Appendix C (To Form 2441) - Worksheet For Discretionary Group Coverages printable pdf download

Appendix C (To Form 2441) - Worksheet For Discretionary Group Coverages

Appendix C

Worksheet for Discretionary Group Coverages

(Appendix to form 440-2441)

Company name:

__________________________________________________________________________

Policy form number:

__________________________________________________________________________

Instructions: Complete the chart with the expected experience for at least 10 years or the period for

which the new rates are anticipated to be adequate, using a closed block of 10,000 lives at the

outset (year 0).

Year Lives at

Deaths*

Lapse

Premiums

Net

Change in

Annual

Accumulated

yearend

rates

earned

benefits

policy

loss ratio

incurred**

reserve

*Show deaths separately if possible. Otherwise, include deaths in total lapse rates.

**For life coverage, any surrender charges must be deducted.

This information must be accompanied by an actuarial memorandum explaining the following.

(1) Assumptions and sources of the data

(2) Information on any new or experimental benefits and features

(3) Effects of the group’s characteristics on these projections

(4) Comment on any influences that could affect the reliability of these projections

440-2441-C (rev. 7/02)

Appendix C (To Form 2441) - Worksheet For Discretionary Group Coverages