ࡱ> q "bjbj AiZjiZj  8tMT?&(" +???????BD?333?4?kkk3F?k3?kk8:yFW9??0?q9hEhE4::&hE;h33k33333??333?3333hE333333333 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 or Guaranteed Minimum Death Benefits    1.2. Index-Linked Variable Annuities without Guaranteed Living Benefits or Guaranteed Minimum Death Benefits    1.3. Variable Annuities with Guaranteed Minimum Death Benefits only    1.4. Variable Annuities with Guaranteed Minimum Accumulation Benefits    1.5. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Guaranteed Minimum Income Benefits in Accumulation Phase    1.6. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Hybrid Guaranteed Minimum Income Benefits in Withdrawal Phase    1.7. Index-Linked Variable Annuities with Guaranteed Living Benefits in Accumulation Phase    1.8. Index-Linked Variable Annuities with Guaranteed Living Benefits in Withdrawal Phase    1.9. Immediate Variable Annuities with a Guaranteed Annuity Payout Floor    1.10. Aggregate Write-Ins for Other Products 2. Total Post-Reinsurance-Ceded Reserve (Sum of Lines 1.1 through 1.10) 3. Pre-Reinsurance-Ceded Reserve  3.1. Variable Annuities without Guaranteed Living Benefits or Guaranteed Minimum Death Benefits    3.2. Index-Linked Variable Annuities without Guaranteed Living Benefits or Guaranteed Minimum Death Benefits    3.3. Variable Annuities with Guaranteed Minimum Death Benefits only    3.4. Variable Annuities with Guaranteed Minimum Accumulation Benefits    3.5. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Guaranteed Minimum Income Benefits in Accumulation Phase    3.6. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Hybrid Guaranteed Minimum Income Benefits in Withdrawal Phase    3.7. Index-Linked Variable Annuities with Guaranteed Living Benefits in Accumulation Phase    3.8. Index-Linked Variable Annuities with Guaranteed Living Benefits in Withdrawal Phase    3.9. Immediate Variable Annuities with a Guaranteed Annuity Payout Floor   3.10. Aggregate Write-Ins for Other Products  4. Total Pre-Reinsurance-Ceded Reserve (Sum of Lines 3.1 through 3.10) 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 1.10 from overflow page   1.1099 Totals (Lines 1.1001 through 1.1003 plus 1.1098) (Line 1.10 above)3.1001. .  3.1002.   3.1003.   3.1098. Summary of remaining write-ins for Line 3.10 from overflow page   3.1099 Totals (Lines 3.1001 through 3.1003 plus 3.1098) (Line 3.10 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 or Guaranteed Minimum Death Benefits      XXXXXXXXXXXX 1.2. Index-Linked Variable Annuities without Guaranteed Living Benefits or Guaranteed Minimum Death Benefits      XXXXXXXXXXXX 1.3. Variable Annuities with Guaranteed Minimum Death Benefits only      XXX  XXX 1.4. Variable Annuities with Guaranteed Minimum Accumulation Benefits      XXXXXXXXXXXX 1.5. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Guaranteed Minimum Income Benefits in Accumulation Phase      XXXXXXXXXXXX 1.6. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Hybrid Guaranteed Minimum Income Benefits in Withdrawal Phase      XXXXXXXXXXXX 1.7. Index-Linked Variable Annuities with Guaranteed Living Benefits in Accumulation Phase      XXXXXXXXXXXX 1.8. Index-Linked Variable Annuities with Guaranteed Living Benefits in Withdrawal Phase      XXXXXXXXXXXX 1.9. Immediate Variable Annuities with a Guaranteed Annuity Payout Floor      XXXXXXXXXXXX 1.10. Aggregate Write-Ins for Other Products     XXX  XXX 2. Total Post-Reinsurance-Ceded Reserve (Sum of Lines 1.1 through 1.10)XXXXXX 3. Pre-Reinsurance-Ceded Reserve  3.1. Variable Annuities without Guaranteed Living Benefits or Guaranteed Minimum Death Benefits       XXXXXX  3.2. Index-Linked Variable Annuities without Guaranteed Living Benefits or Guaranteed Minimum Death Benefits       XXXXXX  3.3. Variable Annuities with Guaranteed Minimum Death Benefits only           3.4. Variable Annuities with Guaranteed Minimum Accumulation Benefits       XXXXXX  3.5. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Guaranteed Minimum Income Benefits in Accumulation Phase       XXXXXX  3.6. Variable Annuities with Guaranteed Minimum Withdrawal Benefits or Hybrid Guaranteed Minimum Income Benefits in Withdrawal Phase       XXXXXX  3.7. Index-Linked Variable Annuities with Guaranteed Living Benefits in Accumulation Phase       XXXXXX  3.8. Index-Linked Variable Annuities with Guaranteed Living Benefits in Withdrawal Phase       XXXXXX  3.9. Immediate Variable Annuities with a Guaranteed Annuity Payout Floor       XXXXXX  3.10. Aggregate Write-Ins for Other Products          4. Total Pre-Reinsurance-Ceded Reserve (Sum of Lines 3.1 through 3.10) 5. Total Reserves 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 1.10 from overflow page     XXX  XXX1.1099 Totals (Lines 1.901 through 1.903 plus 1.998) (Line 1.10 above)XXXXXX3.1001. .          3.1002.          3.1003.          3.1098. 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Segoe UIC. Aptos Display3. Aptos?= .Cx Courier New;WingdingsA$BCambria Math"hsҧ2'j҇V' /' /!88r0 3q@P ? 2!xxP NAIC BLANKS (E) WORKING GROUPCalvin Ferguson Weber, Peter4         Oh+'0 $ D P \ ht| VsportV BLANKS (E) WORKING GROUPCalvin FergusonNormalWeber, Peter8Microsoft Office Word@ @ 8~@L@d䅁' ՜.+,0 hp  VsportV/  VsportV BLANKS (E) WORKING GROUP Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijlmnopqrstuvwxyz{|}~Root Entry F@Data k1TableEWordDocument ASummaryInformation(DocumentSummaryInformation8MsoDataStore`;ZHDNAJGNE5ZA==2pbItem  !PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q