TITLE COMPANIES
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| Company Name:_______________________ |
|
NAIC Company Code: _________ |
| Contact:_____________________________ |
|
Telephone: _________________ |
| REQUIRED FILINGS IN THE STATE OF: Maine |
|
Filings Made During the Year 2012 |
| (1)
Check-List |
(2)
Line
# |
(3)
REQUIRED FILINGS FOR THE ABOVE STATE |
(4)
NUMBER OF COPIES* |
(5)
DUE DATE
Postmarked |
(6)
FORM SOURCE** |
(7)
APPLICABLE
NOTES |
| Domestic |
Foreign |
| State |
NAIC |
State |
| |
|
I. NAIC FINANCIAL STATEMENTS |
|
|
|
|
|
|
| |
1 |
Annual Statement (8 ½"x14") |
XXX |
EO |
XXX |
3/1 |
NAIC |
|
| |
1.1 |
Printed Investment Schedule detail (Pages E01-E27) |
XXX |
EO |
XXX |
3/1 |
NAIC |
|
| |
2 |
Quarterly Financial Statement (8 ½" x 14") |
XXX |
EO |
XXX |
5/15, 8/15, 11/15 |
NAIC |
|
| |
|
II. NAIC SUPPLEMENTS |
|
|
|
|
|
|
| |
11 |
Actuarial Opinion |
XXX |
EO |
XXX |
3/1 |
Company |
|
| |
12 |
Investment Risk Interrogatories |
XXX |
EO |
XXX |
4/1 |
NAIC |
|
| |
13 |
Management Discussion & Analysis |
XXX |
EO |
XXX |
4/1 |
Company |
|
| |
14 |
Schedule SIS |
XXX |
N/A |
N/A |
3/1 |
NAIC |
|
| |
15 |
Supplemental Compensation Exhibit |
XXX |
N/A |
N/A |
3/1 |
NAIC |
|
| |
16 |
Supplemental Schedule of Business Written By Agency |
XXX |
EO |
XXX |
4/1 |
NAIC |
|
| |
|
III. ELECTRONIC FILING REQUIREMENTS |
|
|
|
|
|
|
| |
50 |
Annual Statement Electronic Filing |
XXX |
1 |
XXX |
3/1 |
NAIC |
|
| |
51 |
March .PDF Filing |
XXX |
1 |
XXX |
3/1 |
NAIC |
|
| |
52 |
Supplemental Electronic Filing |
XXX |
1 |
XXX |
4/1 |
NAIC |
|
| |
53 |
Supplemental .PDF Filing |
XXX |
1 |
XXX |
4/1 |
NAIC |
|
| |
54 |
Quarterly Statement Electronic Filing |
XXX |
1 |
XXX |
5/15, 8/15, 11/15 |
NAIC |
|
| |
55 |
Quarterly .PDF Filing |
XXX |
1 |
XXX |
5/15, 8/15, 11/15 |
NAIC |
|
| |
56 |
June .PDF Filing |
XXX |
1 |
XXX |
6/1 |
NAIC |
|
| |
|
IV. AUDIT/INTERNAL CONTROL RELATED REPORTS |
|
|
|
|
|
|
| |
71 |
Accountants Letter of Qualifications |
XXX |
EO |
N/A |
6/1 |
Company |
|
| |
72 |
Audited Financial Reports |
XXX |
EO |
N/A |
6/1 |
Company |
|
| |
73 |
Audited Financial Reports Exemption Affidavit |
XXX |
N/A |
N/A |
|
Company |
|
| |
74 |
Communication of Internal Control Related Matters Noted in Audit |
XXX |
N/A |
N/A |
8/1 |
Company |
|
| |
75 |
Independent CPA (change) |
XXX |
N/A |
N/A |
|
Company |
|
| |
76 |
Management’s Report of Internal Control Over Financial Reporting |
XXX |
N/A |
N/A |
8/1 |
Company |
|
| |
77 |
Notification of Adverse Financial Condition |
XXX |
N/A |
N/A |
|
Company |
|
| |
78 |
Report of Significant Deficiencies in Internal Controls |
XXX |
N/A |
N/A |
|
Company |
|
| |
79 |
Request for Exemption to File |
XXX |
N/A |
N/A |
|
Company |
|
| |
|
V. STATE REQUIRED FILINGS |
|
|
|
|
|
|
| |
101 |
Filings Checklist (with Column 1 completed) |
XXX |
0 |
XXX |
3/1 |
State |
|
| |
102 |
Maine Fraud and Abuse Annual Report |
XXX |
0 |
1 |
3/1 |
State |
P |
| |
103 |
Premium Tax |
XXX |
0 |
1 |
3/15 |
State |
E |
| |
104 |
Signed Jurat |
XXX |
XXX |
XXX |
3/1, 5/15, 8/15, 11/15 |
NAIC |
|
| |
105 |
State Filing Fees |
XXX |
0 |
1 |
8/10 |
State |
C, P |
*If XXX appears in this column, this state
does not require this filing, if hard copy is filed with the state of domicile and if the data is filed electronically
with the NAIC.
If N/A appears in this column, the filing is required with the domiciliary
state. EO (electronic only filing).
**If Form Source is NAIC, the form should be obtained from the appropriate
vendor.
NOTES
AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS)
GENERAL INSTRUCTIONS FOR COMPANIES TO USE CHECKLIST
