Fraternal Benefit Society 2024 Annual Statement and New York Supplement Filings

General Filing Instructions

We are providing for your use the Fraternal Annual Statement Checklist & Instructions. This checklist provides filing requirements for submission to the NAIC and the New York State Department of Financial Services. This Web site also provides specific instructions for filing the New York Supplement and supplemental forms with our Department. Copies of the New York Supplement and supplemental forms are available in the Download section of this Web site.

Insurers subject to these filing requirements are strongly encouraged to submit copies of all annual and quarterly statement filings online with the NAIC. The following electronic submissions to the NAIC will fulfill the online filing requirements of New York:

  • National Form Annual Statement
  • National Form Quarterly Statements
  • New York Supplement

Any statements not filed as above will require an online submission to New York.

Specific Filing Information

The Fraternal Benefit Society Filing INSTRUCTIONS AND FORMS PACKET is a compressed zipped file; after downloading, unzip to obtain the following files.

Forms included:

  • New York State Fraternal Supplement
  • NAIC Fraternal Annual Checklist & Instructions
  • Schedule S Addendum
  • Annual Electronic Filing Requirements Letter
  • Certificate of Compliance - Regulation 74

The New York State Fraternal Supplement (PDF) is also available on the NY Supplement Blanks Page.

Certificate of Compliance (Regulation 74)

Section 53-1.4(b) of Regulation 74 requires all licensed fraternal benefit societies to submit a certificate of compliance with respect to the company’s cost disclosures and sales illustrations for life insurance products. The certificate is included in the forms packet and should be filed via SERFF according to Note U of the checklist.

Due Date

Please refer to the Fraternal Annual Statement Checklist & Instructions.

NAIC Numbers and Company Names:

To view the company listing for this blank type, select Fraternal Companies List.

Problems and Questions

If you need help or have questions, email Stephen Pallas, Life Bureau at [email protected].

For NAIC forms, contact:

National Association of Insurance Commissioners
2301 McGee, Suite 800
Kansas City, MO 64108-2604
(816) 842-3600