How to Fill Out the NAIC Annual Statement Blank

The NAIC Annual Statement Blank is the standardized financial report that every licensed insurance company in the United States must file each year to show its financial condition to state insurance regulators. It is filed electronically with the National Association of Insurance Commissioners and with each company’s state of domicile, with the core annual statement due March 1 for the prior calendar year. Most insurers file the 2025 data-year blank during early 2026, and the version you use must match the data year printed on the official NAIC blank.

A single mistake on this form is not a small thing. State regulators use this blank to decide if an insurer can keep paying claims, and a late or wrong filing can trigger fines, a regulatory hold, or even a market-conduct exam. Roughly 5,000 insurers file these statements every year, and the NAIC database filing fee alone can run from a $240 minimum to a $544,085 group cap, so the stakes are real before you even open the form.

Here is what you will learn in this guide:

• 📋 What the Annual Statement Blank is, which version you need, and who must file it
• 🗂️ Every document and number you must gather before you start
• ✍️ A line-by-line walkthrough of the Jurat, Assets, Liabilities, and key schedules
• 🏢 Three full filing examples for a small P&C insurer, a multistate life insurer, and a first-year health plan
• ⚠️ The most common errors that get a statement rejected and how to dodge each one

What the Form Is and Who Must File It

The NAIC Annual Statement Blank is a statutory financial statement, not a GAAP report. It is built on Statutory Accounting Principles, which are more conservative than the accounting rules public companies use. The goal is solvency: regulators want to know if an insurer holds enough admitted assets to cover its policyholder obligations today, not in the best case.

The NAIC publishes four main versions of the blank, and you must pick the one that matches your license. The four types are Life/Fraternal, Property/Casualty, Health, and Title, and each has its own pages, exhibits, and schedules. A property insurer that files the Life blank by mistake will have its filing rejected, so confirm your statement type against your certificate of authority before downloading.

Every insurer holding a certificate of authority in at least one state must file. This includes domestic insurers (filing in their home state), foreign insurers (licensed in other states), risk retention groups, and most reinsurers. The filing requirement comes from each state’s insurance code, which adopts the NAIC blank by reference, so the form is technically a state form with nationwide uniformity baked in by the NAIC.

The agency that receives the data is the NAIC’s Financial Data Repository in Kansas City, Missouri, which then shares it with all states where the insurer is licensed. Filing once with the NAIC electronically satisfies most foreign-state requirements, but you still file a signed copy with your domiciliary regulator. Missing the March 1 deadline can trigger penalties under your state’s code, such as New York Insurance Law Section 307, which does not allow extensions for the annual statement.

Before You Start: Documents and Information You Need

Gather everything before you open the blank. The statement ties together dozens of pages, and a missing number on one page will throw off the cross-checks the NAIC software runs at import. Pull your full general ledger trial balance for December 31 first, because almost every dollar figure on the form traces back to it.

Here is the pre-filing checklist. Collect each item below and confirm it is for the correct data year:

• Your NAIC company code (a 5-digit number), because the NAIC database keys every filing to this code and a wrong code routes your data to the wrong company.
• Your FEIN (federal employer ID number), since the Jurat page requires it and a mismatch with IRS records can flag the filing.
• The year-end trial balance and general ledger, because every asset, liability, premium, and loss figure flows from it; without it you cannot complete the financial pages.
• Prior-year annual statement, because Column 2 on most pages asks for last year’s figures and regulators compare year-over-year swings.
• Investment records and custodian statements, because Schedules D, DA, and E require CUSIP-level detail and a missing CUSIP fails the electronic edit checks.
• Reinsurance contracts and balances, because Schedule F (P&C) or Schedule S (Life/Health) needs ceded and assumed amounts by reinsurer; missing data here distorts your surplus.
• The signed, notarized actuarial opinion, because it is due March 1 with the statement and the filing is incomplete without it.
• Officer and director names and titles, because the Jurat and the General Interrogatories require them, and the statement must be signed by officers who actually hold those roles.
• Premium and loss data by state, because Schedule T allocates business by jurisdiction and states reconcile this against their own premium-tax records.
• Your RBC (risk-based capital) inputs, because the RBC report is due the same day and pulls directly from statement figures.

