SAMPLE QUARTERLY STATEMENT OF Clause Samples

SAMPLE QUARTERLY STATEMENT OF. ACTIVITY Reference 100% Quota Share ---------------------------------------------------------------- --------- ---- ----------- Quota Share 100.00% 1. Reinsurance Premiums 2. Net Benefit Payments a. Death benefits b. Surrender benefits c. Withdrawals d. Annuity Benefits e. Total benefit payments = a + b +c+d 3. Allowances