N.M. Admin. Code § 13.18.3.23 - FORM C OTHER INSURANCE REPORT

OTHER INSURANCE REPORT

Name of Insurer: ______________________________________________ Calendar Year: ______________

INSURANCE OTHER THAN CREDITOR-PLACED INSURANCE

(1) Blanket Insurance Policies	(2) Other Credit Property Insurance Not Force-Placed	(3) Total Credit Property Insurance Not Force-Placed (1)+(2)	(4) All Other Insurance Purchased by a New Mexico Creditor
A. Gross Written Premium
B. Refunds on Terminations
C. Net Written Premium (A)-(B)
D. Beginning Premium Reserve
E. Ending Premium reserve
F. Net Earned Premium (C)+(D)-(E)
G. Other Income Less Other Expenses
H. Policyholder Dividends
I. Incurred Losses
J. LAE Incurred
K. Commissions Incurred
L. Service Fees Incurred
M. Other Incurred Compensation
N. Other Acquisition Expenses
O. Other Underwriting Expenses
P. Total Loss and Expense Sum (H) to (O)
Q. Underwriting Profit (F)+(G)-(P)

Instructions:

1. Provide all data direct as to reinsurance.

2. In column (1), report New Mexico experience on credit property blanket policies.

3. In column (2), report New Mexico experience on non-file insurance, errors and omissions insurance, coverages prohibited by 13 NMAC 18.3.11 [now 13.18.3.11 NMAC], and all credit property insurance other than creditor-placed insurance or blanket insurance.

4. In column (4), report all insurance purchased by a creditor other than credit property insurance.

5. LAE means loss adjustment expense.

6. Other underwriting expenses means the sum of taxes, licenses, fees, and general expenses. The experience reported should be consistent with the insurance expense exhibit of the insurer's annual statement.

7. Provide a description of the insurance listed in Column (2)

Notes

N.M. Admin. Code § 13.18.3.23

1/1/99; Recompiled 11/30/01