ࡱ> q  bjbj AiZjiZj 8]4>G&(" FFFFFFFdILF###F4F&&&#FF&#F&&?B8jރiF@FG0>G@LlL4BB&LAB##&#####FF"x###>G####L######### Y S: ANNUAL STATEMENT BLANK LIFE/FRATERNAL VARIABLE ANNUITIES SUPPLEMENT Variable Annuity Reserves Valued According to VM-21 by Product Type For The Year Ended December 31, 20__ (To Be Filed by April 1) PART 3A Prior YearCurrent Year1 Reported Reserve in Excess of Cash Surrender Value2 Reported Reserve in Excess of Cash Surrender Value 1. Post-Reinsurance-Ceded Reserve 1.1. Variable Annuities without Guaranteed Living Benefits    1.2. Index-Linked Variable Annuities without Guaranteed Living Benefits    1.3. Variable Annuities with Guaranteed Minimum Accumulation Benefits    1.4. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Guaranteed Minimum Income Benefits in Accumulation Phase    1.5. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Hybrid Guaranteed Minimum Income Benefits in Withdrawal Phase    1.6. Index-Linked Variable Annuities with Guaranteed Living Benefits in Accumulation Phase    1.7. Index-Linked Variable Annuities with Guaranteed Living Benefits in Withdrawal Phase    1.8. Immediate Variable Annuities with a Guaranteed Annuity Payout Floor    1.9. Aggregate Write-Ins for Other Products 2. Total Post-Reinsurance-Ceded Reserve (Sum of Lines 1.1 through 1.9) 3. Pre-Reinsurance-Ceded Reserve  3.1. Variable Annuities without Guaranteed Living Benefits    3.2. Index-Linked Variable Annuities without Guaranteed Living Benefits    3.3. Variable Annuities with Guaranteed Minimum Accumulation Benefits    3.4. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Guaranteed Minimum Income Benefits in Accumulation Phase    3.5. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Hybrid Guaranteed Minimum Income Benefits in Withdrawal Phase    3.6. Index-Linked Variable Annuities with Guaranteed Living Benefits in Accumulation Phase    3.7. Index-Linked Variable Annuities with Guaranteed Living Benefits in Withdrawal Phase    3.8. Immediate Variable Annuities with a Guaranteed Annuity Payout Floor   3.9. Aggregate Write-Ins for Other Products  4. Total Pre-Reinsurance-Ceded Reserve (Sum of Lines 3.1 through 3.9) 5. Total Reserves Ceded (Line 4 minus Line 2)DETAILS OF WRITE-INS1.1001.   1.1002.   1.1003.   1.1098. Summary of remaining write-ins for Line 1.9 from overflow page   1.1099 Totals (Lines 1.1001 through 1.1003 plus 1.1098) (Line 1.9 above)3.1001. .  3.1002.   3.1003.   3.1098. Summary of remaining write-ins for Line 3.9 from overflow page   3.1099 Totals (Lines 3.1001 through 3.1003 plus 3.1098) (Line 3.9 above) VARIABLE ANNUITIES SUPPLEMENT Variable Annuity Reserves Valued According to VM-21 by Product Type For The Year Ended December 31, 20__ (To Be Filed by April 1) PART 3B Current YearSECTION ASECTION B123456789Cash Surrender ValueCTE70 (adjusted)CTE70 (best efforts)Additional Standard Projection AmountStochastic ReserveNumber of Contracts Cash Surrender Value Alternative Method Reserve Number of Contracts 1. Post-Reinsurance-Ceded Reserve 1.1. Variable Annuities without Guaranteed Living Benefits      XXX  XXX 1.2. Index-Linked Variable Annuities without Guaranteed Living Benefits      XXX  XXX 1.3. Variable Annuities with Guaranteed Minimum Accumulation Benefits      XXXXXXXXXXXX 1.4. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Guaranteed Minimum Income Benefits in Accumulation Phase      XXXXXXXXXXXX 1.5. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Hybrid Guaranteed Minimum Income Benefits in Withdrawal Phase      XXXXXXXXXXXX 1.6. Index-Linked Variable Annuities with Guaranteed Living Benefits in Accumulation Phase      XXXXXXXXXXXX 1.7. Index-Linked Variable Annuities with Guaranteed Living Benefits in Withdrawal Phase      XXXXXXXXXXXX 1.8. Immediate Variable Annuities with a Guaranteed Annuity Payout Floor      XXXXXXXXXXXX 1.9. Aggregate Write-Ins for Other Products     XXX  XXX 2. Total Post-Reinsurance-Ceded Reserve Components (Sum of Lines 1.1 through 1.9)XXXXXX 3. Pre-Reinsurance-Ceded Reserve  3.1. Variable Annuities without Guaranteed Living Benefits           3.2. Index-Linked Variable Annuities without Guaranteed Living Benefits           3.3. Variable Annuities with Guaranteed Minimum Accumulation Benefits       XXXXXX  3.4. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Guaranteed Minimum Income Benefits in Accumulation Phase       XXXXXX  3.5. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Hybrid Guaranteed Minimum Income Benefits in Withdrawal Phase       XXXXXX  3.6. Index-Linked Variable Annuities with Guaranteed Living Benefits in Accumulation Phase       XXXXXX  3.7. Index-Linked Variable Annuities with Guaranteed Living Benefits in Withdrawal Phase       XXXXXX  3.8. Immediate Variable Annuities with a Guaranteed Annuity Payout Floor       XXXXXX  3.9. Aggregate Write-Ins for Other Products          4. Total Pre-Reinsurance-Ceded Reserve Components (Sum of Lines 3.1 through 3.9) 5. Total Reserve Component Ceded (Line 4 minus Line 2)XXXXXXDETAILS OF WRITE-INS1.1001. .      XXX  XXX1.1002.      XXX  XXX1.1003.      XXX  XXX1.1098. Summary of remaining write-ins for Line 1.9 from overflow page     XXX  XXX1.1099 Totals (Lines 1.1001 through 1.1003 plus 1.1098) (Line 1.9 above)XXXXXX3.1001. .          3.1002.          3.1003.          3.1098. 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Segoe UIC. Aptos Display3. Aptos?= .Cx Courier New;WingdingsA$BCambria Math"hS҇҇j҇ * *!88r0 3q@P ? 2!xxJ NAIC BLANKS (E) WORKING GROUPCalvin Ferguson Weber, Peter4         Oh+'0 $ D P \ ht| оٷ BLANKS (E) WORKING GROUPCalvin FergusonNormalWeber, Peter7Microsoft Office Word@xA@ 8~@BÃ@|`ރ ՜.+,0 hp  оٷ*  оٷ BLANKS (E) WORKING GROUP Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefgijklmnopqrstuvwxyz{|}~Root Entry F hoރ@Data h1TableLWordDocument ASummaryInformation(DocumentSummaryInformation8MsoDataStoreiރ8jރZHDNAJGNE5ZA==2iރ8jރItem  !PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q