Annual Statement Checklist and Instructions 

• Checklist
• Notes and Instructions
• General Instructions

(1)
Check-list

(2)
Line #

(3)
REQUIRED FILINGS FOR THE ABOVE STATE

(4)
NUMBER OF COPIES*

(5)
DUE DATE

(6)
FORM SOURCE**

(7)
APPLICABLE NOTES

Domestic

 Foreign 

 Alien Accredited*** 

State

 NAIC 

State

State

I. NAIC FINANCIAL STATEMENTS

1

EO

xxx

1

RRG's - Submit hard copies. See NOTE P

Foreign Companies - See NOTE K

1

EO

xxx

N/A

1

EO

xxx

1

RRG's - See NOTE P

Foreign Companies - See NOTE K

1

0

xxx

N/A

1

EO

xxx

N/A

II. NAIC SUPPLEMENTS

1

EO

xxx

N/A

1

EO

xxx

1

1

N/A

N/A

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

1

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

EO

xxx

N/A

1

N/A

N/A

N/A

1

EO

xxx

N/A

1

N/A

N/A

N/A

1

EO

xxx

1

III. ELECTRONIC FILING REQUIREMENTS

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

xxx

N/A

xxx

1

 xxx

N/A

IV. AUDIT/INTERNAL CONTROL RELATED REPORTS

1

N/A

N/A

1

xxx

N/A

1

N/A

N/A

N/A

1

N/A

1

N/A

1

N/A

N/A

N/A

1

N/A

N/A

N/A

1

N/A

1

N/A

1

N/A

1

N/A

1

N/A

N/A

N/A

1

N/A

N/A

N/A

V. STATE REQUIRED FILINGS

1

0

1

N/A

1

0

1

N/A

1

0

1

N/A

1

0

1

N/A

1

0

1

1

0

1

N/A

107

Signed Notarized Jurat (Annual NAIC Blank & New York Supplement)

1

0

1

N/A

Foreign Companies - See NOTE K

RRG's - Submit hard copies. See NOTE P

107(a)

Signed Notarized Jurat (Quarterly)

1

0

1

N/A

Foreign Companies - See NOTE K

RRG's - Submit hard copies. See NOTE P

1

N/A

1

N/A

Mr. Niranjan Robert, Associate Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
25 Beaver Street
New York, NY 10004
(212) 480-5163

E-mail: Niranjan.Robert@dfs.ny.gov
When answering by e-mail, please include telephone number. 

Annual Statement, New York Supplement, and related items (hard copies); Audited Financial Statement; Quarterly Statement (hard copies); Risk-Based Capital Report; Certificate of Compliance; and Certificate of Deposit:

Mr. Niranjan Robert, Associate Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
25 Beaver Street
New York, NY 10004

Note: All Risk Retention Groups should be sent directly to:

Mr. Jack Stein, Principal Insurance Examiner
New York State Department of Financial Services
Property Bureau - 2nd Floor
25 Beaver Street
New York, NY 10004
(212) 480-5479

E-mail: Jack.Stein@dfs.ny.gov

Actuarial Opinion Summary send directly to:

Ms. Gloria Huberman, Deputy Chief Actuary
New York State Department of Financial Services
Property Bureau - 4th Floor
25 Beaver Street
New York, NY 10004

Diskettes (See Note N):

Ms. Nora Dixon
New York State Department of Financial Services
Insurance Regulatory Systems Bureau
25 Beaver Street
New York, NY 10004

All Department of Financial Services filings must be physically received at the appropriate address as indicated in NOTE B no later than the indicated due date. Companies should file ONLY ONE COMPANY per package. If the due date falls on a weekend or a legal holiday, then the filing must be received by the Department by the end of the next business day.

The Supplement must be bound at the left side in sequential order and it must have a "COVER" page that indicates New York Supplement to the Annual Statement, the FULL Company Name and the Year. Diskettes should be labeled.

Failure to timely file any component of an annual, quarterly or NY supplement filing subjects insurer to penalties set forth in NY Insurance Law Section 307 and 308.

New York statute does not provide for any extensions in the filing deadlines for Annual Statements. Further, extensions for the filing of audited financial statements are only provided upon written application by the insurer to the superintendent, and such extension is only granted if the superintendent finds that compliance would constitute a financial or organizational hardship, as provided in Section 307(b)(3) of the Insurance Law.

All amendments to your Annual Statement and/or New York Supplement must be provided in hard copy as well as an amended ELECTRONIC filing. Foreign insurers can file electronically.

Note: For Amended New York Supplement filings, the entire electronic filing is required.

Foreign Companies - Refer to - Supplement No. 1 to Circular Letter No. 4 (2001) dated February 6, 2008, which can be found at the following link: http://www.dfs.ny.gov/insurance/circltr/2008/cl08_04s1.htm

Hard copy filings of the signed notarized jurat page should be directed to:

Mr. Niranjan Robert, Associate Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
25 Beaver Street
New York, NY 10004

Instructions concerning internet filing alternative to filing diskette with New York for the New York Supplement are set forth in the Department's Circular Letter No. 4 (2001) and Supplement 1 to Circular Letter No. 4 (2001), dated 2/6/08.

All companies are strongly encouraged to file national form filings (as identified in items 50, 51, 52, 53, 54, 55, 56, 57, 58, 59 and 60 in the checklist) with the NAIC preferably via the Internet. By filing over the Internet or via diskette with the NAIC an insurer will have fulfilled its electronic filing requirement for national forms with New York and therefore should not file a diskette with the Department.

Mail the CT-33NL return and payment to:

Also mail a copy to:

All RRG's are asked to submit hard copy filings for the filings identified in items 1, 1.1, 11, 28 and 72. For Quarterly Financial Statement filings (Item 2), electronic filings with the NAIC via the internet are acceptable, provided that a hard copy filing of the signed notarized jurat page is submitted. These filings and all other filings made by RRG's should be sent directly to;

Mr. Jack Stein, Principal Insurance Examiner
New York State Department of Financial Services
Property Bureau - 2nd Floor
25 Beaver Street
New York, NY 10004
(212) 480-5479

E-mail: Jack.Stein@dfs.ny.gov
When answering by e-mail, please include telephone number.

Note: The New York Supplement (Items # 101 and 102) are not required filings for Foreign RRG's.

Foreign Companies may submit via E-mail to: specialprojectsprp@dfs.ny.gov

Provide updated information (name, address, telephone number and e-mail address) within 60 days of any change in CPA. See Regulation 118, Section 89.4(c) for additional reporting requirements if the CPA is dismissed or resigns.

Required to be furnished, in writing, to the Superintendent, within five business days of any determination by the CPA that the Company has materially misstated its financial condition as reported to the superintendent as of the balance sheet currently under audit or that the Company does not meet the minimum capital or surplus requirement of the insurance law as of that date.

All companies that are required to file Schedule C-1 can submit the schedule electronically via e-mail to specialprojectsprp@dfs.ny.gov. The electronic Schedule C-1 can be found at the following link: http://www.dfs.ny.gov/insurance/ftz/ftz_app.htm