2013 BSCR Class C by V58nrx

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									BSCR for Class C
                                                                                                                                           BSCRLTC03142012
IMPORTANT: Completion of this submission requires an internet connect.

Questions can be directed to: riskanalytics@bma.bm                                                                                         brrt_FormVersion         #NAME?

Submission Process:



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Comments:




                                                                                                                                           brrt_FilingComments      #NAME?

Comments from BMA:




                                                                                                                                           brrt_FilingCommentsBMA   #NAME?

Validation results:
INDEX
Sample Company
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                                               Company
         Submission         Attachments                             Declaration
                                              Information



BSCR SCHEDULES


           Form 4              Form 5           Form 8              SCHEDULE II             SCHEDULE IV(A)            SCHEDULE V



        SCHEDULE V(a)      SCHEDULE V(b)     SCHEDULE V(c)          SCHEDULE VI             SCHEDULE VII              SCHEDULE VIII



CISSA                                        OPERATIONAL RISK CHARGE

                                                     Corporate
        Schedule IX(a)     Schedule IX(b)                              Risk Management            Operational Risk
                                                    Governance


        Schedule IX(c)



ELIGIBLE CAPITAL                             BSCR MODEL

                                                                          Fixed Income
        Schedule XII(a)    Schedule XII(b)           Summary                                    Equity Investments            Credit Risk
                                                                          Investments

                                                    Interest and                                LT Variable Annuity       LT Other Insurance
                                                                        LT Insurance Risk
                                                   Liquidity Risk                                    Gte Risk                    Risk
File Attachments                                                                                                                                     Return to Index

                                                                                                        Input comment for each attached file here.
 1.   Governance structure                                     <Attach file>
                                                                               Attach   View   Remove
 2.   Risk concentrations                                      <Attach file>
                                                                               Attach   View   Remove
 3.   Description of the insurer's business strategy           <Attach file>
                                                                               Attach   View   Remove
 4.   Summary of product features and risks                    <Attach file>
                                                                               Attach   View   Remove
 5.   Financial impact and description of stress & scenarios   <Attach file>
                                                                               Attach   View   Remove
 6.   Description of the investments and derivatives           <Attach file>
                                                                               Attach   View   Remove
      strategies and policies
 7.   Intra-group transactions                                 <Attach file>
                                                                               Attach   View   Remove
 8.   CISSA attachments                                        <Attach file>
                                                                               Attach   View   Remove
 9.   Company Specific Parameters                              <Attach file>
                                                                               Attach   View   Remove
10. Other attachments                                          <Attach file>
                                                                               Attach   View   Remove
Governance structure

Group structure

Intra-group exposures

Description of the effective duration of assets and liabilities calculations and key assumptions

Financial impact and description of stress & scenarios

Description of the insurer's risk management program

Risk register

CISSA Attachments

CISSA Attachments

Other Attachments
C OM PAN Y IN F ORM ATION PAGE                                                                                                        Return to Index                                        01/01/2012
Sa mp l e Co mp a ny                                                                                                                                                                         12/31/2012
For the Year Ending                             De ce mbe r 31, 2012                                                                                    brrt_ReportForTheYearEnding          #NAME?

    COMPANY I NF ORMATI ON
    Co mp a ny Na me                                                   Sample Company                                                                   brrt_OrganizationName                #NAME?
    Da te I nco r p o r a te d/Or ga ni z e d                                           Lo ng- Te r m B usi ne ss Cl a ss   Class C                     brrt_DateIncorporatedOrOrganized     #NAME?
    Da te Co mme nce d B usi ne ss                                                      R e gi str a ti o n No .                                        brrt_DateCommencedBusiness           #NAME?

    CONTACT PERSON F OR RI SK B ASED CAPI TAL
    F i r st Na me                                                                                   La st Na me                                        brrt_ContactPersonFirstName          #NAME?

    CONTACT PERSON I NF ORMATI ON
    Str e e t a nd Numbe r o f P. O. B o x                                                                                                                                                    #NAME?
                                                                                                                                                        brrt_ContactPersonInformationStreetAndNumberOfPOBox

    Ci ty                                                                                                                                               brrt_ContactPersonInformationCity    #NAME?
    Co untr y                                                                                                                                           brrt_ContactPersonInformationCountry #NAME?
    Po sta l Co de                                                                                                                                                                            #
                                                                                                                                                        brrt_ContactPersonInformationPostalCodeNAME?
    Pho ne Numbe r                                                                      Extension                                                                                           #NAME?
                                                                                                                                                        brrt_ContactPersonInformationPhoneNumber

    Ema i l                                                                                                                                             brrt_ContactPersonInformationEmail   #NAME?
    Da te Pr e p a r e d                                                                                                                                brrt_ContactPersonInformationDatePrepared




                 Cl a ss A
                 Cl a ss B
                 Class C
                 Class C




                                                                                                                                                                                                              5
CAPITAL AND SOLVENCY RETURN DECLARATION                                                      Return to Index                                        01/01/2012
                                                                                                                                                    12/31/2012

Sample Company
December 31, 2012



We declare that to the best of our knowledge and belief, the information in this Capital and Solvency
Return fairly represents the financial condition of the Company in all material respects.




Signatory:                                                                                                     brrt_DeclarationSIgnatory


Print Name:                                                                                                    brrt_DeclarationPrintName
                              Director                                                                         brrt_DeclarationTitle


Date:                                                                                                          brrt_DeclarationDate
                                                                                                               brrt_Declaration            #NAME?




Signatory:                                                                                                     brrt_DeclarationSIgnatory


Print Name:                                                                                                    brrt_DeclarationPrintName
                              Director                                                                         brrt_DeclarationTitle


Date:                                                                                                          brrt_DeclarationDate
                                                                                                               brrt_Declaration            #NAME?



Signatory:                                                                                                     brrt_DeclarationSIgnatory


Print Name:                                                                                                    brrt_DeclarationPrintName
                              Principal Representative                                                         brrt_DeclarationTitle


Date:                                                                                                          brrt_DeclarationDate
                                                                                                               brrt_Declaration            #NAME?
Insurer Name:                 Sample Company


Year-end:                     December 31, 2012




                                                                                                                      6
STATUTORY BALANCE SHEET                                                                                 Return to Index

Sample Company
As at                  December 31, 2012                                                               FORM 4
Expressed in ['000s]   United States Dollars

STMT.
LINE No.                                                                                  2012          2011
                                                                                         ('000s)       ('000s)

1.                     CASH AND TIME DEPOSITS

2.                     QUOTED INVESTMENTS:
(a)                    Bonds and Debentures
                       i. Held to Maturity
                       ii. Other
(b)                    Total Bonds and Debentures                                                  -               -
(c)                    Equities
                         i. Common Stocks
                         ii. Preferred Stocks
                         iii. Mutual Funds
(d)                    Total Equity Investments                                                    -               -
(e)                    Other Quoted Investments
(f)                    Total Quoted Investments                                                    -               -

3.                     UNQUOTED INVESTMENTS:
(a)                    Bonds and Debentures
                       i. Held to Maturity
                       ii. Other
(b)                    Bonds and Debentures                                                        -               -
(c)                    Equities
                         i. Common Stocks
                         ii. Preferred Stocks
                         iii. Mutual Funds
(d)                    Total Equity Investments                                                    -               -
(e)                    Other Unquoted Investments
(f)                    Total Unquoted Investments                                                  -               -

4.                     INVESTMENTS IN AND ADVANCES TO AFFILIATES (EQUITY METHOD):
(a)                    Unregulated entities that conduct ancillary services
(b)                    Unregulated non-financial operating entities
(c)                    Unregulated financial operating entities
(d)                    Regulated non-insurance financial operating entities
(e)                    Regulated insurance financial operating entities
(f)                    Total investments in affiliates (equity method)                             -               -
(g)                    Advances to affiliates
(h)                    Total investments in and advances to affiliates (equity method)             -               -

5.                     INVESTMENTS IN MORTGAGE LOANS ON REAL ESTATE:
(a)                    First Liens
(b)                    Other than First Liens
(c)                    Total Investments in Mortgage Loans on Real Estate                          -               -

6.                     POLICY LOANS

7.                     REAL ESTATE:
(a)                    Occupied by the company (less encumbrances)
(b)                    Other properties (less encumbrances)
(c)                    Total real estate                                                           -               -

8.                     COLLATERAL LOANS

9.                     INVESTMENT INCOME DUE AND ACCRUED

10.                    ACCOUNTS AND PREMIUMS RECEIVABLE
(a)                    In course of collection
(b)                    Deferred - not yet due
(c)                    Receivables from retrocessional contracts
(d)                    Total accounts and premiums receivable                                      -               -




                                                                            7
STATUTORY BALANCE SHEET                                                                                     Return to Index

Sample Company
As at                  December 31, 2012                                                                   FORM 4
Expressed in ['000s]   United States Dollars

STMT.
LINE No.                                                                                        2012       2011
11.                    REINSURANCE BALANCES RECEIVABLE
(a)                    Foreign affiliates
(b)                    Domestic affiliates
(c)                    Pools & associations
(d)                    All other insurers
(e)                    Total reinsurance balances receivable                                           -               -

12.                    FUNDS HELD BY CEDING COMPANIES
(a)                    Affiliates
(b)                    Non-Affiliates
(c)                    Total Funds Held by Ceding Reinsurers                                           -               -

13.                    SUNDRY ASSETS:
(a)                    Derivative instruments
(b)                    Segregated Accounts Companies - Variable Annuities
(c)                    Segregated Accounts Companies - Others
(d)                    Deposit assets
(e)
(f)                    Total sundry assets                                                             -               -

14.                    LETTERS OF CREDIT, GUARANTEES AND OTHER INSTRUMENTS
(a)                    Letters of credit
(b)                    Guarantees
(c)                    Other instruments
(d)                    Total letters of credit, guarantees and other instruments                       -               -

15.                    TOTAL                                                                           -               -


                       LONG-TERM BUSINESS INSURANCE RESERVES, OTHER LIABILITIES AND STATUTORY
                       CAPITAL AND SURPLUS

                       INSURANCE RESERVES

20.                    RESERVES FOR REPORTED CLAIMS

21.                    RESERVES FOR UNREPORTED CLAIMS

22.                    POLICY RESERVES - LIFE

23.                    POLICY RESERVES - ACCIDENT AND HEALTH

24.                    POLICYHOLDER'S FUNDS ON DEPOSIT

25.                    LIABILITY FOR FUTURE POLICYHOLDER DIVIDENDS

26.                    OTHER INSURANCE RESERVES - LONG-TERM

27.                    TOTAL LONG-TERM BUSINESS - INSURANCE RESERVES
(a)                    Gross Long-Term Business Insurance Reserves                                     -               -
(b)                    Less: Reinsurance Recoverable Balance:
                       (i) Foreign Affiliates
                       (ii) Domestic Affiliaties
                       (iii) Pools and Associations
                       (iv) All Other Insurers
(c)                    Total Reinsurance Recoverable Balance                                           -               -
(d)                    Net Long-Term Business Insurance Reserves                                       -               -




                                                                            8
STATUTORY BALANCE SHEET                                                                        Return to Index

Sample Company
As at                  December 31, 2012                                                      FORM 4
Expressed in ['000s]   United States Dollars

STMT.
LINE No.                                                                           2012       2011
                       OTHER LIABILITIES

28.                    INSURANCE AND REINSURANCE BALANCES PAYABLE

29.                    COMMISSIONS, EXPENSES, FEES AND TAXES PAYABLE

30.                    LOANS AND NOTES PAYABLE

31.                    (a) INCOME TAXES PAYABLE

                       (b) DEFERRED INCOME TAXES

32.                    AMOUNTS DUE TO AFFILIATES

33.                    ACCOUNTS PAYABLE AND ACCRUED LIABILITIES

34.                    FUNDS HELD UNDER REINSURANCE CONTRACTS
(a)                    Affiliates
(b)                    Non-Affiliates
(c)                    Total Funds Held Under Reinsurance Contracts                       -               -

35.                    DIVIDENDS PAYABLE

36.                    SUNDRY LIABILITIES:
(a)                    Derivative instruments
(b)                    Segregated accounts companies
(c)                    Deposit liabilities
(d)
(e)                    Total sundry liabilities                                           -               -

37.                    LETTERS OF CREDIT, GUARANTEES AND OTHER INSTRUMENTS
(a)                    Letters of credit
(b)                    Guarantees
(c)                    Other instruments
(d)                    Total letters of credit, guarantees and other instruments          -               -

38.                    TOTAL OTHER LIABILITIES                                            -               -

39.                    TOTAL LONG-TERM BUSINESS INSURANCE                                 -               -
                       RESERVES AND OTHER LIABILITIES

                       STATUTORY CAPITAL AND SURPLUS

40.                    TOTAL STATUTORY CAPITAL AND SURPLUS                                -               -

41.                    TOTAL                                                              -               -

                                                                                   TRUE        TRUE
Notes to Form 4

Line 10                Collateralized balances

Line 11(e)             Collateralized balances

Line 27(c)             Collateralized balances

Line 11                Letters of credit

Line 15                Encumbered assets for policyholder obligations

                                          Asset
                               Cash
                               Total quoted investments
                               Total unquoted investments




                                                                         9
STATUTORY BALANCE SHEET                                                          Return to Index

Sample Company
As at                  December 31, 2012                                        FORM 4
Expressed in ['000s]   United States Dollars

STMT.
LINE No.                                                             2012       2011
                              Funds held by ceding reinsurers               -               -
                              Other asset types
                                   Total assets encumbered                  -               -




                                                                10
STATUTORY BALANCE SHEET                                                                                       Return to Index

Sample Company
As at                  December 31, 2012                                                                     FORM 4
Expressed in ['000s]   United States Dollars

STMT.
LINE No.                                                                                          2012       2011
Line 15                Encumbered assets not securing policyholder obligations

                                           Asset                     Purpose of Encumbrance
                              Cash
                              Total quoted investments
                              Total unquoted investments
                              Other asset types
                                    Total assets encumbered                                              -               -

Line 27                Total gross long-term business insurance reserves at beginning of year

                       Less: Reinsurance recoverable on long-term business at beginning of year

                       Total net long-term business insurance reserves at beginning of year              -               -

                       Long-term business deductions related to:
                                Current year
                                Prior years

                       Total long-term business deductions                                               -               -

                       Less: Long-term business deductions paid or payable related to:
                                Current year
                                Prior years

                       Total long-term business deductions paid or payable                               -               -

                       Total net long-term business insurance reserves at end of year                    -               -

                       Add: Reinsurance recoverable on long-term business at end of year

                       Total gross long-term business insurance reserves at end of year                  -               -

                                                                                                  TRUE        TRUE




                                                                             11
STATUTORY BALANCE SHEET                                     Return to Index

Sample Company
As at                  December 31, 2012                   FORM 4
Expressed in ['000s]   United States Dollars

STMT.
LINE No.                                            2012   2011




                                               12
                                 01/01/201201/01/2011
                                 12/31/201212/31/2011




brrt_CashAndTimeDeposits           #NAME?       #NAME?



                                 #NAME?      #NAME?
brrt_QuotedInvestmentsBondsAndDebenturesHeldToMaturity
                                 #NAME?
brrt_QuotedInvestmentsBondsAndDebenturesOther#NAME?
                                 #NAME?
brrt_QuotedInvestmentsBondsAndDebentures     #NAME?

                                    #NAME?
brrt_QuotedInvestmentsEquitiesCommonStocks      #NAME?
                                    #NAME?
brrt_QuotedInvestmentsEquitiesPreferredStocks   #NAME?
                                    #NAME?
brrt_QuotedInvestmentsEquitiesMutualFunds       #NAME?
brrt_QuotedInvestmentsEquities      #NAME?      #NAME?
brrt_QuotedInvestmentsOther         #NAME?      #NAME?
brrt_QuotedInvestments              #NAME?      #NAME?



                                 #NAME?     #NAME?
brrt_UnquotedInvestmentsBondsAndDebenturesHeldToMaturity
                                 #NAME?     #NAME?
brrt_UnquotedInvestmentsBondsAndDebenturesOther
                                 #NAME?
brrt_UnquotedInvestmentsBondsAndDebentures #NAME?

                                    #NAME?
brrt_UnquotedInvestmentsEquitiesCommonStocks #NAME?
                                    #NAME?
brrt_UnquotedInvestmentsEquitiesPreferredStocks #NAME?
                                    #NAME?
brrt_UnquotedInvestmentsEquitiesMutualFunds #NAME?
brrt_UnquotedInvestmentsEquities #NAME?           #NAME?
brrt_UnquotedInvestmentsOther       #NAME?        #NAME?
brrt_UnquotedInvestments            #NAME?        #NAME?
                                    #NAME?        #NAME?
                                    #NAME?        #NAME?
                                    #NAME?        #NAME?
brrt_UnregulatedEntitiesThatConductAncillaryServices
                                    #NAME?
brrt_UnregulatedNonFinancialOperatingEntities     #NAME?
                                    #NAME?
brrt_UnregulatedFinancialOperatingEntities        #NAME?
                                    #NAME?        #NAME?
brrt_RegulatedNonInsuranceFinancialOperatingEntities
                                    #NAME?
brrt_RegulatedInsuranceFinancialOperatingEntities #NAME?
brrt_InvestmentInAffiliates         #NAME?        #NAME?
brrt_AdvancesToAffiliates           #NAME?        #NAME?
                                    #NAME?
brrt_InvestmentInAndAdvancesToAffiliates          #NAME?


                                  #NAME?       #NAME?
brrt_InvestmentsInMortgageLoansOnRealEstateFirstLiens
                                  #NAME?       #NAME?
brrt_InvestmentsInMortgageLoansOnRealEstateOtherThanFirstLiens
                                  #NAME?
brrt_InvestmentsInMortgageLoansOnRealEstate #NAME?
                                  #NAME?       #NAME?
brrt_PolicyLoans                  #NAME?       #NAME?


                                    #NAME?     #NAME?
brrt_RealEstateOccupiedByTheCompanyLessEncumbrances
                                    #NAME?
brrt_OtherRealEstatePropertiesLessEncumbrances #NAME?
brrt_RealEstate                     #NAME?     #NAME?
                                    #NAME?     #NAME?
brrt_CollateralLoans                #NAME?     #NAME?
                                    #NAME?     #NAME?
                                    #
brrt_InvestmentIncomeDueAndAccrued NAME?       #NAME?
                                    #NAME?     #NAME?
                                    #NAME?     #NAME?
                                    #NAME?     #NAME?
brrt_AccountsAndPremiumsReceivableInCourseOfCollection
                                    #NAME?     #NAME?
brrt_AccountsAndPremiumsReceivableDeferredNotYetDue
                                    #NAME?     #NAME?
brrt_AccountsAndPremiumsReceivableReceivablesFromRetrocessionalContracts
brrt_AccountsAndPremiumsReceivable  #NAME?     #NAME?
                                    #NAME?     #NAME?




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                                   #NAME?        #NAME?
                                   #NAME?        #NAME?
brrt_ReinsuranceBalancesReceivableForeignAffiliates
                                   #NAME?        #NAME?
brrt_ReinsuranceBalancesReceivableDomesticAffiliates
                                   #NAME?        #NAME?
brrt_ReinsuranceBalancesReceivablePoolsAndAssociations
                                   #NAME?        #NAME?
brrt_ReinsuranceBalancesReceivableAllOtherInsurers
brrt_ReinsuranceBalancesReceivable #NAME?        #NAME?


                                     #NAME?
brrt_FundsHeldByCedingInsurersAffiliated       #NAME?
                                     #NAME?
brrt_FundsHeldByCedingInsurersNonAffiliated    #NAME?
brrt_FundsHeldByCedingReinsurers #NAME?        #NAME?


                                    #NAME?
brrt_SundryAssetsDerivativeInstruments       #NAME?
                                    #NAME?   #NAME?
brrt_SundryAssetsSegregatedAccountsCompaniesVariableAnnuities
                                    #NAME?   #NAME?
brrt_SundryAssetsSegregatedAccountsCompaniesOthers
brrt_SundryAssetsDepositAssets      #NAME?   #NAME?
brrt_SundryAssetsOther              #NAME?   #NAME?
brrt_SundryAssets                   #NAME?   #NAME?
brrt_SundryAssetsOtherDescription #NAME?

brrt_AssetsLettersOfCredit          #NAME?      #NAME?
brrt_AssetsGuarantees               #NAME?      #NAME?
brrt_AssetsOtherInstruments         #NAME?      #NAME?
                                    #NAME?      #NAME?
brrt_AssetsLettersOfCreditGuaranteesOtherInstruments

brrt_Assets                         #NAME?     #NAME?