If any item is missing, stop and find it. A statement built on an incomplete trial balance will fail the NAIC cross-checks and bounce back, costing you days you may not have before March 1.

Where to Get the Form and How to Access It

The official blank comes only from the NAIC and approved vendors, never from a generic template site. You can review the structure and the data-year version on the NAIC Publications page, which lists the current Annual Statement Blank for Life, Property/Casualty, Health, and Title. The matching Annual Statement Instructions explain each line and are the controlling rulebook for how to complete the form.

You do not type the blank into a PDF by hand. Insurers complete it inside NAIC-approved annual statement software sold by third-party vendors, which builds the electronic file the NAIC database accepts. The software runs the same edit checks the NAIC runs, so it flags cross-foots and missing fields before you submit.

Once your software file is ready, you submit it through the NAIC Industry Financial Filing system. The electronic filing includes the statement data plus all supplements due March 1, and a separate .PDF filing of the same data is also required by that date. You confirm the exact items and due dates against your domiciliary state’s checklist, such as the New York DFS checklist.

A common misconception is that filing electronically with the NAIC means you skip your state entirely. That is wrong. You still file a signed, notarized Jurat page (and any state supplement) with your home regulator, even though the bulk of the data goes to the NAIC.

Step-by-Step: How to Fill Out the Annual Statement Blank Line by Line

The blank is organized in a fixed order: the Jurat page, the Assets page, the Liabilities, Surplus and Other Funds page, the Summary of Operations (or Statement of Income), the Cash Flow page, the General Interrogatories, and then the lettered Schedules A through T. Complete the financial pages in order, because later pages pull totals from earlier ones. Use the exact line numbers and page titles printed on your statement-type blank, since the software keys on them.

1. The Jurat Page (Cover Page)

The Jurat page is the sworn cover of the statement. In plain English, it asks who you are, where you are located, and which officers swear the numbers are true. You enter the full legal company name, the NAIC company code, the FEIN, the state of domicile, the statutory home office address, the mailing address, and the main phone number.

To fill it out, type the company name exactly as it appears on your certificate of authority, in the same capitalization, and enter the 5-digit NAIC code with no spaces. For example, Evergreen Mutual Insurance Company, NAIC code 14237, FEIN 81-0455219, domiciled in Iowa. The page then lists the officers who sign and swear to the statement, usually the president, the secretary, and the treasurer or CFO.

A frequent edge case is a company that changed its name or address mid-year. Use the legal name and address in effect on December 31 of the data year, and report the change in the General Interrogatories rather than guessing. A common mistake is leaving the NAIC code blank or transposing two digits, which sends your entire filing to the wrong company record and delays processing for every state. Many filers wrongly believe a typed name is enough, but the Jurat must be physically signed and notarized, and an unsigned Jurat makes the whole statement incomplete.

2. The Assets Page

The Assets page reports everything the company owns that statutory accounting lets it count. In plain English, it asks: what are your assets, and how much of each can the regulator actually rely on? The page splits each asset class into Column 1 (gross assets), Column 2 (nonadmitted assets), and Column 3 (net admitted assets), with bonds, stocks, cash, premiums receivable, and reinsurance recoverables each on their own line.

To complete it, pull each balance from your trial balance, subtract the portion that statutory rules disallow, and report the admitted amount in Column 3. For example, Evergreen Mutual holds $48,500,000 in bonds (line for bonds, Column 1), nonadmits $0, and reports $48,500,000 admitted in Column 3. Agent balances over 90 days past due go in Column 2 as nonadmitted, because regulators do not count stale receivables toward solvency.

A common edge case is electronic data processing equipment, which is admitted only up to limited amounts; the excess goes in Column 2. The most common mistake here is admitting an asset that statutory rules require you to nonadmit, such as furniture or overdue receivables, which overstates your surplus and can trigger a regulatory inquiry. A widespread misconception is that admitted and book value are the same; they are not, and treating them as equal will misstate the bottom line of the page.

