23 CAR § 24-302
(a)
(2)
(b)
| Asset Adequacy Tested Amounts—Reserves and Liabilities | |||||
| Statement Item | Formula Reserves(1) | Additional Actuarial Reserves (a) (2) | Analysis Method(b) | Other Amount(3) | Total Amount (1)+(2)+(3) (4) |
| Exhibit 5A Life Insurance | |||||
| B Annuities | |||||
| C Supplementary Contracts Involving Life Contingencies | |||||
| D Accidental Death Benefit | |||||
| E Disability—Active | |||||
| F Disability—Disabled | |||||
| G Miscellaneous | |||||
| Total Exhibit 5 (Page 3, Line 1) | |||||
| Exhibit 6A Active Life Reserve | |||||
| B Claim Reserve | |||||
| Total Exhibit 6 (Page 3, Line 2) | |||||
| Exhibit 7Premium and Other Deposit Funds(Column 5, Line 14) | |||||
| Guaranteed InterestContracts(Column 2, Line 14) | |||||
| Other(Column 6, Line 14) | |||||
| Supplemental Contracts andAnnuities Certain(Column 3, Line 14) | |||||
| Dividend Accumulationsor Refunds(Column 4, Line 14) | |||||
| Total Exhibit 7 (Page 3, Line 3) | |||||
| Exhibit 8, Part 11 Life (Page 3, Line 4.1) | |||||
| 2 Health (Page 3, Line 4.2) | |||||
| Total Exhibit 8, Part 1 | |||||
| Separate Accounts(Page 3 of the Annual Statement of the Separate Accounts, Lines 1, 2, 3.1, 3.2, 3.3) | |||||
| TOTAL RESERVES | |||||
| IMR (General Account, Page Line )___ | |||||
| (Separate Accounts, Page Line )___ | |||||
| AVR (Page Line )___ | (c) | ||||
| Net Deferred and Uncollected Premium |
(d)
(f)