**I PREMIUM ACCOUNTING**

**NOT APPLICABLE** ☑️

**ACCOUNTS CORRECTIONS**

**DEBIT - A/P**

| PRODUCER CODE | EFF. DATE | GROSS | COMM. RATE | REASON |
|---------------|-----------|-------|------------|--------|
|               |           |       |            |        |

**CREDIT - R/P**

| PRODUCER CODE | EFF. DATE | GROSS | COMM. RATE | REASON |
|---------------|-----------|-------|------------|--------|
|               |           |       |            |        |

**DATE** ___________ **NAME** ___________ **APP. BY** ___________

**II REINFORCEMENT**

**NOT APPLICABLE** ☐

**DEBIT - A/P**

| PRODUCER CODE | EFF. DATE | GROSS | COMM. RATE | REASON |
|---------------|-----------|-------|------------|--------|
| 0128          | 5/21/81   | 765.40 | 27.54%     | Code shut on the first row in 5 (Jul date 155) please A/P correct gross premium and balance |

**CREDIT - R/P**

| PRODUCER CODE | EFF. DATE | GROSS | COMM. RATE | REASON |
|---------------|-----------|-------|------------|--------|
| 0128          | 5/21/81   | 1430.80 | 27.54%     | Code shut on the first row in 5 - please make the first premium computed by the 1/40 shut rule for news co. several charity $10, 965.40 net 1430.80 |

**DATE** 7/6/81 **NAME** J. H. O. **O. COPY** 831/96095