3. The Liabilities, Surplus and Other Funds Page

This page reports what the company owes and what is left over for policyholders. In plain English, it asks: what are your obligations, and after subtracting them from admitted assets, how much surplus remains? Loss reserves, loss adjustment expense reserves, unearned premiums, and other liabilities each get their own line, followed by capital and surplus lines at the bottom.

To fill it out, enter each reserve and payable from your closing trial balance and supporting actuarial work. For example, a property insurer enters $22,300,000 in losses on the losses line and $6,100,000 in unearned premiums on the unearned premium line. Total liabilities subtract from total admitted assets to produce surplus as regards policyholders, which must match the surplus shown elsewhere in the statement.

An important edge case is reserves for a long-tail line like workers’ compensation, where you must follow the actuarial opinion rather than a simple ledger balance. The most damaging mistake is understating loss reserves, because it inflates surplus and is the single most scrutinized number by examiners, who can order a reserve restatement. A common misconception is that surplus is cash in the bank; surplus is admitted assets minus liabilities, and a company can show surplus while holding little cash.

4. The Summary of Operations / Statement of Income

This page shows whether the company made or lost money during the year. In plain English, it asks: what came in, what went out, and what was the net result? Premiums earned, net investment income, losses incurred, expenses, and the final net income or loss each appear on numbered lines, with the format differing slightly between the Life and P&C blanks.

To complete it, carry earned premium and incurred losses from the underwriting exhibit, add investment income, subtract expenses, and report net income. For example, Evergreen Mutual reports $31,200,000 earned premium, $18,400,000 incurred losses, and a net income of $2,750,000. The result flows into the change-in-surplus calculation, so an error here ripples through the rest of the statement.

A common edge case is a one-time item such as a reinsurance commutation, which must be classified to the correct line rather than buried in “other income.” The frequent mistake is mismatching earned premium here with written premium on the underwriting exhibit, which fails a built-in cross-check and rejects the file. People often assume this page is just an income statement like a public company files, but statutory income differs from GAAP income, and treating them as identical leads to wrong figures.

5. The Cash Flow Page

The Cash Flow page traces actual cash moving in and out during the year. In plain English, it asks: where did your cash come from, and where did it go? It is grouped into cash from operations, cash from investments, and cash from financing and miscellaneous sources, ending in the net change in cash and short-term investments.

To fill it out, report premiums collected, losses paid, expenses paid, and investment purchases and sales as actual cash amounts, not accruals. For example, a health plan reports $54,000,000 premiums collected and $41,000,000 benefits paid in the operations section. The ending cash balance must tie to the cash and short-term investment lines on the Assets page.

A common edge case is a large bond sale near year-end that settles in January; report it based on the settlement, consistent with the instructions. The usual mistake is mixing accrual figures into a cash-basis page, which breaks the reconciliation to the Assets page. Many filers believe the cash flow page is optional detail, but regulators use it to spot liquidity stress, and an unreconciled page draws immediate questions.

6. The General Interrogatories

The General Interrogatories are a long list of yes/no and short-answer questions about the company’s structure, ownership, and operations. In plain English, the page asks: who controls you, what did you do this year, and are there any red flags? Questions cover ownership changes, affiliated transactions, pledged assets, and dividends paid.

To complete it, answer every question honestly and attach explanations where the instructions require them. For example, if the company paid a stockholder dividend, you answer Yes and report the amount and date. Blank answers are not allowed; every interrogatory needs a response, even if it is No or None.

A common edge case is a company that became part of a holding-company group during the year, which triggers several follow-up disclosures. The biggest mistake is answering No to an affiliated-transaction question that actually occurred, which can be treated as a material misrepresentation. A misconception is that the interrogatories are boilerplate; examiners read them closely, and a false answer carries more weight than a math error.

