURSEMENT REINSURERS
PURSUANT TO A.R.S. § 20-1096.05
DUE APRIL 1, 2003
Complete Company Name _______________________________________ NAIC No. _________
1)
A) Amount of policy reserves (unearned premiums) as of December 31, 2002
$_____________________
B) State in detail the method used to determine policy reserves in calendar year 2002.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2)
A) Amount of loss reserves as of December 31, 2002
$_____________________
B) State in detail the method used to determine loss reserves in calendar year 2002.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
We certify that this report is true, complete and correct to the best of our knowledge and belief.
__________________________________
__________
__________________________
___________
Signature of President
Date
Signature of Secretary
Date
E-MRR.PLR (11/02)
Page 1 of 1

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