                                  #NAME?
brrt_ReservesForReportedClaimsGross            #NAME?                brrt_BusinessClassAxis_brrt_LongTermMember

                                   #NAME?
brrt_ReservesForUnreportedClaimsGross          #NAME?                brrt_BusinessClassAxis_brrt_LongTermMember

brrt_PolicyReservesLifeGross        #NAME?     #NAME?                brrt_BusinessClassAxis_brrt_LongTermMember

                                    #NAME?
brrt_PolicyReservesAccidentAndHealthGross      #NAME?                brrt_BusinessClassAxis_brrt_LongTermMember

                                   #NAME?
brrt_PolicyholdersFundsOnDepositGross          #NAME?                brrt_BusinessClassAxis_brrt_LongTermMember

                                       #NAME?
brrt_LiabilityForFuturePolicyholderDividendsGross #NAME?             brrt_BusinessClassAxis_brrt_LongTermMember

brrt_OtherInsuranceReservesGross    #NAME?     #NAME?                brrt_BusinessClassAxis_brrt_LongTermMember


brrt_InsuranceReservesGross         #NAME?     #NAME?                brrt_BusinessClassAxis_brrt_LongTermMember

                                   #NAME?    #NAME?
brrt_ReinsuranceRecoverableBalanceForeignAffiliates                  brrt_BusinessClassAxis_brrt_LongTermMember
                                   #NAME?    #NAME?
brrt_ReinsuranceRecoverableBalanceDomesticAffiliates                 brrt_BusinessClassAxis_brrt_LongTermMember
                                   #NAME?    #NAME?
brrt_ReinsuranceRecoverableBalancePoolsAndAssociations               brrt_BusinessClassAxis_brrt_LongTermMember
                                   #NAME?    #NAME?
brrt_OtherInsurersReinsuranceRecoverableBalance                      brrt_BusinessClassAxis_brrt_LongTermMember
brrt_ReinsuranceRecoverableBalance #NAME?    #NAME?                  brrt_BusinessClassAxis_brrt_LongTermMember
brrt_InsuranceReservesNet          #NAME?    #NAME?                  brrt_BusinessClassAxis_brrt_LongTermMember




                                                                14
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                                  12/31/201212/31/2011



                                   #NAME?
brrt_InsuranceAndReinsuranceBalancesPayable      #NAME?
                                   #NAME?        #NAME?
                                   #NAME?
brrt_CommissionsExpensesFeesAndTaxesPayable      #NAME?
                                   #NAME?        #NAME?
brrt_LoansAndNotesPayable          #NAME?        #NAME?
                                   #NAME?        #NAME?
brrt_IncomeTaxesPayable            #NAME?        #NAME?
                                   #NAME?        #NAME?
brrt_DeferredIncomeTaxes           #NAME?        #NAME?
                                   #NAME?        #NAME?
brrt_AmountsDueToAffiliates        #NAME?        #NAME?
                                   #NAME?        #NAME?
                                   #NAME?
brrt_AccountsPayableAndAccruedLiabilities        #NAME?


                                        #NAME?
brrt_FundsHeldUnderReinsuranceContractsAffiliated #NAME?
                                        #NAME?    #NAME?
brrt_FundsHeldUnderReinsuranceContractsNonAffiliated
brrt_FundsHeldUnderReinsuranceContracts #NAME?    #NAME?
                                        #NAME?    #NAME?
brrt_DividendsPayable                   #NAME?    #NAME?
                                        #NAME?    #NAME?
                                        #NAME?    #NAME?
                                        #NAME?
brrt_SundryLiabilitiesDerivativeInstruments       #NAME?
                                        #NAME?
brrt_SundryLiabilitiesSegregatedAccountsCompanies #NAME?
brrt_SundryLiabilitiesDepositLiabilities#NAME?    #NAME?
brrt_SundryLiabilitiesOther             #NAME?    #NAME?
brrt_SundryLiabilities                  #NAME?    #NAME?
brrt_SundryLiabilitiesOtherDescription#NAME?
                                        #NAME?    #NAME?
brrt_LiabilitiesLettersOfCredit         #NAME?    #NAME?
brrt_LiabilitiesGuarantees              #NAME?    #NAME?
brrt_LiabilitiesOtherInstruments        #NAME?    #NAME?
                                        #NAME?    #NAME?
brrt_LiabilitiesLettersOfCreditGuaranteesAndOtherInstruments
                                        #NAME?    #NAME?
brrt_OtherLiabilities                   #NAME?    #NAME?
                                        #NAME?    #NAME?
                                        #NAME?
brrt_InsuranceReservesAndOtherLiabilities         #NAME?
                                        #NAME?    #NAME?
                                        #NAME?    #NAME?
                                        #NAME?    #NAME?
                                        #NAME?    #NAME?
brrt_StatutoryCapitalAndSurplus         #NAME?    #NAME?
                                        #NAME?    #NAME?
brrt_Liabilities                        #NAME?    #NAME?
                                        #NAME?    #NAME?
                                        #NAME?    #NAME?
                                        #NAME?    #NAME?
                                        #NAME?    #NAME?
brrt_CollateralizedBalances             #NAME?    #NAME?
                                        #NAME?    #NAME?




brrt_LettersOfCredit                #NAME?       #NAME?
                                    #NAME?       #NAME?

brrt_EncumberedAssetsAxis_brrt_EncumberedAssetsForPolicyholderObligationsMember

brrt_CashAmountOfEncumbrance #NAME?       #NAME?
                               #NAME?
brrt_QuotedInvestmentsAmountOfEncumbrance #NAME?
                               #NAME?     #NAME?
brrt_UnquotedInvestmentsAmountOfEncumbrance




                                                               15
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                              12/31/201212/31/2011

                                  #NAME?    #NAME?
brrt_FundsHeldByCedingReinsurersAmountOfEncumbrance
                                  #NAME?
brrt_OtherAssetsTypesAmountOfEncumbrance #NAME?
                                  #NAME?
brrt_AssetsEncumberedAmountOfEncumbrance #NAME?




                                                      16
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                                  12/31/201212/31/2011


brrt_EncumberedAssetsAxis_brrt_EncumberedAssetsNotSecuringPolicyholderObligationsMember

brrt_CashAmountOfEncumbrance #NAME?       #NAME?                   brrt_CashPurposeOfEncumbrance #NAME?
                               #NAME?
brrt_QuotedInvestmentsAmountOfEncumbrance #NAME?                                                    #NAME?
                                                                   brrt_QuotedInvestmentsPurposeOfEncumbrance
                               #NAME?     #NAME?
brrt_UnquotedInvestmentsAmountOfEncumbrance                                                         #NAME?
                                                                   brrt_UnquotedInvestmentsPurposeOfEncumbrance
                               #NAME?
brrt_OtherAssetsTypesAmountOfEncumbrance #NAME?                                                     #NAME?
                                                                   brrt_OtherAssetsTypesPurposeOfEncumbrance
                               #NAME?
brrt_AssetsEncumberedAmountOfEncumbrance #NAME?

brrt_InsuranceReservesGross        #NAME?     #NAME?
                                   #NAME?     #NAME?
brrt_ReinsuranceRecoverable        #NAME?     #NAME?
                                   #NAME?     #NAME?
brrt_InsuranceReservesNet          #NAME?     #NAME?


brrt_DeductionsRelatedToCurrentYear#NAME?     #NAME?
brrt_DeductionsRelatedToPriorYears #NAME?     #NAME?

brrt_DeductionsNet                 #NAME?     #NAME?


                                   #NAME?
brrt_DeductionsPaidOrPayableRelatedToCurrentYear#NAME?
                                   #NAME?
brrt_DeductionsPaidOrPayableRelatedToPriorYears #NAME?

brrt_DeductionsPaidOrPayableNet    #NAME?     #NAME?

brrt_InsuranceReservesGross        #NAME?     #NAME?

brrt_ReinsuranceRecoverable        #NAME?     #NAME?

brrt_InsuranceReservesNet          #NAME?     #NAME?




                                                              17
01/01/201201/01/2011
12/31/201212/31/2011




                       18
19
20
21
22
23
24
25
26
27
28
29
30
STATUTORY STATEMENT OF INCOME

Sample Company
For the year ending    December 31, 2012
Expressed in ['000s]   United States Dollars


        STMT.
       LINE No.                                                           2012
                                                                          ('000)
                       UNDERWRITING INCOME

          19.          GROSS PREMIUMS AND OTHER CONSIDERATIONS:
          (a)          Direct gross premiums and other considerations
          (b)          Assumed gross premiums and other considerations
          (c)          Total gross premiums and other considerations               -

          (d)          REINSURANCE PREMIUMS CEDED

          (e)          NET PREMIUMS AND OTHER CONSIDERATIONS:
                       (i) Life
                       (ii) Annuities
                       (iii) Accident and health
                       (iv) Total net premiums and other considerations            -

          20.          LONG-TERM BUSINESS INVESTMENT INCOME - NET

          21.          OTHER INSURANCE INCOME

          22.                                                                      -

                       DEDUCTIONS

          23.          CLAIMS - LIFE

          24.          POLICYHOLDERS' DIVIDENDS

          25.          SURRENDERS

          26.          MATURITIES

          27.          ANNUITIES

          28.          ACCIDENT AND HEALTH BENEFITS

          29.          COMMISSIONS

          30.          OTHER

          31.                                                                      -

          32.          OPERATING EXPENSES

          33.                                                                      -

          34.          INCREASE (DECREASE) IN POLICY RESERVES:
          (a)          Life
          (b)          Annuities
          (c)          Accident and health
          (d)          Total increase (decrease) in policy reserves                -

          35.          INCOME BEFORE THE UNDERNOTED ITEMS                          -
STATUTORY STATEMENT OF INCOME

Sample Company
For the year ending    December 31, 2012
Expressed in ['000s]   United States Dollars


        STMT.
       LINE No.                                                2012
                                                               ('000)

          37.          OTHER INCOME (DEDUCTIONS)

          38.          INCOME BEFORE TAXES                              -

          39.          INCOME TAXES (IF APPLICABLE):
          (a)          Current
          (b)          Deferred
          (c)          Total                                            -

          40.          INCOME BEFORE REALIZED GAINS (LOSSES)            -

          41.          REALIZED GAINS (LOSSES)

          42.          NET INCOME                                       -
STATUTORY STATEMENT OF INCOME

Sample Company
For the year ending    December 31, 2012
Expressed in ['000s]   United States Dollars


        STMT.
       LINE No.                                2012
                                               ('000)
STATUTORY STATEMENT OF INCOME

Sample Company
For the year ending    December 31, 2012
Expressed in ['000s]   United States Dollars


        STMT.
       LINE No.                                2012
                                               ('000)

                                               TRUE
 Return to Index


FORM 5


                                                                                    01/01/2012   01/01/2011
                                                                                    12/31/2012   12/31/2011
2011
('000)




                   brrt_GrossPremiumsWrittenAndOtherConsiderationsDirect              #NAME?       #NAME?
                   brrt_GrossPremiumsWrittenAndOtherConsiderationsAssumed             #NAME?       #NAME?
           -       brrt_GrossPremiumsWrittenAndOtherConsiderations                    #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_ReinsurancePremiumsCeded                                      #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_NetPremiumsWrittenAndOtherConsiderationsLife                  #NAME?       #NAME?
                   brrt_NetPremiumsWrittenAndOtherConsiderationsAnnuities             #NAME?       #NAME?
                   brrt_NetPremiumsWrittenAndOtherConsiderationsAccidentAndHealth     #NAME?       #NAME?
           -       brrt_NetPremiumsWrittenAndOtherConsiderations                      #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_InvestmentIncomeNet                                           #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_OtherInsuranceIncome                                          #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
           -       brrt_UnderwritingIncome                                            #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_DeductionsClaimsLife                                          #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_DeductionsPolicyholdersDividends                              #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_DeductionsSurrenders                                          #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_DeductionsMaturities                                          #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_DeductionsAnnuities                                           #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_DeductionsAccidentAndHealthBenefits                           #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_DeductionsCommissions                                         #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_DeductionsOther                                               #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
           -       brrt_Deductions                                                    #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_OperatingExpenses                                             #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
           -       brrt_UnderwritingIncomeNetOfDeductionsAndOperatingExpenses         #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
                   brrt_IncreaseOrDecreaseInPolicyReservesLife                        #NAME?       #NAME?
                   brrt_IncreaseOrDecreaseInPolicyReservesAnnuities                   #NAME?       #NAME?
                   brrt_IncreaseOrDecreaseInPolicyReservesAccidentAndHealth           #NAME?       #NAME?
           -       brrt_IncreaseOrDecreaseInPolicyReserves                            #NAME?       #NAME?
                                                                                      #NAME?       #NAME?
           -       brrt_IncomeBeforeOtherIncomeOrDeductions                           #NAME?       #NAME?
 Return to Index


FORM 5


                                                          01/01/2012   01/01/2011
                                                          12/31/2012   12/31/2011
2011
('000)
                                                            #NAME?       #NAME?
                   brrt_OtherIncomeDeductions               #NAME?       #NAME?
                                                            #NAME?       #NAME?
           -       brrt_IncomeBeforeTaxes                   #NAME?       #NAME?
                                                            #NAME?       #NAME?
                                                            #NAME?       #NAME?
                   brrt_IncomeTaxesCurrent                  #NAME?       #NAME?
                   brrt_IncomeTaxesDeferred                 #NAME?       #NAME?
           -       brrt_IncomeTaxes                         #NAME?       #NAME?
                                                            #NAME?       #NAME?
           -       brrt_IncomeBeforeRealizedGainsLosses     #NAME?       #NAME?
                                                            #NAME?       #NAME?
                   brrt_RealizedGainsLosses                 #NAME?       #NAME?
                                                            #NAME?       #NAME?
           -       brrt_NetIncome                           #NAME?       #NAME?
 Return to Index


FORM 5


                   01/01/2012   01/01/2011
                   12/31/2012   12/31/2011
2011
('000)
 Return to Index


FORM 5


                      01/01/2012   01/01/2011
                      12/31/2012   12/31/2011
2011
('000)

 TRUE         CHECK
brrt_BusinessClassAxis_brrt_LongTermMember
STATUTORY STATEMENT OF CAPITAL AND SURPLUS                                                                 Return to Index

Sample Company
For the year ending         December 31, 2012                                                             FORM 8
Expressed in ['000s]        United States Dollars



STMT.
LINE No.                                                                                     2012          2011
                                                                                            ('000s)       ('000s)

1.           STATUTORY CAPITAL

(a)          Capital stock
             (i) Common shares
             authorized                              shares of par
             value                                   each issued and
             fully paid                              shares

             (ii) Preferred shares
             authorized                              shares of par
             value                                   each issued and
             fully paid                              shares
             aggregate liquidation value for —
                     2011
                     2010

             (iii) Treasury shares
             repurchased                             shares of par
             value                                   each issued

(b)          Contributed surplus

(c)          Any other fixed capital
             (i) Hybrid capital instruments
             (ii) Guarantees and others
             (iii) Total any other fixed capital                                                      -               -

(d)          Total Statutory Capital                                                                  -               -


2.           STATUTORY SURPLUS:

(a)          Statutory Surplus - Beginning of Year

(b)          Add: Income for Year                                                                     -               -

(c)          Less: Dividends paid and payable

(d)          Add (Deduct) change in unrealized appreciation (depreciation) of investments

(e)          Add (Deduct) change in non-admitted assets

(f)          Add (Deduct) change in appraisal of real estate

(g)          Add (Deduct) change in any other statutory capital

(h)          Statutory Surplus - End of Year                                                          -               -


3.           TOTAL STATUTORY CAPITAL AND SURPLUS                                                      -               -




                                                                              43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
                                                                   01/01/2012   01/01/2011
                                                                   12/31/2012   12/31/2011




    brrt_CommonShares                                                 #NAME?      #NAME?
    brrt_CommonSharesAuthorized                                       #NAME?
    brrt_CommonSharesValue                                            #NAME?
    brrt_CommonSharesFullyPaid                                        #NAME?

    brrt_PreferredShares                                              #NAME?      #NAME?
    brrt_PreferredSharesAuthorized                                    #NAME?
    brrt_PreferredSharesValue                                         #NAME?
    brrt_PreferredSharesFullyPaid                                     #NAME?

    brrt_PreferredSharesAggregateLiquidationValue                     #NAME?      #NAME?


    brrt_TreasuryShares                                               #NAME?      #NAME?
    brrt_TreasurySharesRepurchased                                    #NAME?
    brrt_TreasurySharesValue                                          #NAME?

    brrt_ContributedSurplus                                           #NAME?      #NAME?
                                                                      #NAME?      #NAME?
                                                                      #NAME?      #NAME?
    brrt_AnyOtherFixedCapitalHybridCapitalInstruments                 #NAME?      #NAME?
    brrt_AnyOtherFixedCapitalGuaranteesAndOthers                      #NAME?      #NAME?
    brrt_AnyOtherFixedCapital                                         #NAME?      #NAME?
                                                                      #NAME?      #NAME?
    brrt_StatutoryCapital                                             #NAME?      #NAME?
                                                                      #NAME?      #NAME?
                                                                      #NAME?      #NAME?
                                                                      #NAME?      #NAME?
                                                                      #NAME?      #NAME?
    brrt_StatutorySurplus                                             #NAME?      #NAME?
                                                                      #NAME?      #NAME?

0                                                                     #NAME?      #NAME?
    brrt_DividendsPaidAndPayable                                      #NAME?      #NAME?
                                                                      #NAME?      #NAME?
    brrt_ChangeInUnrealizedAppreciationDepreciationOfInvestments      #NAME?      #NAME?
                                                                      #NAME?      #NAME?
    brrt_ChangeInNonAdmittedAssets                                    #NAME?      #NAME?
                                                                      #NAME?      #NAME?
    brrt_ChangeInAppraisalOfRealEstate                                #NAME?      #NAME?
                                                                      #NAME?      #NAME?
    brrt_ChangeInAnyOtherStatutoryCapital                             #NAME?      #NAME?
                                                                      #NAME?      #NAME?
    brrt_StatutorySurplus                                             #NAME?      #NAME?


    brrt_StatutoryCapitalAndSurplus                                   #NAME?      #NAME?




                                                 71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
SCHEDULE OF FIXED INCOME INVESTMENTS BY RATING CATEGORY                                                                                                                                Return to Index

                                           Sample Company
                                           As at                       December 31, 2012                                                                                            SCHEDULE II
                                           Expressed in ['000s]     United States Dollars



                                                        QUOTED INVESTMENTS                                UNQUOTED INVESTMENTS                                           TOTAL
                                                        Bonds and Debentures                               Bonds and Debentures                                [ Form 4 Lines 2(b) & 3(b)]
                                                          [ Form 4 Line 2(b)]                                [ Form 4 Line 3(b)]
Schedule
Line no.                                            2012                     2011                      2012                      2011                       2012                        2011
                                                   ('000s)                  ('000s)                   ('000s)                   ('000s)                    ('000s)                     ('000s)

    1   Government                                                                                                                                                   -                            -      brrt_RiskGradeAxis_brrt_GovernmentMember
    2   High Investment Grade (AAA & AA)                                                                                                                             -                            -      brrt_RiskGradeAxis_brrt_HighInvestmentGradeAAAAndAAMember
    3   Medium Investment Grade (A)                                                                                                                                  -                            -      brrt_RiskGradeAxis_brrt_MediumInvestmentGradeAMember
    4   Low Investment Grade (BBB)                                                                                                                                   -                            -      brrt_RiskGradeAxis_brrt_LowInvestmentGradeBBBMember
    5   Non Investment Grade                                                                                                                                         -                            -      brrt_RiskGradeAxis_brrt_NonInvestmentGradeMember
    6   Mortgaged-backed Securities                                                                                                                                  -                            -      brrt_RiskGradeAxis_brrt_MortgagedBackedSecuritiesMember
    7   Mutual Funds                                                                                                                                                 -                            -      brrt_RiskGradeAxis_brrt_MutualFundsMember
    8   Non Rated                                                                                                                                                    -                            -      brrt_RiskGradeAxis_brrt_NonRatedMember
    9   Total                                                -                        -                         -                         -                          -                            -      brrt_RiskGradeAxis_brrt_TotalMember

                                                   TRUE                      TRUE                      TRUE                      TRUE




                                           01/01/2012                01/01/2011                01/01/2012                01/01/2011               01/01/2012                  01/01/2011
                                           12/31/2012                12/31/2011                12/31/2012                12/31/2011               12/31/2012                  12/31/2011
                                                                     brrt_QuotedInvestmentsBondsAndDebentures
                                           brrt_QuotedInvestmentsBondsAndDebentures                                      brrt_UnquotedInvestmentsBondsAndDebentures
                                                                                               brrt_UnquotedInvestmentsBondsAndDebentures         brrt_BondsAndDebentures     brrt_BondsAndDebentures
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?
                                                   #NAME?                    #NAME?                    #NAME?                    #NAME?                   #NAME?                      #NAME?