7. Schedule T – Premiums and Other Considerations by State

Schedule T allocates the company’s business across every state and territory where it operates. In plain English, it asks: how much premium did you write in each jurisdiction? You list direct premiums written by state, with a total line that must equal the direct premium reported elsewhere in the statement.

To fill it out, pull premium by state from your policy administration system and enter it on the correct jurisdiction line. For example, Evergreen Mutual writes $28,000,000 in Iowa, $3,200,000 in Nebraska, and reports the matching total. States reconcile these figures against the premium taxes you pay them, so accuracy here has direct tax consequences.

A common edge case is surplus-lines or nonadmitted business, which has its own reporting treatment and should not be lumped with admitted premium. The frequent mistake is a state total that does not foot to the underwriting exhibit, which fails the cross-check and can also trigger a premium-tax discrepancy. Filers often assume Schedule T is just informational, but state revenue departments use it, and underreporting a state’s premium can lead to tax penalties.

8. Schedule F (P&C) or Schedule S (Life/Health) – Reinsurance

These schedules report reinsurance ceded and assumed. In plain English, they ask: who shares your risk, and how much do they owe you? Schedule F on the P&C blank lists each reinsurer, the recoverables, and any amounts overdue, while Schedule S serves the same role on the Life and Health blanks.

To complete it, list each reinsurer by name and ID, the ceded reserves and recoverables, and collateral held. For example, a P&C insurer reports $4,500,000 recoverable from Re-Atlantic Reinsurance, with $0 over 90 days past due. Overdue or uncollateralized recoverables from unauthorized reinsurers create a provision that reduces surplus.

A common edge case is a reinsurer that is authorized in some states but not others, which changes the collateral and provision treatment. The classic mistake is omitting a reinsurer or understating overdue balances, which understates the required provision and overstates surplus. A misconception is that ceding risk removes it from your statement; you still report the gross exposure and the credit-risk provision, because the regulator wants to see your reliance on reinsurers.

Three Filled-Out Examples Using Real Scenarios

Below are three realistic filers walking through the core pages. Each table shows what the named company enters in the most important sections.

Scenario 1: Carlos files for a small single-state P&C insurer. Carlos is the controller at Prairie Shield Insurance, an Iowa-domiciled property insurer writing only in Iowa, completing the P&C blank.

Form Section	What Carlos Enters
Jurat – Company Name	Prairie Shield Insurance Company
Jurat – NAIC Code / FEIN	15992 / 42-1188034
Jurat – State of Domicile	Iowa
Assets – Bonds (Column 3)	$26,400,000 admitted
Liabilities – Losses	$9,800,000
Liabilities – Surplus as regards policyholders	$14,200,000
Summary of Operations – Net Income	$1,150,000
Schedule T – Iowa Direct Premium	$17,600,000 (100% of business)
Schedule F – Reinsurance Recoverable	$2,100,000, none overdue

Scenario 2: Janet files for a multistate life insurer. Janet is the CFO of Summit Life Assurance, domiciled in Connecticut and licensed in 38 states, completing the Life/Fraternal blank.

Form Section	What Janet Enters
Jurat – Company Name	Summit Life Assurance Company
Jurat – NAIC Code / FEIN	68420 / 06-0998112
Jurat – State of Domicile	Connecticut
Assets – Bonds (Column 3)	$1,240,000,000 admitted
Liabilities – Aggregate Reserve for Life Contracts	$1,050,000,000
Liabilities – Capital and Surplus	$210,000,000
Summary of Operations – Net Income	$34,600,000
Schedule T – Total Direct Premium All States	$268,000,000
Schedule S – Reinsurance Ceded Reserves	$96,000,000

Scenario 3: Aisha files for a first-year health plan. Aisha is the finance director at NorthStar Health Plan, a Texas-domiciled health insurer filing its first Health blank.

