| "I, [name], am [title] of [insurance company name] and a member of the American Academy of Actuaries. I was appointed by, or by the authority of, the Board of Directors of that company to render this opinion as stated in the letter to the Commissioner dated [insert date]. I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and disability insurance companies." |
| "I, [name], a member of the American Academy of Actuaries, am associated with the firm of [name of consulting firm]. I have been appointed by, or by the authority of, the Board of Directors of [name of company] to render this opinion as stated in the letter to the Commissioner dated [insert date]. I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and disability insurance companies." |
| "I have examined the actuarial assumptions and actuarial methods used in determining reserves and related actuarial items listed below, as shown in the annual statement of the company, as prepared for filing with state regulatory officials, as of December 31, 20[ ]. Tabulated below are those reserves and related actuarial items which have been subjected to asset adequacy analysis. |
| Asset Adequacy Tested Amounts | Reserves and Liabilities | |||||
| Statement Item | Formula Reserves (1) |
Additional Actuarial Reserves (a) (2) |
Analysis Method (b) |
Other Amount (3) |
Total Amount (1) + (2) + (3) (4) |
|
| Exhibit 5 | ||||||
| A | Life Insurance | |||||
| B | Annuities | |||||
| C | Supplementary
Contracts With Life Contingencies |
|||||
| D | Accidental Death Benefit |
|||||
| E | Disability - Active | |||||
| F | Disability - Disabled | |||||
| G | Miscellaneous | |||||
| Total (Exhibit 5 Item 1, Page 3) | ||||||
| Exhibit 6 | ||||||
| A | Active Life Reserve | |||||
| B | Claim Reserve | |||||
| Total (Exhibit 6 Item 2, Page 3) | ||||||
| Exhibit 7 | ||||||
| Premiums and Other Deposit Funds (Column 6, Line 14) | ||||||
| Guaranteed Interest Contracts (Column 2, Line 14) |
||||||
| Annuities Certain (Column 3, Line 14) | ||||||
| Supplemental Contracts (Column 4, Line 14) | ||||||
| Dividend
Accumulations or
Refunds (Column 5, Line 14) |
||||||
| Total (Exhibit 7, Item 3, Page 3) | ||||||
| Exhibit 8 Part 1 | ||||||
| 1 | Life (Page 3, Line 4.1) | |||||
| 2 | Health (Page 3, Line 4.2) | |||||
| Total Exhibit 8, Part 1 | ||||||
| Separate Accounts (Page 3 of the Annual Statement of the Separate Accounts, Lines 1 and 2) | ||||||
| TOTAL RESERVES | ||||||
| IMR (General Account, Page 3, Line 9.4 ) | |
| IMR (Separate Accounts, Page 3, Line 3) | |
| AVR (Page 3, Line 24.1 ) | (c) |
| Net Deferred and Uncollected Premium |
| (a) | The additional actuarial reserves are the reserves
established under WAC 284-07-350 (5)(b). |
| (b) | The appointed actuary must state the method of
analysis, determined in accordance with the
standards for asset adequacy analysis referred to in
WAC 284-07-350(4), by means of symbols which shall
be defined in footnotes to the table. |
| (c) | Allocated amount of Asset Valuation Reserve (AVR)." |
| "I have relied on [name], [title] for [e.g.,
anticipated cash flows from currently owned
assets, including variations in cash flows
according to economic scenarios, or certain
critical aspects of the analysis performed in
conjunction with forming my opinion] as
certified in the attached statement. I have
reviewed the information relied upon for
reasonableness." |
| "My examination included a review of the actuarial assumptions, actuarial methods, the underlying basic asset and liability records, and other tests of the actuarial calculations I considered necessary. I also reconciled the underlying basic asset and liability records to [exhibits and schedules listed as applicable] of the company's current annual statement." |
| "In forming my opinion on [specify types of reserves] I
relied upon data prepared by [name and title of company
officer certifying in-force records or other data] as
certified in the attached statements. I evaluated that
data for reasonableness and consistency. I also
reconciled that data to [exhibits and schedules to be
listed as applicable] of the company's current annual
statement. In other respects my examination included
review of the actuarial assumptions and actuarial methods
used and tests of the actuarial calculations I considered
necessary." |
| (i) | Are computed in accordance with presently accepted actuarial standards consistently applied and are fairly stated, in accordance with sound actuarial principles; |
| (ii) | Are based on actuarial assumptions which produce reserves at least as great as those called for in any contract provision as to reserve basis and method, and are in accordance with all other contract provisions; |
| (iii) | Meet the requirements of the insurance laws and regulations of the state of [state of domicile] and are at least as great as the minimum aggregate amounts required by the state in which this statement is filed; |
| (iv) | Are computed on the basis of assumptions consistent with those used in computing the corresponding items in the annual statement of the preceding year-end (with any exceptions noted below); |
| (v) | Include provision for all actuarial reserves and related statement items which ought to be established. |
| The reserves and related items, when considered in
light of the assets held by the company with respect
to such reserves and related actuarial items
including, but not limited to, the investment
earnings on the assets, and the considerations
anticipated to be received and retained under the
policies and contracts, make adequate
provision, according to presently accepted actuarial
standards of practice, for the anticipated cash
flows required by the contractual obligations and
related expenses of the company. |
| The actuarial methods, considerations, and analyses
used in forming my opinion conform to the
appropriate Standards of Practice as promulgated by
the Actuarial Standards Board, which standards form
the basis of this statement of opinion. |
|
| This opinion is updated annually as required by
statute. To the best of my knowledge, there have
been no material changes from the applicable date of
the annual statement to the date of the rendering of
this opinion which should be considered in reviewing
this opinion. |
|
| or |
| The following material change(s) which occurred
between the date of the statement for which this
opinion is applicable and the date of this opinion
should be considered in reviewing this opinion:
(Describe the change or changes.) |
|
| The impact of unanticipated events subsequent to the date of this opinion is beyond the scope of this opinion. The analysis of asset adequacy portion of this opinion should be viewed recognizing that the company's future experience may not follow all the assumptions used in the analysis. |
| "I [name of officer], [title], of [name of company], hereby affirm that the listings and summaries of policies and contracts in force as of December 31, 20[ ], and other liabilities prepared for and submitted to [name of appointed actuary] were prepared under my direction and, to the best of my knowledge and belief, are substantially accurate and complete. |
| Signature of the Officer of the Company |
| Address of the Officer of the Company |
| Telephone Number of the Officer of the Company |
| Date" |