                                                                                                                                                      99
SCHEDULE OF LONG-TERM BUSINESS PREMIUMS                                                                                                                                                                                                                                                                 Return to Index

Sample Company
For the year ending    December 31, 2012                                                                                                                                                                                                                                                             SCHEDULE IV(A)
Expressed in ['000s]   United States Dollars

                                                                                                                   Gross Premiums And Other Considerations                                                                             Net Premiums and Other Considerations
                                                                                          Unrelated                                    Related                Total [Form 5, Line 19(c)]             Adjustable / Benefit Period           Non-Adjustable / Benefit Period          Total [Form 5, Line 19(e)(iv)]
                                                                                                                                                                                                            <= 2 Years                               > 2 Years
      Schedule                                                                2012                    2011                2012                   2011         2012                 2011               2012                 2011               2012                2011               2012                  2011
       Line no.
                                                                             ('000)                   ('000)              ('000)                 ('000)       ('000)              ('000)             ('000)               ('000)             ('000)              ('000)              ('000)                ('000)

          1            Mortality                                                                                                                                       -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_MortalityMember
          2            Critical Illness                                                                                                                                -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_CriticalIllnessMember
          3            Longevity                                                                                                                                       -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_LongevityMember
          4            Deferred Annuities                                                                                                                              -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_DeferredAnnuitiesMember
          5            Disability Income: Active lives with
                       premium guarantee of —
                       (i) Less than or equal to 1 year                                                                                                                -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesWaiverOfPremiumAndLTCLessThanOneYearMember
                       (ii) More than 1 year but less than 5 years                                                                                                     -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesWaiverOfPremiumAndLTCBetween1AndFiveYearsMember
                       (iii) Greater than 5 years                                                                                                                      -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesWaiverOfPremiumAndLTCMoreThanFiveYearsMember
          6            Disability Income: Actives lives for other                                                                                                      -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesOtherAccidentAndSicknessMember
                       accident and sickness
          7            Disability Income: Claims in payment                                                                                                            -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeClaimsInPaymentWaiverOfPremiumAndLTCMember
          8            Disability Income: Claims in payment for other                                                                                                  -                   -                                                                                                                              brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeClaimsInPaymentOtherAccidentAndSicknessMember
                       accident and sickness
          9            Group Life                                                                                                                                       -                   -                                                                                                                             brrt_LongTermProductRidersAxis_brrt_GroupLifeMember
         10            Group Disability                                                                                                                                 -                   -                                                                                                                             brrt_LongTermProductRidersAxis_brrt_GroupDisabilityMember
         11            Group Health                                                                                                                                     -                   -                                                                                                                             brrt_LongTermProductRidersAxis_brrt_GroupHealthMember
         12            Stop Loss                                                                                                                                        -                   -                                                                                                                             brrt_LongTermProductRidersAxis_brrt_StopLossMember
         13            Rider                                                                                                                                            -                   -                                                                                                                             brrt_LongTermProductRidersAxis_brrt_OtherProductRidersMember
         14            Variable Annuities                                                                                                                               -                   -                                                                                                                             brrt_LongTermProductRidersAxis_brrt_VariableAnnuitiesMember
         15            Total                                                          -                        -                   -                      -            -                   -                  -                    -                  -                   -                   -                      -    brrt_LongTermProductRidersAxis_brrt_TotalMember

                                                                                                                                                               TRUE                TRUE

                                                                        01/01/2012          01/01/2011           01/01/2012           01/01/2011          01/01/2012          01/01/2011           01/01/2012          01/01/2011      01/01/2012           01/01/2011          01/01/2012          01/01/2011
                                                                        12/31/2012          12/31/2011           12/31/2012           12/31/2011          12/31/2012          12/31/2011           12/31/2012          12/31/2011      12/31/2012           12/31/2011          12/31/2012          12/31/2011
                                                                                            brrt_GrossPremiumsAndOtherConsiderationsbrrt_GrossPremiumsAndOtherConsiderationsbrrt_GrossPremiumsAndOtherConsiderationsbrrt_NetPremiumsAndOtherConsiderationsBenefitPeriodLessThanTwoYears
                                                                                                                                                                                                                                       brrt_NetPremiumsAndOtherConsiderationsBenefitPeriodGreaterThanTwoYears
                                                                                                                                                                                                                                                            brrt_NetPremiumsAndOtherConsiderationsBenefitPeriodGreaterThanTwoYears
                                                                        brrt_GrossPremiumsAndOtherConsiderationsbrrt_GrossPremiumsAndOtherConsiderationsbrrt_GrossPremiumsAndOtherConsiderationsbrrt_NetPremiumsAndOtherConsiderationsBenefitPeriodLessThanTwoYears                                 brrt_NetPremiumsAndOtherConsiderations
                                                                                                                                                                                                                                                                                brrt_NetPremiumsAndOtherConsiderations
                                                                                            brrt_TypeOfBusinessAxis_brrt_UnrelatedMember
                                                                                                                 brrt_TypeOfBusinessAxis_brrt_RelatedMember
                                                                        brrt_TypeOfBusinessAxis_brrt_UnrelatedMember                                      brrt_TypeOfBusinessAxis_brrt_TotalMember
                                                                                                                                                                              brrt_TypeOfBusinessAxis_brrt_TotalMember
                                                                                                                                      brrt_TypeOfBusinessAxis_brrt_RelatedMember
                                                                              #NAME?              #NAME?               #NAME?               #NAME?              #NAME?              #NAME?                                                                                           #NAME?              #NAME?
                                                                              #NAME?              #NAME?               #NAME?               #NAME?              #NAME?              #NAME?                                                                                           #NAME?              #NAME?
                                                                              #NAME?              #NAME?               #NAME?               #NAME?              #NAME?              #NAME?                                                                                           #NAME?              #NAME?
                                                                              #NAME?              #NAME?               #NAME?               #NAME?              #NAME?              #NAME?                                                                                           #NAME?              #NAME?


                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?             #NAME?               #NAME?             #NAME?              #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?             #NAME?               #NAME?             #NAME?              #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?             #NAME?               #NAME?             #NAME?              #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?

                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?

                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?                                                                                             #NAME?                #NAME?
                                                                            #NAME?                    #NAME?             #NAME?                  #NAME?       #NAME?             #NAME?             #NAME?               #NAME?             #NAME?              #NAME?              #NAME?                #NAME?
SCHEDULE OF RISK MANAGEMENT                                                                               Return to Index

Sample Company
For the year ending    December 31, 2012                                                         SCHEDULE V
expressed in ['000s]   United States Dollars
                                                                                                                                            01/01/2012
                                                                                                                                            12/31/2012
          (a)          Governance structure                                            See and complete Schedule V(a)

          (b)          Ten largest exposures to unaffiliated counterparties and        See and complete Schedule V(b)
                       any other unaffiliated counterparty exposures or series of
                       linked unaffiliated counterparty exposures exceeding 10%
                        of the insurer's statutory capital and surplus

          (c)          Summary of company performance —
                       (i) Estimated new long-term business premiums written                                                                            #NAME?
                                                                                                                            brrt_EstimatedNewBusinessPremiumsWritten
                       (ii) Projected net income or loss from long-term business                                                                        #NAME?
                                                                                                                            brrt_ProjectedNetIncomeOrLoss
                         If projection is on a group basis, the estimated                                                                               #NAME?
                                                                                                                            brrt_EstimatedPercentageOfContributionByInsurerRelativeToTheGroup
                         percentage of contribution by insurer relative to the group

          (d)          Financial impact and description of stress and scenarios        See and complete Schedule V(c)

          (e)          Details of the long-term business funds held by ceding
                       reinsurers with —
                       (i) AAA & AA rating                                                                                                             #NAME?
                                                                                                                            brrt_FundsHeldByCedingReinsurers                brrt_RiskGradeAxis_brrt_HighInvestmentGradeAAAAndAAMember
                       (ii) A rating                                                                                                                   #NAME?
                                                                                                                            brrt_FundsHeldByCedingReinsurers                brrt_RiskGradeAxis_brrt_MediumInvestmentGradeAMember
                       (iii) Below A rating                                                                                                            #NAME?
                                                                                                                            brrt_FundsHeldByCedingReinsurers                brrt_RiskGradeAxis_brrt_BelowARatingMember
                       (iv) Total funds held by ceding reinsurers                                                   -                                  #NAME?
                                                                                                                            brrt_FundsHeldByCedingReinsurers                brrt_RiskGradeAxis_brrt_TotalMember

                                                                                                     TRUE

          (f)          Details of material intra-group transactions                    See and complete Schedule V(b)
SCHEDULE OF RISK MANAGEMENT - GOVERNANCE STRUCTURE                                                                                                   Return to Index

Sample Company
December 31, 2012                                                                                                                       SCHEDULE V(a)
Expressed in ['000s] United States Dollars

1 Structure of the board of directors and chief and senior executives, including roles and work experience of officers —
    Enter number of Directors                                                                     Apply           Reset
    Enter information for each Director

                        Name                                      Board Position                                          Work Experience



    Enter number of Chief and Senior Executives                                                   Apply           Reset
    Enter information for each Director

                        Name                           Chief and Senior Executive Position                                Work Experience


2 Terms of reference of the board of directors and its sub-committees —                                                                     Attach file

3 Name of the jurisdiction(s) where the group's board of directors primarily deliberates on the following matters —
                                                   (a) Setting strategic decision
                                                   (b) Determining the insurer's risk appetite
                                                   (c) Choosing corporate structure
                                                   (d) Choosing new lines of business, new products, etc.
                                                   (e) Assessing solvency needs

4 Name of the jurisdiction(s) where the group's board of directors and chief and
  senior executives primarily reside —

5 Name of the jurisdiction(s) where the group's central control functions reside
  (i.e. group finance, actuarial, and risk management) —

6 The group's financial position based on its most recent audited general purpose financial statements —
                                                    (a) Total assets
                                                    (b) Total reserves
                                                    (c) Capital and surplus

7 Name of insurers within the group that have the three highest: (i) total asset value, (ii) total insurance reserve value,
  and (iii) capital and surplus, based on the group's most recent audited general purpose financial statements —
                    Name of insurer                               Asset Value                      Insurance Reserve Value            Capital and Surplus




8 Describe any subsequent events or decisions that would or have materially changed the information in items (3) to (7) above
  (e.g. amalgamation, acquisition, or restructuring, etc.) —




9 A copy of the latest group organizational chart —                                                                                         Attach file
SCHEDULE OF RISK MANAGEMENT - GOVERNANCE STRUCTURE            Return to Index

Sample Company
December 31, 2012                                    SCHEDULE V(a)
Expressed in ['000s] United States Dollars




                      #VALUE!

                      #VALUE!
01/01/2012
12/31/2012



             brrt_OfficersDetails                 Director                          Chief And Senior Executive
             brrt_OfficerName                     brrt_OfficerPosition
                                              brrt_OfficerLevel                     brrt_OfficerWorkExperience




             brrt_OfficersDetails
             brrt_OfficerName                     brrt_OfficerPosition
                                              brrt_OfficerLevel                     brrt_OfficerWorkExperience




             brrt_SettingStrategicDecision
             brrt_DeterminingreinsurerRiskAppetite
             brrt_ChoiceOfCorporateStructure
             brrt_ChoiceOfNewLinesOfBusinessNewProductsEtc
             brrt_AssessingSolvencyNeeds


             brrt_NameOfJurisdictionsWhereGroupBoardOfDirectorsAndChiefAndSeniorExecutivesPrimarilyReside


             brrt_NameOfJurisdictionsWhereGroupCentralControlFunctionsResideieGroupFinanceActuarialAndRiskM


             brrt_GroupFinancialPositionBasedOnItsMostRecentAuditedGeneralPurposeFinancialStatementsTotalAsse
             brrt_GroupFinancialPositionBasedOnItsMostRecentAuditedGeneralPurposeFinancialStatementsTotalRe
             brrt_GroupFinancialPositionBasedOnItsMostRecentAuditedGeneralPurposeFinancialStatementsCapitalA


             brrt_NameOfInsurersWithinGroupThatHaveThreeHighestValuesBasedOnMostRecentAuditedGeneralPurp
             brrt_NameOfInsurer                  brrt_InsuranceReserveValueOfInsurerbrrt_CapitalAndSurplusOfI
                                             brrt_AssetValueOfInsurer




             brrt_DescribeAnySubsequentEventsOrDecisionsForAmalgamationAcquisitionOrRestructuringEtc
01/01/2012
               Chief And Senior Executive
               brrt_OfficerWorkExperience
                                               emptyTuple




               brrt_OfficerWorkExperience
                                               emptyTuple




                                               #
                                               #
                                               #
                                               #
                                               #


iefAndSeniorExecutivesPrimarilyReside          #


                                             #
ResideieGroupFinanceActuarialAndRiskManagement


neralPurposeFinancialStatementsTotalAssets      #
neralPurposeFinancialStatementsTotalReserves    #
neralPurposeFinancialStatementsCapitalAndSurplus#


sBasedOnMostRecentAuditedGeneralPurposeFinancialStatements
            brrt_CapitalAndSurplusOfInsurer
                                               #
                                               #
                                               #
                                               #
                                               #
                                               #
                                               #
                                               #
                                               #



onAcquisitionOrRestructuringEtc                #
SCHEDULE OF RISK MANAGEMENT - RISK CONCENTRATIONS AND INTRA-GROUP EXPOSURES                                                                                                             Return to Index

Sample Company
December 31, 2012                                                                                                                                                                SCHEDULE V(b)
Expressed in ['000s] United States Dollars

1 Ten largest exposures to unaffiliated counterparties and any other unaffiliated counterparty exposures or series of linked unaffiliated counterparty exposures exceeding 10% of the
  insurer's statutory capital and surplus —
   Enter Number of Material Counterparty Exposures                                               Apply          Reset
   Enter information for each exposure

                                                                                    Exposure Values
              Name of Counterparty (And Jurisdiction)                                                                       Transaction Type
                                                                              (Face Value or Market Value)


2 Details of material intra-group transactions —
   Enter Number of Material Intra-Group Transactions                                             Apply          Reset
   Enter information for each transaction


                                    Counterparties Involved                                     Transaction Details          Exposure Value
                                                                                                 (Purpose, terms,         (face value or market
             Issuer/Borrower/Debtor (And Jurisdiction)            Investor/Lender/Creditor       transaction cost,                value)
                                                                      (And Jurisdiction)           duration and


3 Details of all intra-group reinsurance and retrocession arrangements —
   Enter Number of Intra-Group (Re)insurance Arrangements                                        Apply          Reset
   Enter information for each arrangement


                                    Counterparties Involved                                        Aggregated values of the exposure limits                   Aggregated premium flows
                    Assuming party (And Rating)                   Ceding party (And Rating)            Gross                      Net                       Gross                       Net


4 The proportion of the insurer's insurance business covered by internal reinsurance, retrocession and other risk transfer arrangements —
  (in percentage)




                              #VALUE!

                              #VALUE!
01/01/2012
12/31/2012




             brrt_DetailsOfMaterialCounterpartyExposures
                 brrt_ExposureValuesFaceValue
             brrt_NameOfCounterparty                    brrt_TransactionType
                                                    brrt_ExposureValuesMarketValue




             brrt_DetailsOfMaterialIntragroupTransactions
                 brrt_CounterpartiesInvolvedInvestorLenderCreditorJurisdiction
                                                    brrt_TransactionDetailsPurposeTermsTransactionCostDurationAndPerformanceTrigger
                                                        brrt_ExposureValueFaceValueOrMarketValue
             brrt_CounterpartiesInvolvedIssuerBorrowerDebtorJurisdiction




             brrt_DetailsOfAllIntragroupReinsuranceAndRetrocessionArrangements
                 brrt_CounterpartiesInvolvedCedingPartyJurisdiction
                                                    brrt_AggregatedGrossValuesOfExposureLimits
                                                        brrt_AggregatedNetValuesOfExposureLimits
             brrt_CounterpartiesInvolvedAssumingPartyJurisdiction                            brrt_AggregatedNetPremiumFlows
                                                                                          brrt_AggregatedGrossPremiumFlows




             brrt_ProportionOfInsurerInsuranceBusinessCoveredByInternalReinsuranceRetrocessionAndOtherRiskTransferArrangementsInPercentage
                 emptyTuple




                 emptyTuple




atedNetPremiumFlows

                 emptyTuple


                  #
SCHEDULE OF RISK MANAGEMENT - STRESS/SCENARIO TESTS                                                                                                                                                 Return to Index

Sample Company
December 31, 2012                                                                                                                                                                          SCHEDULE V(c)
Expressed in ['000s]          United States Dollars
                                                                                                       Statutory        Statutory          Statutory
                                                                                                        Assets          Liabilities        Capital &
                                                                                                                                            Surplus
                                                                      Pre-stress/scenario position             -                    -               -

A. FINANCIAL MARKET SCENARIOS
                                                                                                     POST-STRESS/SCENARIO POSITION
                                                                                                       Statutory        Statutory          Statutory
                                                                                         Loss                                              Capital &
                                                                                                        Assets          Liabilities
                                                                                                                                            Surplus
                         R1. 40% decline in equity prices                                       -                                                   -                                                                 brrt_StressScenarioTestsEconomicAxis_brrt_R1Member
                         R2. Widening of credit spreads at 99th percentile                      -                                                   -                                                                 brrt_StressScenarioTestsEconomicAxis_brrt_R2P99Member
                         R3. Combined R1. and R2. at 99th percentile                            -                                                   -                                                                 brrt_StressScenarioTestsEconomicAxis_brrt_CombinedP99Member
                         R4. Foreign currency shocks                                            -                                                   -                                                                 brrt_StressScenarioTestsEconomicAxis_brrt_ForeignCurrencyShocksMember
                         R5. Escalation of European sovereign risk                              -                                                   -                                                                 brrt_StressScenarioTestsEconomicAxis_brrt_EscalationOfEuropeanSovereignRiskMember

                              Valuation losses on debt securities and loans            Belgium          Greece            Ireland            Italy          Portugal     Spain                                        brrt_ValuationLossesOnDebtSecuritiesAndLoansIssuedByDebtorsInEachEuropeanState
                              issued by creditors in each European state —                                                                                                                                                           brrt_ValuationLossesOnDebtSecuritiesAndLoansIssuedByDebtorsInEachEuropeanStateFrance
                                                                                                                                                                                                                                                    brrt_ValuationLossesOnDebtSecuritiesAndLoansIssuedByDebtorsInEachEuropeanStateGreece
                                                                                                                                                                                                                                                                   brrt_ValuationLossesOnDebtSecuritiesAndLoansIssuedByDebtorsInEachEuropeanStateIreland
                                                                                                                                                                                                                                                                                  brrt_ValuationLossesOnDebtSecuritiesAndLoansIssuedByDebtorsInEachEuropeanStateItaly
                                                                                                                                                                                                                                                                                                     brrt_ValuationLossesOnDebtSecuritiesAndLoansIssuedByDebtorsInEachEuropeanStatePortugal
                                                                                                                                                                                                                                                                                                                 brrt_ValuationLossesOnDebtSecuritiesAndLoansIssuedByDebtorsInEachEuropeanStateSpain
                                                                                                                                                                                                                                                                                                                             #NAME?
                                                                                                                                                                                                                      brrt_ValuationLossesOnDebtSecuritiesAndLoansIssuedByDebtorsInEachEuropeanStateBelgium

B. UNDERWRITING SCENARIOS
The (re)insurer is to submit the description of three of its own underwriting scenarios and related key assumptions with the impact on the statutory balance sheet
                                                                                                        POST-STRESS/SCENARIO GROSS LOSS POSITION                       POST-STRESS/SCENARIO NET LOSS POSITION         brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptions
                                                                                                                                           Statutory                                                   Statutory
                                                                                      Gross Loss       Statutory        Statutory          Capital &        Net Loss    Statutory     Statutory        Capital &
                           Description                               Assumptions        Impact          Assets          Liabilities         Surplus          Impact      Assets       Liabilities       Surplus       brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsDescription
                                                                                                                                                                                                                                     brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsGrossLossImpactPostStressScenarioGrossLoss
                                                                                                                                                                                                                                                    brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsAggregateStatutoryAdmittedAssetsPostStressScenarioGrossLoss
                                                                                                                                                                                                                                                                   brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsAdmittedLiabilitiesPostStressScenarioGrossLoss
                                                                                                                                                                                                                                                                                  brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsStatutoryCapitalAndSurplusPostStressScenarioGrossLoss
                                                                                                                                                                                                                                                                                                      brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsNetLossImpactPostStressScenarioNetLoss
                                                                                                                                                                                                                                                                                                                 brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsAggregateStatutoryAdmittedAssetsPostStressScenarioNetLoss
                                                                                                                                                                                                                                                                                                                             brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsAdmittedLiabilitiesPostStressScenarioNetLoss
                                                                                                                                                                                                                                                                                                                                         brrt_UnderwritingLossScenariosNotApplicableOrPartiallyApplyDescriptionOfThreeOfInsurerUnderwritingScenariosAndRelatedKeyAssumptionsStatutoryCapitalAndSurplusPostStressScenarioNetLoss
                                                                     See attached.            -                                                     -              -                                           -                     #NAME?
                                                                     See attached.            -                                                     -              -                                           -                     #NAME?
                                                                     See attached.            -                                                     -              -                                           -                     #NAME?