Form Section	What Aisha Enters
Jurat – Company Name	NorthStar Health Plan, Inc.
Jurat – NAIC Code / FEIN	17005 / 74-3320887
Jurat – State of Domicile	Texas
Assets – Cash and Short-Term (Column 3)	$22,500,000 admitted
Liabilities – Claims Unpaid	$8,400,000
Liabilities – Capital and Surplus	$11,900,000
Statement of Revenue and Expenses – Net Income	$640,000
Cash Flow – Premiums Collected	$54,000,000
Schedule T – Texas Direct Premium	$58,200,000

How to File the Completed Statement

The annual statement is filed electronically with the NAIC, with a parallel signed filing to your domiciliary state. You confirm every item and due date on your state’s checklist, such as the New York DFS property checklist, because supplements have staggered dates even though the core statement is due March 1.

Here are the channels and what each requires:

• NAIC electronic filing through the Industry Financial Filing system: submit the annual statement data file plus all March 1 supplements; there is no per-file charge here, but the separate database filing fee applies. Processing is near-immediate, and you keep the NAIC confirmation as proof of filing.
• NAIC March .PDF filing: a PDF version of the same data, also due March 1, filed through the same system; keep the upload receipt.
• Domiciliary state filing: file the signed, notarized Jurat page (and any state supplement) with your home regulator, often through a state portal; due March 1, with the portal confirmation as your proof.
• Database filing fee payment: pay through the NAIC Account Manager online, or by ACH/wire to UMB (routing 101000695, account 9870877295), or by check payable to the NAIC mailed to NAIC, Attn: Database Filing Fees, P.O. Box 87-9135, Kansas City, MO 64187-9135; due March 1, 2026 (combined P&C fee May 1, 2026), and the fee runs a $240 minimum up to a $108,817 individual cap.

Keep every confirmation number and a copy of the as-filed statement. If a state later questions your filing, the NAIC and portal receipts are your proof that you met the deadline.

What Happens After You File

After you submit, the NAIC software validates your file against hundreds of cross-checks and edit rules. If your totals foot and tie, the data loads into the Financial Data Repository and is shared with every state where you are licensed. If a check fails, you get an error report and must refile the corrected data, which still counts against the March 1 deadline.

Your domiciliary regulator and the NAIC’s financial analysts then review the statement for solvency warning signs. They run financial-ratio tests, compare year-over-year changes, and read the actuarial opinion and interrogatories. A statement that shows declining surplus, weak reserves, or odd affiliated transactions can prompt follow-up questions, a targeted exam, or a request for a corrective plan.

Late or incomplete filings draw penalties under state law. New York, for example, applies penalties under Insurance Law Sections 307 and 308 and grants no extension on the annual statement, while California enforces penalties under its insurance code. The cleanest outcome is a statement that loads with no errors and raises no flags, which usually means no further contact until next year’s filing.

Mistakes to Avoid When Filling Out the Statement

Each error below has cost real insurers time, money, or a regulatory inquiry. Watch for these:

• Using the wrong data-year blank, which causes the NAIC import to reject the file outright.
• Entering the wrong NAIC company code, which routes your data to another company’s record.
• Filing the wrong statement type (Life instead of P&C, etc.), which fails to match your license and is rejected.
• Admitting assets that statutory rules require you to nonadmit, which overstates surplus and invites an inquiry.
• Understating loss or claim reserves, which inflates surplus and is the top target of examiners.
• Mismatching earned and written premium between pages, which fails an internal cross-check.
• A Schedule T state total that does not foot to the underwriting exhibit, which triggers premium-tax discrepancies.
• Omitting a reinsurer or overdue recoverable on Schedule F or S, which understates the required provision.
• Leaving a General Interrogatory blank, which makes the filing incomplete and delays acceptance.
• Filing an unsigned or un-notarized Jurat page, which voids the sworn nature of the entire statement.
• Forgetting the separate .PDF filing, which is a distinct required item even after the data file is sent.
• Missing the database filing fee deadline, which can lead to a late penalty separate from the statement itself.

Do’s and Don’ts

Use these quick rules as a final pass before you submit.

