Form Cm-2b - Hawaii Statement Of Financial Condition And Other Information Page 2

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Section II.
General Financial Information - continued
11. Real and lease property (Brief description and type of ownership)
Physical Address (include tax map key)
12. Life Insurance (Name of Company)
Policy Number
Type
Face Amount
Available Loan Value
Total (Enter in Item 19)
13. Securities (stocks, bonds, mutual funds, money market funds, government securities, etc.) Attach additional sheets as necessary.
Quantity or
Current
Where
Owner
Kind
Denomination
Value
Located
of Record
14. Additional information regarding financial condition (Court proceedings, bankruptcies filed or anticipated, transfers of assets for
less than full value, changes in market conditions, etc.)
15. Accounts / Notes Receivable (include current contract jobs, loans to stockholders, officers, partners, etc.)
Name
Address
Amount Due
Date Due
Status
Total (Enter in Item 20)
Form CM-2B
Page 2

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