C. RATING DOWNGRADE
The (re)insurer is to submit a detailed disclosure on the impact of a ratings downgrade of its Bermuda legal entity or group by TWO NOTCHES OR BELOW A-, WHICHEVER IS LOWER.
                                                                                                                                                                                                                                      #NAME?
                                                                                                                                                                                                                      brrt_ReinsurerSpecificPostStressScenario




D. WORST-CASE ANNUAL AGGREGATE CATASTROPHE LOSS SCENARIO
The (re)insurer is to submit the following: (1) and (2)
(1) R3 above and the three other scenarios
                                                                       Worst-case
                                               R3 at 99th percentile                            -                                                                                                                                    #NAME?
                                                                                                                                                                                                                      brrt_WorstCasePostStressScenarioR3
                             Aggregate of 3 underwriting scenarios                              -                                                                                                                                    #NAME?
                                                                                                                                                                                                                      brrt_WorstCasePostStressScenarioAggregateOfThreeOtherScenarioLosses
                                                           Total loss                           -                                                                                                                                    #NAME?
                                                                                                                                                                                                                      brrt_WorstCasePostStressScenarioTotalLoss
                                                        Assumptions   See attached.

(2) (Re)insurer specific worst-case scenario
The (re)insurer is to submit a description of its own worst-case annual aggregate loss scenario and the underlying assumptions.
                                 Worst-case annual aggregate loss                                                                                                                                                                     #NAME?
                                                                                                                                                                                                                      brrt_ReinsurerSpecificWorstcaseScenarioWorstcaseAnnualAggregateLossScenarioDescription
                                                scenario description
                                                          Gross loss                                                                                                                                                                  #NAME?
                                                                                                                                                                                                                      brrt_ReinsurerSpecificWorstcaseScenarioGrossLoss
                                                            Net loss                                                                                                                                                                  #NAME?
                                                                                                                                                                                                                      brrt_ReinsurerSpecificWorstcaseScenarioNetLoss
                                           Underlying assumptions            See attached.




                                                                                     01/01/2012 01/01/2012          01/01/2012       01/01/2012
                                                                                     12/31/2012 12/31/2012          12/31/2012       12/31/2012
                                                                                                    brrt_AggregateStatutoryAdmittedAssetsPostStressScenarioGrossLoss
                                                                                                                    brrt_AdmittedLiabilitiesPostStressScenarioGrossLoss
                                                                                     brrt_GrossLossImpactPostStressScenarioGrossLoss brrt_StatutoryCapitalAndSurplusPostStressScenarioGrossLoss
                                                                                        #NAME?          #NAME?          #NAME?             #NAME?
                                                                                         #VALUE!        #VALUE!         #VALUE!            #VALUE!
                                                                                        #NAME?          #NAME?          #NAME?             #NAME?
                                                                                         #VALUE!        #VALUE!         #VALUE!            #VALUE!
                                                                                        #NAME?          #NAME?          #NAME?             #NAME?
                                                                                        #NAME?          #NAME?          #NAME?             #NAME?
                                                                                        #NAME?          #NAME?          #NAME?             #NAME?




                                                          Largest Loss
                                                            UW1. Northeast Hurricane
                                                            UW2. Carolinas Hurricane
                                                            UW3. Miami-Dade Hurricane
                                                            UW4. Pinellas Hurricane
                                                            UW5. Gulf Windstorm (onshore)
                                                            UW6. Gulf Windstorm (offshore)
                                                             UE1. Los Angeles Earthquake
                                                             UE2. San Francisco Earthquake
                                                             UE3. New Madrid (NM) RDS
                                                             UE4. NM Extreme Stress Scenario
                                                             IW1. European Windstorm
                                                             IW2. Japanese Typhoon
                                                              IE1. Japanese Earthquake
                                                               A1. Aerospace/ Aviation Event
                                                              M1. Marine Collision in Prince
                                                              M2. Major Cruise Vessel Incident
                                                               N1. US Oil Spill
                                                               N2. US Tornadoes
                                                               N3. Australian Flooding
                                                               N4. Australian Wildfires
                                                                   Largest Loss                                                                               #REF!

                                                            UW1.     Northeast Hurricane                                                                      #REF!
                                                            UW2.     Carolinas Hurricane                                                                      #REF!
                                                            UW3.     Miami-Dade Hurricane                                                                     #REF!
                                                            UW4.     Pinellas Hurricane                                                                       #REF!
                                                            UW5.     Gulf Windstorm (onshore)                                                                 #REF!
                                                            UW6.     Gulf Windstorm (offshore)                                                                #REF!
                                                             UE1.    Los Angeles Earthquake                                                                   #REF!
                                                             UE2.    San Francisco Earthquake                                                                 #REF!
                                                             UE3.    New Madrid (NM) RDS                                                                      #REF!
                                                             UE4.    NM Extreme Stress Scenario                                                               #REF!
                                                             IW1.    European Windstorm                                                                       #REF!
                                                             IW2.    Japanese Typhoon                                                                         #REF!
                                                              IE1.   Japanese Earthquake                                                                      #REF!
                                                               A1.   Aerospace/ Aviation Event                                                                #REF!
                                                              M1.    Marine Collision in Prince                                                               #REF!
                                                              M2.    Major Cruise Vessel Incident                                                             #REF!
                                                               N1.   US Oil Spill                                                                             #REF!
                                                               N2.   US Tornadoes                                                                             #REF!
                                                               N3.   Australian Flooding                                                                      #REF!
                                                               N4.   Australian Wildfires                                                                     #REF!
                                                                            2nd Largest Loss                                                                  #REF!

                                                            UW1.     Northeast Hurricane                                                                      #REF!
                                                            UW2.     Carolinas Hurricane                                                                      #REF!
                                                            UW3.     Miami-Dade Hurricane                                                                     #REF!
                                                            UW4.     Pinellas Hurricane                                                                       #REF!
                                                            UW5.     Gulf Windstorm (onshore)                                                                 #REF!
                                                            UW6.     Gulf Windstorm (offshore)                                                                #REF!
                                                             UE1.    Los Angeles Earthquake                                                                   #REF!
                                                             UE2.    San Francisco Earthquake                                                                 #REF!
                                                             UE3.    New Madrid (NM) RDS                                                                      #REF!
                                                             UE4.    NM Extreme Stress Scenario                                                               #REF!
                                                             IW1.    European Windstorm                                                                       #REF!
                                                             IW2.    Japanese Typhoon                                                                         #REF!
                                                              IE1.   Japanese Earthquake                                                                      #REF!
                                                               A1.   Aerospace/ Aviation Event                                                                #REF!
                                                              M1.    Marine Collision in Prince                                                               #REF!
                                                              M2.    Major Cruise Vessel Incident                                                             #REF!
                                                               N1.   US Oil Spill                                                                             #REF!
                                                               N2.   US Tornadoes                                                                             #REF!
                                                               N3.   Australian Flooding                                                                      #REF!
                                                               N4.   Australian Wildfires                                                                     #REF!
                                                                     3rd Largest Loss                                                                         #REF!
   SCHEDULE OF FIXED INCOME SECURITIES                                                                                                                                                       Return to Index

   Sample Company
   December 31, 2012                                                                                                                                                                  SCHEDULE VI
   Expressed in ['000s] United States Dollars

                            Security Type                       Amount per Form 4,                                                                Average        Average        Effective      Effective
                                                                                               Face Value                   Fair Value
                                                                Lines 2(b) and 3(b)                                                                 YTM           Rating        Duration       Convexity

1 U.S. Government
    (a) U.S. Government Federal                                                                                                                                                                                        brrt_SecurityTypeAxis_brrt_USGovernmentMember
    (b) U.S. Government Agency - mortgage-backed securities                                                                                                                                                            brrt_SecurityTypeAxis_brrt_USGovernmentAgencyMortgageBackedSecuritiesMember
    (c) U.S. Government Agency - other                                                                                                                                                                                 brrt_SecurityTypeAxis_brrt_USGovernmentAgencyOtherMember
2 Non-U.S. Government                                                                                                                                                                                                  brrt_SecurityTypeAxis_brrt_NonUSGovernmentMember
3 States, Municipalities, and Political Subdivision                                                                                                                                                                    brrt_SecurityTypeAxis_brrt_StatesMunicipalitiesAndPoliticalSubdivisionMember
4 Corporate Securities
    (a) U.S. Government-backed Corporate                                                                                                                                                                               brrt_SecurityTypeAxis_brrt_USGovernmentBackedCorporateSecuritiesMember
    (b) Non-U.S. Government-backed Corporate                                                                                                                                                                           brrt_SecurityTypeAxis_brrt_NonUSGovernmentBackedCorporateSecuritiesMember
    (c) FDIC Guaranteed Corporate                                                                                                                                                                                      brrt_SecurityTypeAxis_brrt_FDICGuaranteedCorporateSecuritiesMember
    (d) Other Corporate                                                                                                                                                                                                brrt_SecurityTypeAxis_brrt_OtherCorporateSecuritiesMember
5 Asset-backed Securities                                                                                                                                                                                              brrt_SecurityTypeAxis_brrt_AssetBackedSecuritiesMember
6 Mortgage-backed Securities
    (a) Residential Subprime                                                                                                                                                                                           brrt_SecurityTypeAxis_brrt_MortgageBackedSecuritiesSubprimeMember
    (b) Residential Non-subprime                                                                                                                                                                                       brrt_SecurityTypeAxis_brrt_MortgageBackedSecuritiesNonSubprimeMember
    (c) Commercial                                                                                                                                                                                                     brrt_SecurityTypeAxis_brrt_MortgageBackedSecuritiesCommercialMember
7 Mutual Funds                                                                                                                                                                                                         brrt_SecurityTypeAxis_brrt_MutualFundsMember
8 Bank Loans                                                                                                                                                                                                           brrt_SecurityTypeAxis_brrt_BankLoansMember
9 Catastrophe Bonds and Insurance-Linked Securities                                                                                                                                                                    brrt_SecurityTypeAxis_brrt_CatastropheBondsAndInsuranceLinkedSecuritiesMember
10 Others (Briefly describe)                                                                                                                                                                                           brrt_SecurityTypeAxis_brrt_OtherMember
                                            TOTAL PORTFOLIO                       -                         -                            -                                                                             brrt_SecurityTypeAxis_brrt_TotalMember
                                                                                                                                                                                                                       brrt_SecurityTypeOtherDescription   #

   Effective duration of the portfolio                                                                                                                                                                                 brrt_PortfolioEffectiveDuration

   Effective convexity of the portfolio                                                                                                                                                                                brrt_PortfolioEffectiveConvexity


                                                              brrt_BondsAndDebentures                               brrt_BondsAndDebenturesFairValue
                                                                                        brrt_BondsAndDebenturesFaceValue                                      brrt_BondsAndDebenturesAverageRating
                                                                                                                                                                             brrt_BondsAndDebenturesEffectiveDuration
                                                                                                                                               brrt_BondsAndDebenturesAverageYieldToMaturity brrt_BondsAndDebenturesEffectiveConvexity
   01/01/2012                                                 01/01/2012                01/01/2012                  01/01/2012                 01/01/2012     01/01/2012 01/01/2012 01/01/2012
   12/31/2012                                                 12/31/2012                12/31/2012                  12/31/2012                 12/31/2012     12/31/2012 12/31/2012 12/31/2012
                                                                       #NAME?                    #NAME?                     #NAME?                #NAME?        #NAME?         #NAME?            #NAME?
                                                                       #NAME?                    #NAME?                     #NAME?                #NAME?        #NAME?         #NAME?            #NAME?
                                                                       #NAME?                    #NAME?                     #NAME?                #NAME?        #NAME?         #NAME?            #NAME?
                                                                       #NAME?                    #NAME?                     #NAME?                #NAME?        #NAME?         #NAME?            #NAME?
                                                                       #NAME?                    #NAME?                     #NAME?                #NAME?        #NAME?         #NAME?            #NAME?

                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?

                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?               #NAME?          #NAME?         #NAME?         #NAME?
                                                                      #NAME?                    #NAME?                       #NAME?




                               #NAME?

                               #NAME?
     SCHEDULE OF LONG-TERM INSURANCE                                                                                                                                                                                         Return to Index

     Sample Company
     December 31, 2012                                                                                                                                                                                                    SCHEDULE VII
     Expressed in ['000s] United States Dollars

SCHEDULE OF LONG-TERM INSURANCE DATA
                                                                                          (1)                   (2)                  (3)                   (4)                      (5)                 (6)                     (7)
                                                                                                                                                                                                 Net Amount at Risk
                                                                                                                                                     Best Estimate
                                                                                      Bermuda               Reported                                    Reserve                Adjustable          Non-adjustable
                                                                                      Statutory                DAC             Best Estimate        (Subject to zero            product/             product/
                                                                                       Reserve               (if any)             Reserve                floor)                  treaty                treaty                  Total
                                                                                        ('000s)               ('000s)              ('000s)               ('000s)                  ('000s)               ('000s)               ('000s)
1.  Mortality (term assurance, whole life, universal life)                                                                                                         -                                                                    -                 brrt_LongTermProductRidersAxis_brrt_MortalityMember
2.  Critical Illness (including accelerated CI products)                                                                                                           -                                                                    -                 brrt_LongTermProductRidersAxis_brrt_CriticalIllnessMember
3.  Longevity (payout annuities, contingent annuities, pension blocks)                                                                                             -                                                                                      brrt_LongTermProductRidersAxis_brrt_LongevityMember
4.  Deferred annuities (including index linked products with no guarantees)                                                                                        -                            Net Annual Premium                                        brrt_LongTermProductRidersAxis_brrt_DeferredAnnuitiesMember
5.  Disability Income: active lives - incl. waiver of premium and LTC                                                                                                        Benefit Period        Benefit period              Total
    Length of Premium Guarantee                                                                                                                                               <= 2 years             >2 years
    (a) <= 1 year                                                                                                                                                                          -                     -                      -                 brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesWaiverOfPremiumAndLTCLessThanOneYearMember
    (b) 1-5 years                                                                                                                                                                          -                     -                      -                 brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesWaiverOfPremiumAndLTCBetween1AndFiveYearsMember
    (c) >5 years                                                                                                                                                                           -                     -                      -                 brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesWaiverOfPremiumAndLTCMoreThanFiveYearsMember
    Total                                                                                                                                                          -                                                                    -                 brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesWaiverOfPremiumAndLTCTotalMember
6. Disability income: active lives - other accident and sickness                                                                                                   -                                                                    -                 brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeActiveLivesOtherAccidentAndSicknessMember
7. Disability income: claims in payment - incl. waiver of premium and LTC                                                                                          -                                                                                      brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeClaimsInPaymentWaiverOfPremiumAndLTCMember
8. Disability income: claims in payment - other accident and sickness                                                                                              -                            Net Annual Premium                                        brrt_LongTermProductRidersAxis_brrt_DisabilityIncomeClaimsInPaymentOtherAccidentAndSicknessMember
9. Group Life                                                                                                                                                      -           Adjustable         Non-adjustable                                          brrt_LongTermProductRidersAxis_brrt_GroupLifeMember
10. Group Disability                                                                                                                                               -            product/             product/                  Total                      brrt_LongTermProductRidersAxis_brrt_GroupDisabilityMember
11. Group Health                                                                                                                                                   -             treaty                treaty                                             brrt_LongTermProductRidersAxis_brrt_GroupHealthMember
12. Stop Loss                                                                                                                                                      -                                           -                        -                 brrt_LongTermProductRidersAxis_brrt_StopLossMember
13. Rider (other product riders not included above)                                                                                                                -                                           -                        -                 brrt_LongTermProductRidersAxis_brrt_OtherProductRidersMember

14. Total (excluding variable annuities)                                                          -                     -                    -                     -                                                                                      brrt_LongTermProductRidersAxis_brrt_TotalMember




                                                                                    Duration (yrs)
15. Weighted average of the difference between assets duration and liabilities
    duration (weighted by reported reserves)                                                                                                                                                                                                              brrt_WeightedAverageOfTheDifferenceBetweenAssetsDurationAndLiabilitiesDurationWeightedByReportedReserves         #NAME?

                                                                                     % Reserves
16. Reserves with known difference in duration / Total Reserves                                                                                                                                                                                           brrt_ReservesWithKnownDifferenceInDurationOrTotalReserves                                                        #NAME?




                                                                                 01/01/2012
                                                                                 12/31/2012
                                                                                                       brrt_ReportedDAC
                                                                                 brrt_BermudaStatutoryReserve                                      b                        brrt_NetAmountAtRiskAdjustableProductOrTreaty brrt_NetAmountAtRisk
                                                                                                                            brrt_BestEstimateReserverrt_BestEstimateReserveSubjectToZeroFloor     brrt_NetAmountAtRiskNonAdjustableProductOrTreaty
                                                                                                                                                                                                  brrt_NetAnnualPremiumBenefitPeriodGreaterThanTwoYears
                                                                                                                                                                                                                          brrt_NetAnnualPremium
                                                                                                                                                                            brrt_NetAnnualPremiumBenefitPeriodLessThanTwoYears
                                                                                                                                                                                                  brrt_NetAnnualPremiumNonAdjustableProductTreaty
                                                                                                                                                                            brrt_NetAnnualPremiumAjustableProductTreaty brrt_NetAnnualPremium
                                                                                       #NAME?                #NAME?                #NAME?                 #NAME?                   #NAME?                #NAME?                  #NAME?
                                                                                       #NAME?                #NAME?                #NAME?                 #NAME?                   #NAME?                #NAME?                  #NAME?
                                                                                       #NAME?                #NAME?                #NAME?                 #NAME?
                                                                                       #NAME?                #NAME?                #NAME?                 #NAME?



                                                                                                                                                                                 #NAME?                #NAME?                 #NAME?
                                                                                                                                                                                 #NAME?                #NAME?                 #NAME?
                                                                                                                                                                                 #NAME?                #NAME?                 #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?                                                               #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?                                                               #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?                                        #NAME?                 #NAME?
                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?                                        #NAME?                 #NAME?

                                                                                       #NAME?                #NAME?               #NAME?                 #NAME?