Do:

• Reconcile every financial page to your December 31 trial balance, because untied figures fail edit checks.
• Run the software’s edit checks before submitting, because they catch the same errors the NAIC catches.
• Use the exact line numbers and page titles from your blank, because the database keys on them.
• File the signed Jurat with your domiciliary state, because NAIC electronic filing does not replace it.
• Keep all confirmation numbers, because they are your proof of timely filing.
• Confirm your statement type against your certificate of authority, because the wrong blank is rejected.

Don’t:

• Don’t admit overdue receivables or disallowed assets, because it overstates surplus.
• Don’t guess on the actuarial reserves, because the actuarial opinion controls those numbers.
• Don’t leave any interrogatory blank, because every question needs an answer.
• Don’t assume statutory income equals GAAP income, because they differ and will misstate results.
• Don’t wait until February 28 to start, because edit-check errors can take days to resolve.
• Don’t skip the database filing fee, because it carries its own deadline and penalty.

Pros and Cons of Filing on Your Own vs. With Help

Many insurers debate whether in-house staff can handle the statement or whether outside accountants and consultants should drive it. Here is the trade-off.

Pros of filing in-house:

• Lower cost, because you avoid consultant fees that can run into five or six figures.
• Faster internal turnaround, because your own staff already knows your ledger.
• Better institutional knowledge, because the team learns the form year over year.
• Direct control of the timeline, because you are not waiting on an outside firm.
• Easier mid-process corrections, because the people with answers are in the building.

Cons of filing in-house:

• Higher error risk if staff lack statutory accounting depth, because SAP differs from GAAP.
• Key-person risk, because losing one expert can derail the whole filing.
• Heavier software learning curve, because the annual statement tools are complex.
• Less protection on judgment calls, because you lack an outside firm’s review.
• Time strain on a small team during a tight March 1 window.

FAQs

Do I have to file the Annual Statement Blank if my company wrote no premium this year?

Yes. Any insurer holding a certificate of authority must file, even with zero premium, reporting None or $0 on the relevant lines rather than skipping the statement.

Do I use the prior data-year blank or the current one for a December 31 filing?

Yes, use the blank matching the data year being reported. The 2025 data-year statement filed in early 2026 uses the 2025 blank, not the 2026 version.

Do I write my NAIC code or my FEIN in the company code field on the Jurat?

No. The company code field takes the 5-digit NAIC company code, not the FEIN; the FEIN has its own separate field on the Jurat page.

Do agent balances over 90 days past due go in the admitted column?

No. Receivables over 90 days past due belong in Column 2 as nonadmitted assets, because statutory rules do not count stale balances toward solvency.

Do I report reinsurance I ceded if the reinsurer took all the risk?

Yes. You still report the gross exposure and any credit-risk provision on Schedule F or Schedule S, because regulators want to see your reliance on reinsurers.

Do I have to answer every General Interrogatory even if it does not apply?

Yes. Every interrogatory needs a response, using No or None where it does not apply; a blank answer makes the filing incomplete.

Do I file separately with each state where I am licensed?

No. Filing electronically with the NAIC satisfies most foreign states, but you still file the signed Jurat (and any supplement) with your domiciliary state.

Do I need to file a PDF version if I already sent the electronic data file?

Yes. The March .PDF filing is a separate required item, due the same March 1 as the data file, per your state checklist.

Do I have to get the Jurat page notarized?

Yes. The Jurat must be signed by the required officers and notarized; an unsigned or un-notarized Jurat voids the sworn statement.

Do the Schedule T state totals have to match the rest of the statement?

Yes. The Schedule T direct premium total must foot to the underwriting exhibit, or the filing fails a cross-check and may flag a premium-tax issue.

Do I owe the NAIC database filing fee if I am a small insurer with little premium?

Yes. A minimum fee of $240 applies even with little or no premium, calculated under the NAIC fee schedule.

Do I get an extension if March 1 falls on a weekend?

Yes, in many states; if the due date lands on a weekend or holiday, the filing is generally due the next business day, but you confirm this with your state’s instructions.