FILE NAME
BR PRODUCER POLICY NO CO SOURCE JUL DT PROC SLIP PAGE
P54214012 0 0 1 1 1 2 2 2 J8/04/82 3

PAGE ** ** 3

ITEM REINS POL NO SOURCE KIND PERCENT RICO PGE/ITEM COMRATE OPER FIRST PREMIUM CR SECOND PREMIUM CR
5 3 6 4 6 1 1 5 6 7 8 9 9 0
1 3 6 4 6 1 1 5 6 7 8 0 1 2 0
14 60 00,000 6215 / 27*500 6217-04 400
15 60 00,000 6206 27*500 1,683-00
16 60 00,000 6203 27*500 1,683-00
17 60 00,000 6220 27*500 2,693-00 = 0,00
GROSS PREMIUM
FIRST PREMIUM
SECOND
REINS PREMIUM
FIRST
SECOND
.00
.00
941.50
.00