                                                                                                                                                                                                                                                                                                                                      115
     SCHEDULE OF LONG-TERM VARIABLE ANNUITY GUARANTEES                                                                                                                            Return to Index

     Sample Company
     December 31, 2012                                                                                                                                                         SCHEDULE VIII
     Expressed in ['000s] United States Dollars

SCHEDULE OF LONG TERM VARIABLE ANNUITY GUARANTEES
                                                                                                        (1)                          (2)                         (3)                (4)
                                                                                                    Bermuda                                 Account Value 4                  Net Amount at Risk
                                                                                                    Statutory                                                                        1, 3
                                                                                                                                 Volatility            Volatility >10.0%
                                                                                                    Reserve                    (0%,10.0%]
                                                                                                      ('000s)                      ('000s)                     ('000s)             ('000s)
 1   Guaranteed Minimum Accumulation Benefit: <5 years to maturity                                                                                                                                  brrt_VariableAnnuitiesGuaranteesAxis_brrt_GuaranteedMinimumAccumulationBenefitLessThanFiveYearsToMaturityMember
 2   Guaranteed Minimum Accumulation Benefit: >=5 years to maturity                                                                                                                                 brrt_VariableAnnuitiesGuaranteesAxis_brrt_GuaranteedMinimumAccumulationBenefitGreaterThanOrEqualToFiveYearsToMaturityMember
 3   Guaranteed Minimum Death Benefit: Return of Premium, Ratchet and Reset 2.                                                                                                                      brrt_VariableAnnuitiesGuaranteesAxis_brrt_GuaranteedMinimumDeathBenefitReturnOfPremiumRatchetAndResetMember
 4   Guaranteed Minimum Death Benefit: Enhanced Benefits (Roll up) 2.                                                                                                                               brrt_VariableAnnuitiesGuaranteesAxis_brrt_GuaranteedMinimumDeathBenefitEnhancedBenefitsRollUpMember
 5   Guaranteed Minimum Income Benefit                                                                                                                                                              brrt_VariableAnnuitiesGuaranteesAxis_brrt_GuaranteedMinimumIncomeBenefitMember
 6   Guaranteed Minimum Withdrawal Benefit                                                                                                                                                          brrt_VariableAnnuitiesGuaranteesAxis_brrt_GuaranteedMinimumWithdrawalBenefitMember
 7   Guaranteed Enhanced Earnings Benefit                                                                                                                                                           brrt_VariableAnnuitiesGuaranteesAxis_brrt_GuaranteedEnhancedEarningsBenefitMember

 8 Total (Variable Annuities)                                                                                    -                            -                          -                   -      brrt_VariableAnnuitiesGuaranteesAxis_brrt_TotalMember



Notes
1. Factors should be applied to Net Amount at Risk (NAR) defined as:
    GMAB      Total claim payable if all contracts mature immediately
    GMDB      Total claim amount payable upon immediate death of all policyholders
    GMIB      Total claim payable upon full and immediate annuitization of all policies using an 80% factor applied to the GV (the 80% represents the ratio between current market
              annuitization factors and the guaranteed annuitization factors)
    GMWB Total claim payable if 100% of the guaranteed withdrawal benefit base in excess of the current account value is withdrawn immediately
    GEEB      Total guaranteed enhanced payments upon immediate death of all policyholders

2. Where ratchets, resets and roll-ups exist, please use the roll-up category.

3. NAR is net of reinsurance.

4. The proportion used for the account value under reinsurance is the proportion used for NAR.

5. Volatility is defined as the annual volatility of the fund. In the case where there is no, or limited, history of the fund, use the volatility of the benchmark.




                                                                                              01/01/2012
                                                                                              12/31/2012
                                                                                                                      brrt_AccountValueVolatilityLessThanTenPercent
                                                                                              brrt_BermudaStatutoryReserve                                                  brrt_NetAmountAtRisk
                                                                                                                                                 brrt_AccountValueVolatilityMoreThanTenPercent
                                                                                                     #NAME?                  #NAME?                     #NAME?                     #NAME?
                                                                                                     #NAME?                  #NAME?                     #NAME?                     #NAME?
                                                                                                     #NAME?                  #NAME?                     #NAME?                     #NAME?
                                                                                                     #NAME?                  #NAME?                     #NAME?                     #NAME?
                                                                                                     #NAME?                  #NAME?                     #NAME?                     #NAME?
                                                                                                     #NAME?                  #NAME?                     #NAME?                     #NAME?
                                                                                                     #NAME?                  #NAME?                     #NAME?                     #NAME?

                                                                                                      #NAME?                      #NAME?                      #NAME?              #NAME?
       SCHEDULE OF COMMERCIAL INSURER'S SOLVENCY SELF ASSESSMENT (CISSA)
       CAPITAL SUMMARY (TABLE 8)                                                                                                                   Return to Index

       Sample Company
       December 31, 2012                                                                                                               SCHEDULE IX(a)
       expressed in              ['000s] (currency used (vide Reg. 10(2))

       Note: Documents supporting the CISSA filling should be retained for such period as specified in the [Order]


                                                                                                CISSA Capital                         Regulatory Capital

       Risk Categories

       Insurance risk                                                                                                                                         -
       Market risk                                                                                                                                            -
       Credit risk                                                                                                                                            -
       Group, Reputational and Strategic risk                                                                                                                 -
       Other (specify)                                                                                                                                        -

       Total capital pre-diversification between risk categories                                                      -                                       -

       Diversification credit between risk categories                                                                                                         -

       Total capital after diversification before operational risk                                                    -                                       -

       Operational risk                                                                                                                                       -

       Total capital after diversification and opertional risk                                                        -                                       -

       Where:
a)
       CISSA Capital is the amount of capital the Company has determined, that is required to achieve its strategic goals upon undertaking an assessment of all
       material (reasonably foreseeable) risks arising from its operations or operational environment.

b)
       Regulatory capital as determined by the Bermuda Solvency Capital Requirement (“BSCR”) as described in the Insurance Prudential Standards (Class C
       Solvency Requirement) Order or regulatory capital determined from an approved internal model for regulatory purposes at 99.0% TVaR.


       ADDITIONAL INFORMATION

       The insurer should review the following statements and select from the drop-down list as applicable and/or provide a brief description or an attachment.
       Where an attachment is provided, include references (e.g. page number, paragraph number) of where the information is located in the comments box in
       the attachments tab.


     1 What is the primary reason(s) (select multiple responses where applicable) for aiming at the disclosed CISSA Capital amount?
       (select all that apply by choosing Yes/No )

                Target agency rating (e.g. "A-", "AA", etc)
                Market share
                Business expansion
                Nature of product(s) (e.g. risk characteristics)
                Manage downgrade risk
                Regulatory capital requirements
                Others

     2 What methodology is used to aggregate the risk categories? (select all that apply by choosing Yes/No)

                Correlation matrix
                Linear correlations
                T copulas
                Gumbel copulas
                Clayton copulas
                Causal drivers approach e.g. inflation, cycles
                Others
  SCHEDULE OF COMMERCIAL INSURER'S SOLVENCY SELF ASSESSMENT (CISSA)
  CAPITAL SUMMARY (TABLE 8)                                                                                                                          Return to Index

  Sample Company
  December 31, 2012                                                                                                                        SCHEDULE IX(a)
  expressed in             ['000s] (currency used (vide Reg. 10(2))

3 What contingency plans are in place for raising additional capital under stress situations? (select all that apply by choosing Yes/No)

          Parental guarantees
          Revolving letters of credit
          Issue subordinated debt
          Issue preference shares
          Float additional shares
          Capital injections from parent
          Contingent surplus notes
          Catastrophe derivatives (e.g. bonds, swaps and options)
         Others

4 Does the insurer have arrangements / contractual commitments to provide support, including forward purchase
  arrangements or guarantees, to affiliates / other companies in stressed situations? (Yes or No)
  If yes, briefly describe the arrangement(s) and the aggregate exposure.




5 Has the insurer down streamed debt to establish equity positions in the insurer, or engaged in double or multiple
  gearing? (Yes or No)
  If yes, provide details and amount of capital.




6 Has debt been down streamed to establish equity positions in the insurer, or is the insurer using capital that is
  double or multiple geared? (Yes or No)
  If yes, provide details and amount of capital.




7 Are there any assets of a subsidiary of the insurer that are restricted for use that cannot be transferred to another
  subsidiary or the insurer, that were not included in the encumbered assets (for both policyholders obligations and
  not policyholder obligations) reported in the Schedule of Eligible Capital? (Yes or No)
  If yes, provide:
                                                                                                         Total restricted assets
                                              Less: Regulatory capital requirements for members for which the assets pertain
                                Restricted assets in excess of capital requirements to the extent that these amounts are not
                                               included in the encumbered assets reported in the Schedule of Eligible Capital                                   -

                                                                                                                           brrt_RegulatoryCapital
                                                                                  brrt_CommercialInsurersSolvencySelfAssessmentCapital
                                                                                  Contingency plans for additional capital

                                                                                  Parental guarantees
                                                                                  revolving letters of credit
                                                                                  Contingent capital arrangements
                                                                                  Issue subordinated debt
                                                                                  Issue preference shares
                                                                                  Float additional shares
                                                                                  Capital injections from parent



                                                                                  Correlation matrix
                                                                                  Linear correlations
                                                                                  T copulas
                                                                                  Gumbel copulas
                                                                                  Clayton copulas
                                                                                  Causal drivers approach e.g. inflation, cycles
                                                                                  Other
                                                                                  Not applicable
SCHEDULE OF COMMERCIAL INSURER'S SOLVENCY SELF ASSESSMENT (CISSA)
CAPITAL SUMMARY (TABLE 8)                                                      Return to Index

Sample Company
December 31, 2012                                                    SCHEDULE IX(a)
expressed in        ['000s] (currency used (vide Reg. 10(2))




                                                               Yes
                                                               No
                                                                                         01/01/2012
                                                                                         12/31/2012




brrt_RiskCategoryAxis_brrt_InsuranceRiskMember          #NAME?    #NAME?
brrt_RiskCategoryAxis_brrt_MarketRiskMember             #NAME?    #NAME?
brrt_RiskCategoryAxis_brrt_CreditRiskMember             #NAME?    #NAME?
                                                        #NAME?
brrt_RiskCategoryAxis_brrt_GroupReputationalAndStrategicRiskMember#NAME?
brrt_RiskCategoryAxis_brrt_OtherRiskMember              #NAME?    #NAME?
brrt_RiskCategoryOtherDescription                       #NAME?
                                                        #NAME?    #NAME?
brrt_RiskCategoryAxis_brrt_TotalCapitalPrediversificationBetweenRiskCategoriesMember

                                                      #NAME?     #NAME?
brrt_RiskCategoryAxis_brrt_DiversificationCreditBetweenRiskCategoriesMember

                                                        #NAME?     #NAME?
brrt_RiskCategoryAxis_brrt_TotalCapitalAfterDiversificationBeforeOperationalRiskMember

brrt_RiskCategoryAxis_brrt_OperationalRiskMember     #NAME?      #NAME?

brrt_RiskCategoryAxis_brrt_TotalMember               #NAME?      #NAME?




                                                 #NAME?
brrt_PrimaryReasonForAimingAtTheDisclosedCISSACapitalAmountIsTargetAgencyRatingAMinusAA
                                                 #NAME?
brrt_PrimaryReasonForAimingAtTheDisclosedCISSACapitalAmountIsMarketShare
                                                 #NAME?
brrt_PrimaryReasonForAimingAtTheDisclosedCISSACapitalAmountIsBusinessExpansion
                                                 #NAME?
brrt_PrimaryReasonForAimingAtTheDisclosedCISSACapitalAmountIsNatureOfProductsRiskCharacteristics
                                                 #NAME?
brrt_PrimaryReasonForAimingAtTheDisclosedCISSACapitalAmountIsManageDowngradeRisk
                                                 #NAME?
brrt_PrimaryReasonForAimingAtTheDisclosedCISSACapitalAmountIsRegulatoryCapitalRequirements
                                                 #NAME?
brrt_PrimaryReasonForAimingAtTheDisclosedCISSACapitalAmountIsOther




                                                  #NAME?
brrt_MethodologyUsedToAggregateTheRiskCategoriesInDerivingTheCISSACapitalIsCorrelationMatrix
                                                  #NAME?
brrt_MethodologyUsedToAggregateTheRiskCategoriesInDerivingTheCISSACapitalIsLinearCorrelations
                                                  #NAME?
brrt_MethodologyUsedToAggregateTheRiskCategoriesInDerivingTheCISSACapitalIsTCopulas
                                                  #NAME?
brrt_MethodologyUsedToAggregateTheRiskCategoriesInDerivingTheCISSACapitalIsGumbelCopulas
                                                  #NAME?
brrt_MethodologyUsedToAggregateTheRiskCategoriesInDerivingTheCISSACapitalIsClaytonCopulas
                                                  #NAME?
brrt_MethodologyUsedToAggregateTheRiskCategoriesInDerivingTheCISSACapitalIsCausalDriversApproachInflationCycles
                                                  #NAME?
brrt_MethodologyUsedToAggregateTheRiskCategoriesInDerivingTheCISSACapitalIsOthers
                                                  #NAME?
brrt_MethodologyUsedToAggregateTheRiskCategoriesInDerivingTheCISSACapitalIsOthersDescription
                                                                                   01/01/2012
                                                                                   12/31/2012




brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsParentalGuarantees
                                                     #NAME?
brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsRevolvingLettersOfCredit
                                                     #NAME?
brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsIssueSubordinatedDebt
                                                     #NAME?
brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsIssuePreferenceShares
                                                     #NAME?
brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsFloatAdditionalShares
                                                     #NAME?
brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsCapitalInjectionsFromParent
                                                     #NAME?
brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsContingentSurplusNotes
                                                     #NAME?
brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsCatastropheDerivativesBondsSwapsAndOptions
                                                     #NAME?
brrt_ContingencyPlansInPlaceForRaisingAdditionalCapitalUnderStressSituationsIsOther
                                                     #NAME?

                                                 #NAME?
brrt_InsureHasArrangementsContractualCommitmentsToProvideSupportToAffiliatesOtherCompaniesInStressedSituations



brrt_ArrangementsContractualCommitmentsToProvideSupportToAffiliatesOtherCompaniesInStressedSituationsDescription

                                                   #NAME?
                                                   #NAME?
                                                   #NAME?
brrt_InsurerDownstreamedDebtToEstablishEquityPositionsParticipationsOrEngagedInDoubleOrMultipleGearing
                                                   #NAME?
                                                   #NAME?
brrt_InsurerDownstreamedDebtToEstablishEquityPositionsParticipationsOrEngagedInDoubleOrMultipleGearingDescriptionAndAmount
                                                  #NAME?
                                                  #NAME?
                                                  #NAME?
brrt_DebtBeenDownstreamedToEstablishEquityPositionsInsurerOrIsInsurerUsingCapitalThatisDoubleOrMultipleGeared
                                                  #NAME?
                                                  #NAME?


                                                  #NAME?
brrt_DebtBeenDownstreamedToEstablishEquityPositionsInsurerOrIsInsurerUsingCapitalThatisDoubleOrMultipleGearedDescriptionAndAmount
                                                  #NAME?
                                                  #NAME?
brrt_AssetsOfSubsidiaryOfInsurerRestrictedForUseReportedInScheduleOfEligibleCapital
                                                  #NAME?
                                                  #NAME?
                                                  #NAME?
                                                  #NAME?
brrt_AssetsOfSubsidiaryOfInsurerRestrictedForUseReportedInScheduleOfEligibleCapitalTotalRestrictedAssets
                                                  #NAME?
brrt_AssetsOfSubsidiaryOfInsurerRestrictedForUseReportedInScheduleOfEligibleCapitalLessRegulatoryCapitalRequirements
                                                  #NAME?
                                                  #NAME?
brrt_AssetsOfSubsidiaryOfInsurerRestrictedForUseReportedInScheduleOfEligibleCapitalRestrictedAssetsInExcessOfCapitalRequirements
01/01/2012
12/31/2012
   SCHEDULE OF COMMERCIAL INSURER'S SOLVENCY SELF ASSESSMENT (CISSA) GENERAL
   QUESTIONS (TABLE 8A)                                                                                                        Return to Index

   Sample Company
   December 31, 2012                                                                                                         SCHEDULE IX(b)

   The insurer should review the following statements and select from the drop-down list as applicable and/or provide a brief description
   or an attachment. Where an attachment is provided, include references (e.g. page number, paragraph number) of where the
   information is located in the comments box in the attachments tab.


1 Is the CISSA and its underlying information integrated (i.e. considered when making key strategic decisions) into
  the Company's strategic and risk management decision-making processes? (Yes or No)


   If Yes, how is CISSA and its underlying information used? (select all that apply by choosing Yes/No )

   Strategic planning
   Annual business planning
   Setting risk limits
   Defining risk appetite
   Evaluation of capital adequacy
   Allocation of capital to business segments and lines of business
   Capital management
   Determination of rates of return for pricing and underwriting guidelines
   Reinsurance purchase
   Determination of investment policies and strategies
   Meeting regulatory requirements
   Improving credit rating
   Improving investor relations
   Assessing risk adjusted product profitability
   Performance measurement and assessment
   Improving mergers and acquisition decisions
   Others



2 Has the insurer applied reverse stress testing to both identify the scenarios that could cause business failure
  and the required actions to manage such situations? (Yes or No)

3 Is the CISSA process clearly documented and regularly amended for changes in strategic direction, risk management
  framework, and market developments? (Yes/No)

4 How often is the information underlying CISSA discussed and reviewed by the Board and chief
  and senior executives?



5 Has the Board of Directors and chief and senior executives ensured that an appropriate oversight process is in place,
  including an appropriate level of independent verification, whereby material deficiencies are reported on a timely basis
  and suitable actions taken? (Yes/No)

   Optionally, the Company may provide brief comments.
SCHEDULE OF COMMERCIAL INSURER'S SOLVENCY SELF ASSESSMENT (CISSA) GENERAL
QUESTIONS (TABLE 8A)                                                                    Return to Index

Sample Company
December 31, 2012                                                                     SCHEDULE IX(b)

                                                               Yes
                                                               No

                                                               Annually
                                                               Semi-annually
                                                               Quarterly
                                                               Monthly
                                                               Bi-monthly
                                                               Ad-hoc
                                                               Other

                                                               Strong
                                                               Moderate
                                                               Weak


                                                               Fully documented
                                                               Partially documented
                                                               Other
                                                                                                                   01/01/2012
                                                                                                                   12/31/2012




                                                                        #NAME?
brrt_CISSAAndItsUnderlyingInformationIsIntegratedConsideredWhenMakingKeyStrategicDecisionsIntoTheInsurersStrategicAndRiskManagementDecisionMaki




brrt_CISSAAndItsUnderlyingInformationIsUsedForStrategicPlanning            #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForAnnualBusinessPlanning       #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForSettingRiskLimits            #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForDefiningRiskAppetite         #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForEvaluationOfCapitalAdequacy #NAME?
                                                                           #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForAllocationOfCapitalToBusinessSegmentsAndLinesOfBusiness
brrt_CISSAAndItsUnderlyingInformationIsUsedForCapitalManagement            #NAME?
                                                                           #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForDeterminationOfRatesOfReturnForPricingAndUnderwritingGuidelines
brrt_CISSAAndItsUnderlyingInformationIsUsedForReinsurancePurchase          #NAME?
                                                                           #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForDeterminationOfInvestmentPoliciesAndStrategies
brrt_CISSAAndItsUnderlyingInformationIsUsedForMeetingRegulatoryRequirements#NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForImprovingCreditRating        #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForImprovingInvestorRelations #NAME?
                                                                           #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForAssessingRiskAdjustedProductProfitability
                                                                           #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForPerformanceMeasurementAndAssessment
                                                                           #NAME?
brrt_CISSAAndItsUnderlyingInformationIsUsedForImprovingMergersAndAcquisitionDecisions
brrt_CISSAAndItsUnderlyingInformationIsUsedForOthersList                   #NAME?




                                                                          #NAME?
brrt_TheInsurerHasAppliedReverseStressTestingToBothIdentifyTheScenariosThatCouldCauseBusinessFailureAndTheRequiredActionsToManageSuchSituation
                                                                          #NAME?

