2021 ANNUAL STATEMENT and NEW YORK SUPPLEMENT
Fraternal Benefit Society - General Filing Instructions
IMPORTANT FILING REMINDER:
You are required to file ONLY ONE HARD COPY of the 2021 ANNUAL FILING. Please refer to the Department’s guidance for electronic signatures, transactions and filings.
New York State Department of Financial Services
One State Street
New York, NY 10004 Do NOT mail to Albany.
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 electronically with the NAIC. The following electronic submissions to the NAIC will fulfill the electronic filing requirements of New York:
- National Form Annual Statement via the internet or diskette.
- National Form Quarterly Statements via the internet or diskette.
- New York Supplement via the internet only.
Any statements not filed as above will require the filing of a diskette with New York.
Fraternal Benefit Society - 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 for Download and/or Print:
- NEW YORK STATE FRATERNAL SUPPLEMENT 2021
- NAIC Fraternal Annual Checklist & Instructions
- SCHEDULE S ADDENDUM
- BAR CODE INSTRUCTIONS
- Annual Electronic Filing Requirement Letter
- Certificate of Compliance - Regulation 74
When printing the blanks, be sure to use legal size paper (8 1/2" X 14"). Each of the Blanks is bookmarked for on-line viewing.
The NEW YORK STATE FRATERNAL SUPPLEMENT 2021 (in PDF Format) 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 on this page and should be filed via SERFF according to Note U of the checklist.
DUE DATE & MAILING:
Please refer to the Fraternal Annual Statement Checklist & Instructions.
For 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 filling out your forms, call: Mr. Stephen Pallas, Life Bureau at (212) 480-4765. For diskette related questions, contact Information Systems & Technology Bureau, Albany (518) 473-3775.
For NAIC forms, contact:
National Association of Insurance Commissioners
2301 McGee, Suite 800
Kansas City, MO 64108-2604