New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 2 - INSURANCE GROUP
Subchapter 43 - TREATMENT OF ALLOCATED DEPOSIT-TYPE DEFERRED ANNUITY CONTRACT FUNDS FOR PURPOSES OF CALCULATING THE SPECIAL PURPOSE APPORTIONMENT AND THE FRAUD ASSESSMENT
Appendix - APPENDIX
Universal Citation: NJ Admin Code
Current through Register
Vol. 56, No. 6, March 18, 2024
CERTIFICATION OF ALLOCATED DEPOSIT-TYPE FUNDS
SPECIAL PURPOSE APPORTIONMENT AND FRAUD ASSESSMENT FOR YEAR ENDED DECEMBER 31, ......
Company Name: ......... Company NAIC No. ......
| 1. | Annuity Considerations (State Business Page, Line 2, Column 5) | ......... |
| 2. | Allocated Deposit-Type Deferred Annuity Contract Funds | ......... |
| Included in Line 1 above | ||
| 3. | Prior Year Annuitizations or Immediate Annuities not included | ......... |
| in Line 1 above or not previously included in the assessment | ||
| base. | ||
| 4. | Dividends to Policyholders (State Business Page, Line 7.1 + | ......... |
| Line 7.3, Column 5) | ||
| 5. | Net Annuity Considerations Subject to Assessment (Line 1 - | ......... |
| Line 2 + Line 3 - Line 4) |
CERTIFICATION
The undersigned certifies that (s)he is authorized to file this information on behalf of (Company Name) and that the information contained herein is correct to the best of his/her knowledge, information and belief.
| (Signature) .................................. |
| Type or print name ........................... |
| Title ........................................ |
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