                                                                      #NAME?
brrt_TheCISSAProcessIsClearlyDocumentedAndRegularlyAmendedForChangesInStrategicDirectionRiskManagementFrameworkAndMarketDevelopments
                                                                      #NAME?

                                                                        #NAME?
brrt_FrequencyOfDiscussionAndRevisionOfTheInformationUnderlyingCISSAByTheBoardAndChiefAndSeniorExecutives




                                                                       #NAME?
brrt_TheBoardOfDirectorsAndChiefAndSeniorExecutivesHaveEnsuredThatAnAppropriateOversightProcessIsInPlaceIncludingAnAppropriateLevelOfIndependent




                                                                       #NAME?
brrt_TheBoardOfDirectorsAndChiefAndSeniorExecutivesHaveEnsuredThatAnAppropriateOversightProcessIsInPlaceIncludingAnAppropriateLevelOfIndependent
01/01/2012
12/31/2012
01/01/2012
12/31/2012
01/01/2012
12/31/2012
    SCHEDULE OF COMMERCIAL INSURER'S SOLVENCY SELF ASSESSMENT (CISSA)
    ASSESSMENT OF MATERIAL RISKS OF THE COMPANY (TABLE 13B)                                                                                 Return to Index

    Sample Company
    December 31, 2012                                                                                                                  SCHEDULE IX(c)

    The board must review policies, processes, and procedures to assess its material risks and self-determine the capital requirement it would
    need to support its insurance undertaking, at least annually. Minimally, the assessment should:
     • Be an integral part of the insurer's risk management framework
     • Be clearly document, reviewed, and evaluated regularly by the board and the chief and senior executives to ensure continual advancement in
        light of changes in the strategic direction, risk management framework, and market developments; and
     • Ensure an appropriate oversight process whereby material deficiencies are reported on a timely basis and suitable actions taken.

    The insurer shall undertake and file with the Authority the insurer's most recent report (insurer specific report) comprising of a solvency self-
    assessment of the insurer's material risks and the determination of both the quality (types of capital) and quantity of CISSA capital required
    to cover these risks, while remaining solvent and achieving the insurer's business goals.

    Minimally, the assessment should include:

1   The date the assessment was completed.

2   A description of the insurer's business and strategy.

    The identification and assessment of all reasonably foreseeable material risks, (i.e. insurance underwriting risk; investment, liquidity and
3   concentration risk; market risk; operational risk; strategic risk; reputational risk and legal risk).

4   The identification of the relationships of the material risks with one another, and the quantity and type of capital required to cover the risks.

5   A description of the insurer's risk appetite, including limits imposed and how they are enforced.

6   Assumptions and methodology used to assess and aggregate risks.

7   A forward looking analysis of the risks faced by the insurer over its planning horizon and an analysis demonstrating the ability to manage its
    business and capital needs in adverse circumstances and still meet regulatory capital requirements.

8   An evaluation of whether the insurer has sufficient capital and liquidity available, including an assessment of whether capital is fungible and
    assets are transferable, to achieve its strategic goals over its planning horizon and any potential adverse consequences if insufficient.


9   A description of business continuity and disaster plans.

10 A description of how the results of the self assessment are integrated into the management and strategic decision making process.

11 The risk measure, time horizon and confidence level (if any) used to determine the CISSA capital.
SCHEDULE OF COMMERCIAL INSURER'S SOLVENCY SELF ASSESSMENT (CISSA)
ASSESSMENT OF MATERIAL RISKS OF THE COMPANY (TABLE 13B)                                        Return to Index

Sample Company
December 31, 2012                                                                          SCHEDULE IX(c)




                                                                    Yes
                                                                    No

                                                                    Annually
                                                                    Semi-annually
                                                                    Quarterly
                                                                    Monthly
                                                                    Bi-monthly
                                                                    Ad-hoc
                                                                    Other

                                                                    Strong
                                                                    Moderate
                                                                    Weak


                                                                    Fully documented
                                                                    Partially documented
                                                                    Other
SCHEDULE OF COMMERCIAL INSURER'S SOLVENCY SELF ASSESSMENT (CISSA)
ASSESSMENT OF MATERIAL RISKS OF THE COMPANY (TABLE 13B)                       Return to Index

Sample Company
December 31, 2012                                                         SCHEDULE IX(c)




                                                                    No
                                                                    Yes
                                                                    N/A
01/01/2012
12/31/2012
         01/01/2012
         12/31/2012




Others
01/01/2012
12/31/2012
SCHEDULE OF ELIGIBLE CAPITAL                                                                                                                                            Return to Index

Sample Company
               December 31, 2012
For the year ending                                                                                                                                                   SCHEDULE XII(a)
               United
expressed in ['000s] States Dollars


Total statutory capital and surplus (Form 8, STMT LINE 3, plus applicable adjustments)                                                                                               -
    Less: Encumbered assets not securing policyholder obligations (Form 4, STMT Line 15) See Note 1                                                          -
    Less: relative liability or contingent liability (included on Form 4) for which the encumbered assets are held                                                                   -
    Subtotal:                                                                                                                                                                        -

TIER 1 BASIC CAPITAL
    (a) Fully paid common shares (Form 8, STMT LINE 1(a)(i))
    (b) Contributed surplus or share premium (Form 8, STMT LINE 1(b))
    (c) Statutory surplus - End of Year (Form 8, STMT LINE 2(h) (deficit) or retained earnings)
    (d) Capital adjustments
    (e) Hybrid capital instruments: Perpetual or fixed term preference shares (Form 8, STMT LINE 1a(ii))
    (f) Other:
    (g) Less: Treasury shares (Form 8, STMT LINE 1(a)(iii))
    (h) Less: Difference between encumbered assets for policyholder obligations and policyholder obligations, calculated as follows:
               (i) Encumbered assets where the pledged assets exceed policyholder obligations (per contract)                                                                               -
              (ii) Policyholder obligations where the pledged assets exceed Policyholder obligations (per contract) See Note 2                                                             -
             (iii) Capital requirement applicable to encumbered assets for policyholder obligations under (i) above (equal to the contribution
                   of the pledged assets to the ECR)                                                                                                                                       -
             (iv) Subtotal: (equal to (i) minus the sum of (ii) and (iii) above)                                                                             -                             -
              (v) Total policyholder obligations where the pledged assets are equal or exceed policyholder obligations (per contract)                                                      -
             (vi) Total encumbered assets where policyholder obligations exceed the pledged assets (per contract)                                                                          -
            (vii) Subtotal: (equal to the sum of (v) and (vi) above)                                                                                         -                             -
           (viii) Total policyholder obligations (Form 4, STMT LINE 27(a))                                                                                   -                             -
             (ix) Proportion of non-collateralized policyholder obligations                                                                                      0%                            0%
              (x) Subtotal: (equal to the product of (iv) and (ix) above)                                                                                                            -     -
    (i) Less: Encumbered assets not securing policyholder obligations (Form 4, STMT LINE 15)
        Less: relative liability or contingent liability (Form 4A) for which the encumbered assets are held                                                                          -
    (j) Less: Restricted assets in excess of capital requirements, reported in CISSA, to the extent that these amounts are not included in the
    encumbered assets for policyholder obligations and not for securing policyholder obligations
TIER 1 ANCILLARY CAPITAL
    Perpetual or fixed term subordinated debt
TOTAL TIER 1 AVAILABLE CAPITAL                                                                                                                                                       -     -

TIER 2 BASIC CAPITAL
    (a) Hybrid capital instruments: Preference shares - Qualifying
    (b) Other:
    (c) Add: Difference between encumbered assets for policyholders' obligations and policyholders' obligations deducted from Tier 1                                                 -     -
TIER 2 ANCILLARY CAPITAL
    (a) Unpaid and callable common shares (Form 8, STMT LINE 1 (c)(i))
    (b) Qualifying unpaid and callable hybrid capital (Form 8, STMT LINE (c)(i))
    (c) Qualifying unpaid and callable perpetual or fixed term preference shares (Form 8, STMT LINE 1(c) (i))
    (d) Perpetual or fixed term subordinated debt (Form 8, STMT LINE 1 (c)(i))
    (e) Approved letters of credit (Form 8, STMT Line 1(c)(ii))
    (f) Approved guarantees (Form 8, Line 1(c)(ii))
TOTAL TIER 2 AVAILABLE CAPITAL                                                                                                                                                       -     -

TIER 3 BASIC CAPITAL
    Short-term hybrid capital instruments: Perpetual or fixed term preference shares (Form 8, STMT Line 1(a)(ii))
TIER 3 ANCILLARY CAPITAL
    (a) Short-term subordinated debt (Form 8, STMT LINE 1(c)(i))
    (b) Approved letters of credit (Form 8, STMT LINE 1(c)(i))
    (c) Approved guarantees (Form 8, STMT Line 1(c)(ii))
TOTAL TIER 3 AVAILABLE CAPITAL                                                                                                                                                       -

TOTAL AVAILABLE STATUTORY CAPITAL AND SURPLUS                                                                                                                                        -

REGULATORY CAPITAL LEVELS
   Minimum Margin of Solvency                                                                                                                                                        375
   Enhanced Capital Requirement                                                                                                                                                      250

                       Limits          MSM                 ECR            Applied to MSM                             Met - Y/N                   Applied to ECR          Met - Y/N
    Tier 1                      min    80%                 50%                         -                               No                                     -            No
    Tier 2                      max    20%                 50%                         -                                                                      -
    Tier 3                                                 15%                                                                                                -
    Eligible Capital                                                                     -                              No                                   -              No

    Note 1 - No deduction from Tier 1 would be required where an insurer can demonstrate that the assets are encumbered for its own risk management purposes.
    Note 2 - The ceding insurer's reserves may be used for this calculation (where applicable).
*¹
                                                                                                                                   01/01/2012
                                                                                                                                   12/31/2012




brrt_StatutoryCapitalAndSurplus                        #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
                                                       #NAME?
brrt_EncumberedAssetsNotSecuringPolicyholdersObligations                            brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
                                                       #NAME?    brrt_TierAxis_brrt_Tier1Member
brrt_RelativeLiabilityOrContingentLiabilityForWhichTheEncumberedAssetsAreHeld       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                       #NAME?    brrt_TierAxis_brrt_Tier1Member
                                                                                    brrt_BasicAncillaryAxis_brrt_BasicMember
brrt_StatutoryCapitalAndSurplusNetOfEncumberedAssetsNotSecuringPolicyholdersObligations



brrt_FullyPaidShares                               #NAME?                        brrt_BasicAncillaryAxis_brrt_BasicMember
                                                              brrt_TierAxis_brrt_Tier1Member
brrt_ContributedSurplus                            #NAME?                        brrt_BasicAncillaryAxis_brrt_BasicMember
                                                              brrt_TierAxis_brrt_Tier1Member
brrt_StatutorySurplus                              #NAME?                        brrt_BasicAncillaryAxis_brrt_BasicMember
                                                              brrt_TierAxis_brrt_Tier1Member
brrt_CapitalAdjustments                            #NAME?                        brrt_BasicAncillaryAxis_brrt_BasicMember
                                                              brrt_TierAxis_brrt_Tier1Member
                                                   #NAME?     brrt_TierAxis_brrt_Tier1Member
brrt_HybridCapitalInstrumentsNoncumulativePerpetualOrFixedTermPreferenceShares brrt_BasicAncillaryAxis_brrt_BasicMember
brrt_OtherBasicCapital                             #NAME?                        brrt_BasicAncillaryAxis_brrt_BasicMember
                                                              brrt_TierAxis_brrt_Tier1Member
brrt_TreasuryShares                                #NAME?                        brrt_BasicAncillaryAxis_brrt_BasicMember
                                                              brrt_TierAxis_brrt_Tier1Member

                                                       #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
brrt_EncumberedAssetsWherePledgedAssetsExccedPolicyholderObligationsPerContract
                                                       #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
brrt_PledgedAssetsExceedingPolicyholderObligationsPerContract brrt_TierAxis_brrt_Tier1Member
brrt_CapitalRequirementApplicableToEncumberedAssetsForPolicyholderObligations
                                                       #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
                                                       #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
brrt_EncumberedAssetsWherePledgedAssetsExceedPolicyholderObligationsMinusHigherOfPledgedAssetsExceedingPolicyholderObligationsAndCapitalRequirementApplicableToEncumberedAssetsForPolicyholderO
                                                       #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
brrt_PolicyholderObligationsWherePledgedAssetsAreEqualOrExceedPolicyholderObligationsPerContract
                                                       #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
brrt_EncumberedAssetsWherePolicyholderObligationsExceedPledgedAssetsPerContract
                                                       #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
brrt_PolicyholderObligationsWherePledgedAssetsAreEqualOrExceedPolicyholderObligationsAndEncumberedAssetsWherePolicyholderObligationsExceedPledgedAssets
brrt_PolicyholdersObligations                          #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
                                                       #NAME?
brrt_ProportionOfNonCollateralizedPolicyHolderObligations                           brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
                                                       #NAME?    brrt_TierAxis_brrt_Tier1Member
brrt_EncumberedAssetsForPolicyholdersObligationsNetOfPolicyholdersObligationsbrrt_BasicAncillaryAxis_brrt_BasicMember
                                                       #NAME?
brrt_EncumberedAssetsNotSecuringPolicyholdersObligations                            brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member
                                                       #NAME?    brrt_TierAxis_brrt_Tier1Member
brrt_RelativeLiabilityOrContingentLiabilityForWhichTheEncumberedAssetsAreHeld       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                       #NAME?                       brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                 brrt_TierAxis_brrt_Tier1Member


brrt_AnyOtherFixedCapital                            #NAME?                         brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                 brrt_TierAxis_brrt_Tier1Member
brrt_AvailableCapital                                #NAME?                         brrt_BasicAncillaryAxis_brrt_TotalMember
                                                                 brrt_TierAxis_brrt_Tier1Member



                                                   #NAME?
brrt_HybridCapitalInstrumentsCumulativePreferenceShares                            brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                brrt_TierAxis_brrt_Tier2Member
brrt_OtherBasicCapital                             #NAME?                          brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                brrt_TierAxis_brrt_Tier2Member
brrt_OtherBasicCapitalDescription                  #NAME?                          brrt_BasicAncillaryAxis_brrt_BasicMember
                                                                brrt_TierAxis_brrt_Tier2Member
brrt_EncumberedAssetsForPolicyholdersObligationsNetOfPolicyholdersObligations
brrt_UnpaidAndCallableCommonShares                 #NAME?                          brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                brrt_TierAxis_brrt_Tier2Member
brrt_QualifyingUnpaidAndCallableHybridCapital      #NAME?                          brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                brrt_TierAxis_brrt_Tier2Member
                                                   #NAME?       brrt_TierAxis_brrt_Tier2Member
brrt_QualifyingUnpaidAndCallableNonCumulativePerpetualPreferenceShares             brrt_BasicAncillaryAxis_brrt_AncillaryMember
brrt_PerpetualOrFixedTermSubordinatedDebt          #NAME?                          brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                brrt_TierAxis_brrt_Tier2Member
brrt_ApprovedLettersOfCredit                       #NAME?                          brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                brrt_TierAxis_brrt_Tier2Member
brrt_ApprovedGuarantees                            #NAME?                          brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                brrt_TierAxis_brrt_Tier2Member
brrt_AvailableCapital                              #NAME?                          brrt_BasicAncillaryAxis_brrt_TotalMember
                                                                brrt_TierAxis_brrt_Tier2Member



                                                    #NAME?    brrt_TierAxis_brrt_Tier3Member
brrt_ShortTermHybridCapitalInstrumentsCumulativePreferenceShares                 brrt_BasicAncillaryAxis_brrt_BasicMember

brrt_ShortTermSubordinatedDebt                       #NAME?                         brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                 brrt_TierAxis_brrt_Tier3Member
brrt_ApprovedLettersOfCredit                         #NAME?                         brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                 brrt_TierAxis_brrt_Tier3Member
brrt_ApprovedGuarantees                              #NAME?                         brrt_BasicAncillaryAxis_brrt_AncillaryMember
                                                                 brrt_TierAxis_brrt_Tier3Member
brrt_AvailableCapital                                #NAME?                         brrt_BasicAncillaryAxis_brrt_TotalMember
                                                                 brrt_TierAxis_brrt_Tier3Member

brrt_TotalAvailableStatutoryCapitalAndSurplus        #NAME?



brrt_MinimumSolvencyMargin                           #NAME?
brrt_EnhancedCapitalRequirement                      #NAME?
0
    SCHEDULE OF ELIGIBLE CAPITAL- ADDITIONAL DETAILS                                                                                                           Return to Index

    Sample Company
    For the year ending                          December 31, 2012                                                                                         SCHEDULE XII(b)
    expressed in ['000s]                         United States Dollars

    1) Enter number of capital instruments                               -
                                                                                Apply        Reset
    2) Enter description of each capital instrument

                                                                                                           Date approved by the   Value of capital
    Description of capital instrument            Date of issue               Maturity date (as applicable) authority              instrument             Eligible capital tier
1
    Total available capital and surplus                                                                                                              0
             01/01/2012
             12/31/2012



brrt_EligibleCapitalDetails

              brrt_EligibleCapitalDetailsDateOfIssue
                           brrt_EligibleCapitalDetailsMaturityDate
                                        brrt_EligibleCapitalDetailsDateApprovedByAuthority
                                                     brrt_EligibleCapitalDetailsValueOfCapitalInstrument
brrt_EligibleCapitalDetailsDescriptionOfCapitalInstrument brrt_EligibleCapitalDetailsEligibleCapitalTier
emptyTuple
               #NAME?
brrt_TotalAvailableCapitalAndSurplus
OPERATIONAL RISK: CORPORATE GOVERNANCE                                                                                                             Return to Index

Sample Company
December 31, 2012



The insurer is to review the following statements below. The insurer is to place an “X” in the column “Implemented” where the Corporate Governance
function meets the criteria (200 points for each fulfilled criteria). The worksheet will automatically aggregate all scores.

The Board of Directors:
                                                                                                                                                                                                         01/01/2012
                                                              Description                                                            Implemented          Score                                          12/31/2012
Sets risk policies, practices and tolerance limits for all material foreseeable operational risks at least annually                                         0                                              #NAME?
                                                                                                                                                                     brrt_TheBoardOfDirectorsSetsRiskPoliciesPracticesAndToleranceLimitsForAllMaterialForeseeableOperationalRisksAtLeastAnnuallyAndEnsuresTheyAreCommunicat
Ensures they are communicated to relevant business units                                                                                                    0
Monitors adherence to operational risk tolerance limits more regularly than annually                                                                        0                                            #NAME?
                                                                                                                                                                     brrt_TheBoardOfDirectorsMonitorsAdherenceToOperationalRiskToleranceLimitsMoreRegularlyThanAnnually
Receives, at least annually, reports on the effectiveness of material operational risk internal controls as well as senior
                                                                                                                                                           0
management’s plans to address related weaknesses                                                                                                                                                          #NAME?
                                                                                                                                                                     brrt_TheBoardOfDirectorsReceivesAtLeastAnnuallyReportsOnTheEffectivenessOfMaterialOperationalRiskInternalControlsAsWellAsManagementsPlansToAddressRel
Ensures that systems and/or procedures are in place to identify, report and promptly address internal control deficiencies related
                                                                                                                                                           0
to operational risks                                                                                                                                                                                      #NAME?
                                                                                                                                                                     brrt_TheBoardOfDirectorsEnsuresThatSystemsAndOrProceduresAreInPlaceToIdentifyReportAndPromptlyAddressInternalControlDeficienciesRelatedToOperationalRis
Promotes full, open and timely disclosure from senior management on all significant issues related to operational risk                                     0                                              #NAME?
                                                                                                                                                                     brrt_TheBoardOfDirectorsPromotesFullOpenAndTimelyDisclosureFromSeniorManagementOnAllSignificantIssuesRelatedToOperationalRisk
Ensures that periodic independent reviews of the risk management function are performed and receives the findings of the
                                                                                                                                                           0
review                                                                                                                                                                                                   #NAME?
                                                                                                                                                                     brrt_TheBoardOfDirectorsEnsuresThatPeriodicIndependentReviewsOfTheRiskManagementFunctionArePerformedAndReceivesTheFindingsOfTheReview
                                                                                                                                                           0                                             #NAME?

