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Domestic Life Insurers and Domestic Fraternal Organizations

The following is being made available by the Department for the benefit of all life insurance companies and fraternal benefit societies doing business in New York and all insurers holding a certificate from the Superintendent as being accredited for the reinsurance of life insurance, annuities, or accident and health insurance.

The category Industry-Wide Letters and Inquiries is applicable to all licensed life insurers, accredited reinsurers and fraternal benefit societies. All remaining categories are applicable only to Domestic Life Insurance Companies and Domestic Fraternal Benefit Organizations.

Domestic Life Insurance Companies and Domestic Fraternal Benefit Organizations are annually required to provide, according to §4217 and §4516, year-end valuation submissions to the Life Bureau Reserve Section. These forms and instructions can be found below under the categories Year-End Instructions, Questionnaires and Checklists, Electronic Data Processing Forms and Instructions, and Analysis of Valuation Reserves.

Submissions should be sent via email to:

or by mail to:

Mr. Michael D. Cebula
Deputy Chief Life Actuary
Life Bureau – Reserve Section
New York State Department of Financial Services
One Commerce Plaza
Albany, New York 12257

For additional information or if there are questions, please email us or call (518) 474-7929.

Filing Requirements Matthew Ryan
AOMsDwight Hazzard
Formula ReservesDaniel Leifer

Industry-Wide Letters & Inquiries

Actuarial Opinions and Memoranda

Documents Release Date Link(s)
Special Considerations - Reserves 12/09/2016 PDF
AOM & Risk Based Capital Checklist 12/16/2016



Actuarial Opinion Requirements - Reserves 12/16/2016 PDF

Formula Reserves

Documents Release Date Link(s)
Requirements for using the 2001 CSO Mortality Table 12/13/2004 PDF


Documents Release Date Link(s)
Liquidity and Severe Mortality Inquiry - 12/31/2016 02/21/2017 Word
Tables and Top Ten   Excel

Year-End Instructions, Questionnaires and Checklists

Document Release Date Link(s)
Department Cover letter dated 12/13/2016 to the Annual Mailing for 12/31/2016 Reserves 12/16/2016 PDF
Notice regarding Accumulation-type Annuity Formatting for 12/31/2003 Reserves 11/06/2003 PDF
Instructions for Filing Valuations: 2016 Year-End Statutory Valuation 12/16/2016



General Account Questionnaires & Checklists

Documents PDF links Word links
Accident and Health Reserve Questionnaire PDF Word
Accumulation-Type Annuity Questionnaire PDF Word
Group Life Insurance Questionnaire PDF Word
Interest Sensitive Life Questionnaire PDF Word
Structured Settlements and Fixed Payment Annuity Questionnaire PDF Word
Valuation Filing Check-list PDF Word

Separate Account Questionnaires & Checklists

Documents PDF Links Word Links
Annuity Questionnaire PDF Word
Interest Sensitive Life Questionnaire PDF Word
Valuation Filing Check-List PDF Word

EDP Formats & Instructions

Categories Instructions External Labels Excel Links
Annuities – Accumulation-Type PDF Word PDF Word n/a
Annuities – Structured Settlement and Immediate Annuity PDF Word PDF Word Aggregate Test Worksheet
Interest Sensitive Life PDF Word PDF Word n/a
Traditional Life PDF Word PDF Word n/a
EDP Reconciliation n/a n/a n/a n/a Sample EDP Reconciliation

Analysis of Valuation Reserves

Categories General Account AoVR Separate Account AoVR
Domestic Life Insurance Company PDF Word PDF Word
Fraternal Benefit Society PDF Word n/a n/a

Updated 02/21/2017


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