Comments (optionally, the insurer may provide comments in the box below to support its responses above):




                                                                                                                                                                                                        #NAME?
                                                                                                                                                                     brrt_AdditionalCommentsCorporateGovernance




                                                                                                                                                     31
OPERATIONAL RISK: RISK MANAGEMENT FUNCTION                                                                                                  Return to Index

Sample Company
December 31, 2012

The insurer is to review the following statements below. The insurer is to place an “X” in the column “Implemented” where the Risk Management function
meets the criteria (150 points for each fulfilled criteria). The worksheet will automatically aggregate all scores.



The Risk Management Function:                                                                                                                                                                 01/01/2012
                                                                                                                                                                                              12/31/2012
                                                            Description                                                       Implemented        Score
Is independent of other operational units and has direct access to the Board of Directors                                                           0                                          #NAME?
                                                                                                                                                              brrt_TheRiskManagementFunctionIsIndependentOfOtherOperationalUnitsAndHasDirectAccessToTheBoardOfDirectors
Is entrenched in strategic planning, decision making and budgeting process                                                                          0                                          #NAME?
                                                                                                                                                              brrt_TheRiskManagementFunctionIsEntrenchedInStrategicPlanningDecisionMakingAndBudgetingProcess
Ensures that the risk management procedures and policies are well documented and approved by the Board of Directors                                 0                                         #NAME?
                                                                                                                                                              brrt_TheRiskManagementFunctionEnsuresThatTheRiskManagementProceduresAndPoliciesAreWellDocumentedAndApprovedByTheBo
Ensures the risk management policies and procedures are communicated throughout the organisation.                                                   0                                         #NAME?
                                                                                                                                                              brrt_TheRiskManagementFunctionEnsuresTheRiskManagementPoliciesAndProceduresAreCommunicatedThroughoutTheOrganisation
Ensures that operational risk management processes and procedures are reviewed at least annually                                                    0                                         #NAME?
                                                                                                                                                              brrt_TheRiskManagementFunctionReviewsOperationalRiskManagementProcessesAndProceduresAtLeastAnnually
Ensures that loss events arising from operational risks are documented and loss event data is integrated into the risk
                                                                                                                                                    0                                         #NAME?
                                                                                                                                                              brrt_TheRiskManagementFunctionEnsuresThatLossEventsArisingFromOperationalRisksAreDocumentedAndLossEventDataIsIntegrated
management strategy
Documents its risk management recommendations are documented for operational units, ensures that deficiencies have remedial
                                                                                                                                                    0                                         #NAME?
                                                                                                                                                              brrt_TheRiskManagementFunctionDocumentsItsRiskManagementRecommendationsForOperationalUnitsEnsuresThatDeficienciesHav
plans and that progress on the execution of such plans are reported to the Board of Directors at least annually
                                                                                                                                                    0


Comments (optionally, the insurer may provide comments in the box below to support its responses above):




                                                                                                                                                                                              #NAME?
                                                                                                                                                              brrt_AdditionalCommentsRiskManagement




                                                                                                                                32
OPERATIONAL RISK: OPERATIONAL RISK CHARGE CALCULATION                                                                Return to Index


Subject to the Authority applying a re-assessment upon onsite inspection, the “Total Operational Risk Capital Charge” below will be
applied to the insurer’s BSCR (After Covariance Adjustment) sub-total in the BSCR model for purposes of arriving at its Enhanced
Capital Requirement for the year-end filing.


Overall CIRA Score                                 0


CIRA Scoring Grid

                                        APPLICABLE OPERATIONAL
                                        RISK CHARGE % OF "BSCR
                                           AFTER COVARIANCE
        OVERALL SCORE                         ADJUSTMENT"


             <= 800                               10%
         > 800 <= 1,200                            9%
        > 1,200 <= 1,400                           8%
        > 1,400 <= 1,600                           7%
        > 1,600 <= 1,800                           6%
        > 1,800 <= 2,000                           5%
        > 2,000 <= 2,200                           4%
        > 2,200 <= 2,400                           3%
        > 2,400 <= 2,600                           2%
             > 2,600                               1%

BSCR After Covariance
Adjustment:                         $                            -


Operational Risk Charge %
(Decimals):                                       10%

                                                                                         0.1       0.03
Total Operational Risk Capital
Charge:                             $                            -




                                                                                                                                      33
SUMMARY                                                                                                                                                                                                                                           Return to Index
Sample Company
Bermuda Solvency Capital Requirement - Class C Insurers (BSCR-LT)                                                                                Solvency Capital Distribution
For the Year Ending                          December 31, 2012
Expressed in ['000s]                         United States Dollars
                                                                                                                                                                                            Fixed Income Investment Risk



    REQUIRED CAPITAL AND SURPLUS                                                                                                                                                                                                                                    Data for Pie Chart

    C fi       Fixed Income Investment Risk                                                0                                                                                                Equity Investment Risk
                                                                                                                                                                                                                                                                     Fixed Income Investment Risk
    C eq       Equity Investment Risk                                                      0                                                                                                                                                                         Equity Investment Risk
    C cred     Credit Risk                                                                 0                                                                                                Credit Risk                                                              Credit Risk
    C LTint    Long Term Interest and Liquidity Risk                                       0                                                                                                                                                                         Long Term Interest and Liquidity Risk
    C LTmort   Long Term Insurance Risk - Mortality                                        0                                          9%                                                                                                                             Long Term Insurance Risk - Mortality
                                                                                                                                                 10%               9%                       Long Term Interest and Liquidity Risk


    C LTsl     Long Term Insurance Risk - Stop-Loss                                        0                                                                                                                                                                         Long Term Insurance Risk - Stop-Loss
    C LTr      Long Term Insurance Risk - Riders                                           0                                9%                                                                                                                                       Long Term Insurance Risk - Riders
                                                                                                                                                                                            Long Term Insurance Risk - Mortality

    C LTmorb   Long Term Insurance Risk - Morbidity and Disability                         0                                                                                                                                                                         Long Term Insurance Risk - Morbidity and Disability
    C LTlong   Long Term Insurance Risk - Longevity                                        0                                                                                                                                                                         Long Term Insurance Risk - Longevity
    C LTVA     Long Term Variable Annuity Guarantee Risk                                   0                         9%                                            9%                       Long Term Insurance Risk - Stop-Loss
                                                                                                                                                                                                                                                                     Long Term Variable Annuity Guarantee Risk
    C LToth    Long Term Other Insurance Risk                                              0                                                                                                                                                                         Long Term Other Insurance Risk
                                                                                                                                                                                            Long Term Insurance Risk - Riders




    BSCR LT (Prior to Covariance Adjustment and prior to C op)                             0                           9%                                        9%
                                                                                                                                                                                            Long Term Insurance Risk - Morbidity and Disability


    BSCR LT (After Covariance Adjustment and prior to C op)                                0                                                                                                                                                                                             Minimum Solvency Margin
                                                                                                                                 9%                         9%
                                                                                                                                                                                            Long Term Insurance Risk - Longevity


    Operational risk charge (%)                                                          10%                                                                                                                                                                         Asset Base
                                                                                                                                      9%
                                                                                                                                                                                                                                                                     Class A
                                                                                                                                                                                            Long Term Variable Annuity Guarantee Risk
    C op       Operational risk capital charge ($)                                         0                                                                                                                                                                         Class B
                                                                                                                                                                                                                                                                     Class C
    Capital add-on / reduction (BMA assessment)                                            0                                                                                                                                                                         Class D
                                                                                                                                                                                            Long Term Other Insurance Risk




                                                                                                                                                                                                                                                                     Class E
    Final BSCR LT                                                                          0

    AVAILABLE STATUTORY CAPITAL AND SURPLUS
                                                                                                                    Regulatory Action Level vs. Available Statutory Capital and Surplus
    Total statutory capital and surplus                              Form 4, line (40)     0              30.00
                                                                                                                                                                                                                                                                    Data for Column Chart
    50% credit on margins in reserves                                                      0
    Capital contribution
    Pre-adjustment available statutory capital and surplus                                 0

                                                                                                          25.00
               Capital add-on / reduction (BMA Assessment)                                 0

    Available Statutory Capital and Surplus                                                0                                                                                                                                                                        Data for Column Chart

    MINIMUM MARGIN OF SOLVENCY
                                                                                               Billions




                                                                                                          20.00

    Minimum Margin of Solvency                                                           500
    Transitional Adjustment Factor                                                       25%
    Current Minimum Margin of Solvency                                                   375

                                                                                                          15.00
    ENHANCED CAPITAL REQUIREMENT & TARGET CAPITAL LEVEL                                                                                                                                                                                                              Adjusted Surplus                                      Available Statutory Capital and Surplus

    Enhanced Capital Requirement                                                         500                                                                                                                                                                         Mandatory Control Level (100% of ACL)                 Regulatory Action Level 1
    Transitional Adjustment Factor                                                       50%
    Current Enhanced Capital Requirement                                                 250              10.00                                                                                                                                                      Authorized Control Level (120% of ACL)                Regulatory Action Level 2

    Target Capital Level                                                                 300

    RATIOS
                                                                                                           5.00
    Bermuda Solvency Capital Requirement Ratio                                           n/a

    Transitory Enhanced Capital Requirement Ratio                                        n/a                                                                                                                                                                         Transitional Adjustment Factor                        2012

    Enhanced Capital Requirement Ratio                                                   n/a               0.00
                                                                                                                  Available Statutory Capital and Surplus    Enhanced Capital Requirement                      Target Capital Level
                                                                                                                                                                                                                                                                                                                           2013




                                                                                                                                               34
BSCR LT =                            {C fi 2 + C eq 2 + C cred 2 + C LTint 2 + (C LTmort +C LTsl + C LTr )2 + C LTmorb 2 + C LTlong 2 + C LTVA 2 + C LToth 2} + C op




Rounding (decimal places)           01/01/2012                                                                               10
                                    12/31/2012
brrt_CapitalContribution                    #NAME?
                                            #NAME?
brrt_CapitalAddonReductionBMAAssessmentRequiredCapitalAndSurplus
                                            #NAME?
brrt_CapitalAddonReductionBMAAssessmentAvailableStatutoryCapitalAndSurplus




                                                                                                                                                                       35
36
37
38
                        0                 0.10
                        0                 0.10
                        0                 0.10
                        0                 0.10
                        0                 0.10
                        0                 0.10
                        0                 0.10
                        0                 0.10
                        0                 0.10
                        0                 0.10
                        0                 0.10

                        0                    1




                        0    First Cap Factor     Second Cap Factor Fixed Limit       Minimum Amount
                                        0.00%               0.50%                 0          120        120
                                        0.00%               1.00%                 0          250        250
                                          0.00%               1.50%               0         500         500
                                          2.00%               1.50%       250000           4000        4000
                                          2.00%               1.50%       500000           8000        8000




                    500




                                 Bottom                 Top              Level



Available Statutory Capital and Surplus                25,000,000      25,000,000

Regulatory Action Level 1                              25,000,000         250,000

Regulatory Action Level 2                              25,000,000         300,000

                            Max Column                 25,000,000




                     50%



                     75%




                                                                                                              39
40
41
42
43
FIXED INCOME INVESTMENTS                                                                                           Return to Index
Sample Company
Fixed Income Investment Risk ($'000)                   December 31, 2012             (1)          (2)             (3)


    TYPE OF                                                                         ASSET       CAPITAL        REQUIRED
    FIXED INCOME INVESTMENTS                           STATEMENT SOURCE             VALUE       FACTOR          CAPITAL

    (a) Bonds By Rating Category                                                                                (1) x (2)

    Government                                         Schedule II, Line (1)                -       0.30%                   -
    High Investment Grade (AAA & AA)                   Schedule II, Line (2)                -       0.80%                   -
    Medium Investment Grade (A)                        Schedule II, Line (3)                -       3.20%                   -
    Low Investment Grade (BBB)                         Schedule II, Line (4)                -       5.00%                   -
    Non Investment Grade                               Schedule II, Line (5)                -      26.30%                   -
    Mortgage-Backed Securities                         Schedule II, Line (6)                -      10.00%                   -
    Mutual Funds                                       Schedule II, Line (7)                -      15.00%                   -
    Non Rated Bonds                                    Schedule II, Line (8)                -      50.00%                   -

    (a) SUBTOTAL - BONDS                                                                    -                               -

    (b) Other Fixed Income Investments

    Mortgage Loans                                     Form 4, Line (5c)                    -           5.0%                -
    Other Loans                                        Form 4, Line (8)                     -           5.0%                -
    Cash and Time deposits                             Form 4, Line (1)                     -           0.3%                -

    (b) SUBTOTAL - OTHER FIXED INCOME INVESTMENTS                                           -                               -

    (c) TOTAL FIXED INCOME INVESTMENTS [ (a) + (b) ]                                        -                               -




                                                                               44
EQUITY INVESTMENTS                                                                                                    Return to Index
Sample Company
Equity Investment Risk ($'000)                         December 31, 2012                   (1)          (2)          (3)


    TYPE OF                                                                               ASSET       CAPITAL     REQUIRED
    EQUITY INVESTMENTS                                 STATEMENT SOURCE                   VALUE       FACTOR       CAPITAL

    (a) Common Stocks                                                                                              (1) x (2)

    Non-Affiliated (Quoted)                            Form 4, Line (2c)-i                        -       14.4%                -
    Non-Affiliated (Unquoted)                          Form 4, Line (3c)-i                        -       14.4%                -
    Mutual Funds                                       Form 4, Lines (2c)-iii, (3c)-iii           -       14.4%                -

    (a) SUBTOTAL - COMMON STOCKS                                                                  -                            -

    (b) Preferred Stocks

    Non-Affiliated (Quoted)                            Form 4, Line (2c)-ii                       -       14.4%                -
    Non-Affiliated (Unquoted)                          Form 4, Line (3c)-ii                       -       14.4%                -

    (b) SUBTOTAL - PREFERRED STOCKS                                                               -                            -

    (c) Other Equity Investments

    Real Estate
    Company-Occupied Less Encumbrances                 Form 4, Line (7a)                          -       10.0%                -
    Investments Less Encumbrances                      Form 4, Line (7b)                          -       20.0%                -

    Other Equity Investments                           Form 4, Lines (2e), (3e)                   -       20.0%                -
    Other Tangible Assets (Net of Segregated           Form 4, Lines (13f), (14d) Less
    Accounts Companies)                                Lines (13b), (13c)                         -       20.0%                -

    (c) SUBTOTAL - OTHER EQUITY INVESTMENTS                                                       -                            -

    (d) TOTAL EQUITY INVESTMENTS [ (a) + (b) + (c) ]                                              -                            -




                                                                                           45
CREDIT RISK                                                                                                           Return to Index
Sample Company
Credit Risk ($'000)                                   December 31, 2012                  (1)         (2)             (3)


    TYPE OF                                                                         RECEIVABLES/   CAPITAL        REQUIRED
    DEBITOR                                           STATEMENT SOURCE              RECOVERABLES   FACTOR          CAPITAL

    (a) Accounts and Premiums Receivable                                                                           (1) x (2)

    In Course of Collection                           Form 4, Line (10a)                       -           5.0%                -
    Deferred - Not Yet Due                            Form 4, Line (10b)                       -           5.0%                -
    Receivables from retrocessional contracts         Form 4, Line (10c)
    Less: Collateralized Balances                     Less Notes to Form 4                     -       10.0%                   -

    (a) SUBTOTAL - ACCOUNTS AND PREMIUMS RECEIVABLE                                            -                               -

    (b) Reinsurance Balances Receivable

    Foreign Affiliates                                Form 4, Line (11a)                       -       10.0%                   -
    Domestic Affiliates                               Form 4, Line (11b)                       -        0.0%                   -
    Pools & Associations                              Form 4, Line (11c)                       -       10.0%                   -
    All Other Insurers                                Form 4, Line (11d)                       -        9.4%                   -
    Less: Collateralized Balances                     Notes to Form 4, Line 11(e)              -       10.0%                   -
    Less: Letters of Credit                           Notes to Form 4                          -        9.0%                   -
    Less: Funds Held Under Reinsurance Contracts      Form 4, Line (34c)                       -        9.7%                   -

    (b) SUBTOTAL - REINSURANCE BALANCES RECEIVABLE                                             -                               -

    (c) All Other Receivables

    Funds Held by Ceding Companies (AAA, AA rating)   Schedule V, Line (e)(i)                  -           0.8%                -
    Funds Held by Ceding Companies (A rating)         Schedule V, Line (e)(ii)                 -           3.2%                -
    Funds Held by Ceding Companies (Below A rating)   Schedule V, Line (e)(iii)                -           5.0%                -
    Accrued Investment Income                         Form 4, Line (9)                         -           2.5%                -
    Investments in and Advances to Affiliates         Form 4, Line (4h)                        -           5.0%                -
    Policy Loans                                      Form 4, Line (6)                         -           0.0%                -

    (c) SUBTOTAL - ALL OTHER RECEIVABLES                                                       -                               -

    (d) Total Reinsurance Recoverable Balance

    Foreign Affiliates                                Form 4, Line (27b)(i)                    -       10.0%                   -
    Domestic Affiliates                               Form 4, Line (27b)(ii)                   -        0.0%                   -
    Pools & Associations                              Form 4, Line (27b)(iii)                  -       10.0%                   -
    All Other Insurers                                Form 4, Line (27b)(iv)                   -        9.4%                   -
    Less: Collateralized Balances                     Notes to Form 4, Line 27(c)              -       10.0%                   -

    (d) SUBTOTAL - REINSURANCE RECOVERABLE BALANCE                                             -                               -

    (e) TOTAL CREDIT RISK [ (a) + (b) + (c) + (d) ]                                            -                               -




                                                                             46
INTEREST AND LIQUIDITY RISK                                                                                                                                                                                                                     Return to Index
Sample Company
Interest Rate and Liquidity Risk ($'000)                        December 31, 2012                           (1)                        (2)                                               (3)               (5)               (6)        (7)           (8)

                                                                                                                               WEIGHTED AVERAGE
                                                                                                                              DIFFERENCE IN ASSET                                RESERVES WITH KNOWN
                                                                                                                             DURATION AND LIABILITY                                  DIFFERENCE IN
                                                                                                    200 BASIS POINT         DURATION (MINIMUM OF 1                                 DURATIONS / TOTAL                                  CAPITAL     REQUIRED
    EXTENT OF MISMATCH                                                                           INTEREST RATE SHOCK                 YEAR)              STATEMENT SOURCE               RESERVES        ASSET VALUE       ALM CREDIT   FACTOR       CAPITAL

    For assets (and liabilities) where the extent of the duration mismatch is:
    (a) Known                                                                                               2%                          1                Schedule VII, Line 16           0%                          -     0.00%       0.0%                 -
    (b) Unknown                                                                                             2%                          2                                                N/A                         -      N/A        4.0%                 -

    TOTAL INTEREST RATE AND LIQUIDITY RISK                                                                                                                                                                                                                  -

                                                                                                                                                                                                                                                  DISCOUNT
    ALM CREDIT                                                                                                                                                                                                                                     FACTOR

    Has the insurer implemented policies on Asset Liability Management, including tolerances for deviation?                                                                                                                  No
                                                                                                                                                                                                                                      Yes/No
    Question 1: Have clear roles and responsibilities for the execution of the Asset Liability Management program been assigned?                                                                                                        No          0.00%

    Question 2: Are Asset Liability Management positions / tolerances communicated to the investment function, senior management and the board on a timely basis?                                                                       No          0.00%

    Question 3: Have systems and procedures been established to identify, report and promptly address asset liability management deficiencies?                                                                                          No          0.00%

    Question 4: Are the Asset Liability Management policies and procedures reviewed and reapproved or revised at least annually?                                                                                                        No          0.00%

    Question 5: Is the insurer's current Asset Liability Management position in compliance with the insurer’s policies?                                                                                                                 No          0.00%

    Total discount factor to apply on the interest rate / liquidity risk capital requirement                                                                                                                                           Total        0.00%




                                                                                                                                                 47
LONG TERM INSURANCE RISK                                                                                                                                                                                                                Return to Index
Sample Company                                                 December 31, 2012
Long Term Insurance Risk ($'000)                                    (1)                 (2)                                                                               (3)                      (4)              (5)


    TYPE OF RISK                                                       RISK MEASURE                        STATEMENT SOURCE                                                 CAPITAL FACTORS                       CAPITAL REQUIREMENTS

    Insurance risks
    Definition of Adjustable: re/insurer has the ability to make a material adjustment to the cost of insurance, based on recent experience
                                                                                         Non-
                                                                    Adjustable                            Adjustable     Non-adjustable                               Adjustable         Non-adjustable        Adjustable          Non-adjustable
                                                                                     adjustable                                                          NAR
                                                                     product/                              product/          product/         Tier                     product/            product/             product/             product/
                                                                                      product/                                                       (B=$Billions)
                                                                      treaty                                treaty             treaty                                   treaty               treaty              treaty                treaty
                                                                                        treaty
                                                                       Net Amount at Risk                           Schedule VII                                         Factor (per 1000 of NAR)                (1) * (3)            (2) * (4)
    Mortality                                                                 -                -             Line 1             Line 1         1       NAR <1B           1.99                3.97                             -                    -
     (term assurance, whole life, universal life, AD&D)                                                                                        2        1B - 5B          0.90                 1.8                             -                    -
                                                                                                                                               3       5B -10B           0.72                1.44                             -                    -
                                                                                                                                               4      10B - 50B          0.65                1.29                             -                    -
                                                                                                                                               5      NAR > 50B          0.57                1.13                             -                    -
                                                                                                                                                                                           Subtotal                          -                    -
                                                                     Net Amount at Risk                                                                                  Factor (per 1000 of NAR)
    Critical Illness                                                      -             -                 Line 2             Line 2            1       NAR <1B           5.96                11.91                            -                    -
     (Critical Illness including accelerated CI products)                                                                                      2        1B - 5B          2.70                 5.4                             -                    -
                                                                                                                                               3       5B -10B           2.16                4.32                             -                    -
                                                                                                                                               4      10B - 50B          1.94                3.87                             -                    -
                                                                                                                                               5      NAR > 50B          1.70                3.39                             -                    -
                                                                                                                                                                                           Subtotal                          -                    -

                                                                         Net Reserve                                                                                            % of Net Reserve
    Longevity                                                                                 -                     Line 3                                                           6.00%                       (1) * (4)                        -
    (payout annuities, contingent annuities)
                                                                          Net Reserve
    Disability income: claims in payment                                                      -                     Line 7                                                            7.00%                      (1) * (4)                        -
     Waiver of premium and LTC
    Disability income: claims in payment                                                      -                     Line 8                                                          10.00%                       (1) * (4)                        -
     other accident and sickness

    Disability income: active lives                                  Net Annual Premium
    (including Waiver of Premium and LTC)                                                                                                                                  % of Annual Premiums
                                                                 Benefit Period   Benefit Period                                                                     Benefit Period       Benefit Period
    Length of premium g'tee                                                                               Line 5             Line 5
                                                                  <= 2 years        > 2 years                                                                         <= 2 years            > 2 years
     <= 1 year                                                              -                 -            (a)                 (a)                                               9.00%        12.00%       (1) * (3) + (2) * (4)                  -
     1 - 5 years                                                            -                 -            (b)                 (b)                                              15.00%        20.00%       (1) * (3) + (2) * (4)                  -
     >5 years                                                               -                 -            (c)                 (c)                                              22.50%        30.00%       (1) * (3) + (2) * (4)                  -

                                                                     Net Annual Premium                                                                                    % of Annual Premiums
    Disability income: active lives                                                           -                     Line 6                                                          12.00%
    Other accident and sickness                                                                                                                                                                                  (1) * (4)                        -


    Other products                                                   Net Annual Premium                                                                                    % of Annual Premiums
    Stop Loss                                                                           -                          Line 12                                                        50.00%                         (1) * (4)                        -
    Rider (Other product riders not included above)                                     -                          Line 13                                                        25.00%                         (1) * (4)                        -
    (for example: Guaranteed Insurability Options, Conversion options, etc)

    TOTAL INSURANCE RISK
    Mortality                                                                                                                                                                                                                                     -
    Stop Loss                                                                                                                                                                                                                                     -
    Riders                                                                                                                                                                                                                                        -
    Morbidity and Disability                                                                                                                                                                                                                      -
    Longevity                                                                                                                                                                                                                                     -




                                                                                                                                                                                                                                                          48
LONG TERM VARIABLE ANNUITY GUARANTEE RISK                                                                                                                                                                        Return to Index
Sample Company
Long Term Business Variable Annuity Guarantee Risk ($'000)                              December 31, 2012
                 (1)                (2)                (3)                  (4)               (5)               (6)              (7)          (8)                     (9)                           (10)           (11)

          TYPE OF RISK
                  ACCOUNT VALUE                                               NAR FACTOR                    MINIMUM FLOOR FACTOR
                                                                         Volatility                                                        WEIGHTED                                            BERMUDA
               Volatility                        NET AMOUNT AT             (0%,         Volatility         Volatility      Volatility      AVERAGE          TOTAL BALANCE                     STATUTORY          CAPITAL
             (0%,10.0%]      Volatility >10.0%     RISK (NAR)             10.0%]        >10.0%             (0%,10.0%]      >10.0%           FACTOR        SHEET REQUIREMENT                   RESERVES         REQUIREMENT
     Variable Annuity Guarantee Risk                                                                                                                      Max [{(6) x (1) + (7) x (2)},(8) x (3)]                (9) - (10)

     Guaranteed Minimum Accumulation Benefit (GMAB): <5 years to maturity                                    See notes
                    -               -                   -                65%                     125%              4.00%           7.00%        0.00%                            -                         -                  -
     Guaranteed Minimum Accumulation Benefit (GMAB): >=5 years to maturity
                    -               -                   -               20%                          70%          1.50%            4.00%        0.00%                            -                         -                  -
     Guaranteed Minimum Death Benefit: Return of Premium, Ratchet and Reset
                    -                -                  -                4%                          13%          0.25%            0.75%        0.00%                            -                         -                  -
     Guaranteed Minimum Death Benefit: Enhanced Benefits (Roll up)
                    -                -                   -                        12%                21%          0.75%            1.25%        0.00%                            -                         -                  -
     Guaranteed Minimum Income Benefit (GMIB)
                    -              -                           -               100%              160%             5.00%            8.00%        0.00%                            -                         -                  -
     Guaranteed Minimum Withdrawal Benefit (GMWB)
                    -               -                          -                  60%                90%          3.25%            5.00%        0.00%                            -                         -                  -
     Guaranteed Enhanced Earnings Benefit (GEEB)
                    -                -                         -                  1%                 17%          0.00%            1.00%        0.00%                            -                         -                  -
     Total
                        -                 -                    -                                                                                                                -                          -                  -
     TOTAL - VARIABLE ANNUITY GUARANTEE RISK                                                                                                                                    -                          -                  -

     Notes
     1. Factors should be applied to Net Amount at Risk (NAR) defined as:
        GMAB               Total claim payable if all contracts mature immediately
        GMDB               Total claim amount payable upon immediate death of all policyholders
        GMIB               Total claim payable upon full and immediate annuitization of all policies using an 80% factor applied to the Guaranteed Value (the 80% represents the ratio between current market annuitization
                           factors and the guaranteed annuitization factors)
        GMWB               Total claim payable if 100% of the guaranteed withdrawal benefit base in excess of the current account value is withdrawn immediately
        GEEB               Total guaranteed enhanced payments upon immediate death of all policyholders

     2.   Where ratchets, resets and roll-ups exist, please use the roll-up category.
     3.   NAR is net of reinsurance.
     4.   The proportion used for the account value under reinsurance is the proportion used for NAR.
     5.   Need minimium amount when Guaranteed Value (GV) < Account Value (AV), the minimum floor factor is applied to AV.




                                                                                                                                    49
50
51
52
LONG TERM OTHER INSURANCE RISK ($'000)                                                                                                                           Return to Index
Sample Company
December 31, 2012                                                                                                         (1)                (2)                  (3)



                                                                                                                        BERMUDA
                                                                                                                       STATUTORY                             CAPITAL
       OTHER INSURANCE RISK                                                                         STATEMENT SOURCE    RESERVE        CAPITAL FACTOR      REQUIREMENT
       (covering insurance risks such as policyholder behaviour, expenses, and product
       guarantees)
                                                                                                                                                           Max [0, (1) x (2)]
       Line of Business
       Mortality (term insurance, whole life, universal life)                            Schedule VII, Line (1)                    -               2.00%                   -
       Critical Illness (including accelerated CI products)                              Schedule VII, Line (2)                    -               2.00%                   -
       Longevity (payout annuities, contengent annuities, pension blocks)                Schedule VII, Line (3)                    -               0.50%                   -
       Deferred annuities (including indexed linked products with no guarantees)         Schedule VII, Line (4)                    -               0.50%                   -
       Disability Income: active lives - incl. waiver of premium and LTC                 Schedule VII, Line (5)                    -               2.00%                   -
       Disability Income: active lives - other accident and sickness                     Schedule VII, Line (6)                    -               2.00%                   -
       Disability Income: claims in payment - incl. waiver of premium and LTC            Schedule VII, Line (7)                    -               0.50%                   -
       Disability Income: claims in payment - other accident and sickness                Schedule VII, Line (8)                    -               0.50%                   -
       Group Life                                                                        Schedule VII, Line (9)                    -               0.50%                   -
       Group Disability                                                                  Schedule VII, Line (10)                   -               0.50%                   -
       Group Health                                                                      Schedule VII, Line (11)                   -               0.50%                   -
       Stop Loss arrangements                                                            Schedule VII, Line (12)                   -               2.00%                   -
       Riders (all other products excluding Variable Annuity Guarantees)                 Schedule VII, Line (13)                   -               2.00%                   -



       TOTAL OTHER INSURANCE RISK                                                                                                  -                                            -




                                                                                                      53
COMPANY SPECIFIC PARAMETERS                                                                                                              Return to Index
Sample Company                                                                                         Details of User Capital Factor to be included in
For the Year Ending                     December 31, 2012                                              the attachments section 9.


                               To be completed only with prior approval from the Bermuda Monetary Authority

                                                                                       STANDARD        STANDARD                 USER          USER
   TYPE OF                                                                 ASSET        CAPITAL        REQUIRED                CAPITAL      REQUIRED
   FIXED INCOME INVESTMENTS             STATEMENT SOURCE                   VALUE        FACTOR          CAPITAL                FACTOR        CAPITAL
   (a) Bonds By Rating Category                                             (1)           (2)            (1) x (2)                (3)         (1) x (3)
   Government                           Schedule II, Line (1)                      0        0.3%                     0                                    0
   High Investment Grade (AAA & AA)     Schedule II, Line (2)                      0        0.8%                     0                                    0
   Medium Investment Grade (A)          Schedule II, Line (3)                      0        3.2%                     0                                    0
   Low Investment Grade (BBB)           Schedule II, Line (4)                      0        5.0%                     0                                    0
   Non Investment Grade                 Schedule II, Line (5)                      0       26.3%                     0                                    0
   Mortgage-Backed Securities           Schedule II, Line (6)                      0       10.0%                     0                                    0
   Mutual Funds                         Schedule II, Line (7)                      0       15.0%                     0                                    0
   Non Rated                            Schedule II, Line (8)                      0       50.0%                     0                                    0
   (a) SUBTOTAL - BONDS                                                            0                                 0                                    0
   (b) Other Fixed Income Investments

   Mortgage Loans                       Form 4, Line (5c)                          0            5.0%                 0                                    0
   Other Loans                          Form 4, Line (8)                           0            5.0%                 0                                    0
   Cash and time deposit                Form 4, Line (1)                           0            0.3%                 0                                    0
   (b) SUBTOTAL - OTHER FIXED INCOME INVESTMENTS                                   0                                 0                                    0
   (c) TOTAL FIXED INCOME INVESTMENTS [ (a) + (b) ]                                0                                 0                                    0


                                                                                       STANDARD        STANDARD                 USER          USER
   TYPE OF                                                                 ASSET        CAPITAL        REQUIRED                CAPITAL      REQUIRED
   EQUITY INVESTMENTS                   STATEMENT SOURCE                   VALUE        FACTOR          CAPITAL                FACTOR        CAPITAL
   (d) Common Stocks                                                        (1)           (2)            (1) x (2)                (3)         (1) x (3)
   Non-Affiliated (Quoted)              Form 4, Line (2c)-i                        0       14.4%                     0                                    0
   Non-Affiliated (Unquoted)            Form 4, Line (3c)-i                        0       14.4%                     0                                    0
   Mutual Funds                         Form 4, Lines (2c)-iii, (3c)-iii           0       14.4%                     0                                    0
   (d) SUBTOTAL - COMMON STOCKS                                                    0                                 0                                    0
   (e) Preferred Stocks
   Non-Affiliated (Quoted)              Form 4, Line (2c)-ii                       0       14.4%                     0                                    0
   Non-Affiliated (Unquoted)            Form 4, Line (3c)-ii                       0       14.4%                     0                                    0
   (e) SUBTOTAL - PREFERRED STOCKS                                                 0                                 0                                    0
   (f) Other Equity Investments
   Real Estate
                                    Form 4, Line (7a)
   Company-Occupied Less Encumbrances                                              0       10.0%                     0                                    0
   Investments Less Encumbrances    Form 4, Line (7b)                              0       20.0%                     0                                    0
   Other Equity Investments             Form 4, Lines (2e), (3e)                   0       20.0%                     0                                    0
   Other Tangible Assets - Net of       Form 4, Lines (13e), (14d) less
   Segregated Accounts Companies        Line (13b)                                 0       20.0%                     0                                    0
   (f) SUBTOTAL - OTHER EQUITY INVESTMENTS                                         0                                 0                                    0
   (g) TOTAL EQUITY INVESTMENTS [ (d) + (e) + (f) ]                                0                                 0                                    0

                                                                                       STANDARD        STANDARD                 USER          USER
   TYPE OF                                                                 ASSET        CAPITAL        REQUIRED                CAPITAL      REQUIRED
   INTEREST RATE/LIQUIDITY RISK         STATEMENT SOURCE                   VALUE        FACTOR          CAPITAL                FACTOR        CAPITAL
   Known                                Form 4, Lines 2b,3b,2cii,3cii,5c           0            0.0%                 0                                    0
   Unknown                              Form 4, Lines 2b,3b,2cii,3cii,5c           0            4.0%                 0                                    0
   (h) TOTAL INTEREST RATE / LIQUIDITY RISK                                        0                                 0                                    0
                                                                                          STANDARD           STANDARD          USER       USER
TYPE OF                                                                      ASSET         CAPITAL           REQUIRED         CAPITAL   REQUIRED
CREDIT RISK                             STATEMENT SOURCE                     VALUE         FACTOR             CAPITAL         FACTOR     CAPITAL
(i) Accounts and Premiums Receivable                                           (1)              (2)           (1) x (2)         (3)      (1) x (3)
In Course of Collection                 Form 4, Line (10a)                            0           5.0%                    0                          0
Deferred - Not Yet Due                  Form 4, Line (10b)                            0           5.0%                    0                          0
Receivables from retrocessional         Form 4, Line (10c), Notes to Form             0          10.0%                    0                          0
(i) SUBTOTAL - ACCOUNTS AND PREMIUMS RECEIVABLE                                       0                                   0                          0
(j) Reinsurance Balances Receivable
Foreign Affiliates                  Form 4, Line (11a)                                0          10.0%                    0                          0
Domestic Affiliates                 Form 4, Line (11b)                                0           0.0%                    0                          0
Pools & Associations                Form 4, Line (11c)                                0          10.0%                    0                          0
All Other Insurers                  Form 4, Line (11d)                                0           9.4%                    0                          0
Less: Collateralized Balances       Notes to Form 4, Line (11e)                       0          10.0%                    0                          0
Less: Letters of Credit             Notes to Form 4, Line (11)                        0           9.0%                    0                          0
                                    Form 4,
Less: Funds Held Under Reinsurance Contracts Line (34)                                0           9.7%                    0                          0
(j) SUBTOTAL - REINSURANCE BALANCES RECEIVABLE                                        0                                   0                          0
(k) All Other Receivables
Funds Held (rated AAA, AA)              Schedule V, Line (g)(i)                       0               0.8%                0                          0
Funds Held (rated A)                    Schedule V, Line (g)(ii)                      0               3.2%                0                          0
Funds Held (rated below A)              Schedule V, Line (g)(iii)                     0               5.0%                0                          0
Accrued Investment Income               Form 4, Line (9)                              0               2.5%                0                          0
Investments in & Advances to Aff        Form 4, Line (4c)                             0               5.0%                0                          0
Policy Loans                            Form 4, Line (6)                              0               0.0%                0                          0
(k) SUBTOTAL - ALL OTHER RECEIVABLES                                                  0                                   0                          0
(l) Reinsurance Recoverable Balance
Foreign Affiliates                      Form 4, Line (27b)-i                          0          10.0%                    0                          0
Domestic Affiliates                     Form 4, Line (27b)-ii                         0           0.0%                    0                          0
Pools & Associations                    Form 4, Line (27b)-iii                        0          10.0%                    0                          0
All Other Insurers                      Form 4, Line (27b)-iv                         0           9.4%                    0                          0
Less: Collateralized Balances           Notes to Form 4, Line (27c)                   0          10.0%                    0                          0
(l) SUBTOTAL - REINSURANCE RECOVERABLE BALANCE                                        0                                   0                          0
(m) TOTAL CREDIT RISK [ (i) + (j) + (k) + (l) ]                                       0                                   0                          0

                                                                                                             STANDARD          USER       USER
                                                                              Net Amount of Risk             REQUIRED         CAPITAL   REQUIRED
                                                  Statement Source          Adjustable   Non-Adjust           CAPITAL         FACTOR     CAPITAL
Mortality                               Column 5 & Column 6, Line 1                   0                 0                 0                          0
Critical Illness                        Column 5 & Column 6, Line 2                   0                 0                 0                          0

                                                                                                             STANDARD          USER       USER
                                                                             Net Annual Premium              REQUIRED         CAPITAL   REQUIRED
                                                  Statement Source          <2 years      >2 years            CAPITAL         FACTOR    CAPITAL
Disability Income: Active Lives         Column 5 & Column 6, Line 5
< = 1 Year                                            (a)                             0                 0                 0                          0
1 - 5 years                                           (b)                             0                 0                 0                          0
> 5 years                                             (c)                             0                 0                 0                          0

                                                                                                             STANDARD          USER       USER
                                                                                                             REQUIRED         CAPITAL   REQUIRED
                                                  Statement Source               Net Reserves                 CAPITAL         FACTOR    CAPITAL
Disability Inc:Claims in Pymnt (1)      Column 1, Line 7                              0                                   0                          0
Disability Inc:Claims in Pymnt (2)      Column 1, Line 8                              0                                   0                          0
Longevity                               Column 1, Line 3                              0                                   0                          0
                                                                                                         STANDARD         USER      USER
                                                                                                         REQUIRED        CAPITAL   REQUIRED
                                             Statement Source               Net Annual Premium            CAPITAL        FACTOR    CAPITAL
Other Accident & Sickness             Column 7, Line 6                                  0                            0                       0
Stop Loss                             Column 7, Line 12                                 0                            0                       0
Rider                                 Column 7, Line 13                                 0                            0                       0


                                                                                            STANDARD     STANDARD         USER       USER
                                                                                              CAPITAL     REQUIRED       CAPITAL   REQUIRED
LINE OF LONG-TERM BUSINESS                 STATEMENT SOURCE              NET RESERVES         FACTOR       CAPITAL       FACTOR     CAPITAL

Mortality                             Sch VII, Column 1, Line (1)                       0         2.0%               0                       0
Critical Illness                      Sch VII, Column 1, Line (2)                       0         2.0%               0                       0
Longevity                             Sch VII, Column 1, Line (3)                       0         0.5%               0                       0
Deferred annuities                    Sch VII, Column 1, Line (4)                       0         0.5%               0                       0
Disability Income: active lives       Sch VII, Column 1, Line (5)                       0         2.0%               0                       0
Disability: accident & sickness       Sch VII, Column 1, Line (6)                       0         2.0%               0                       0
Disability claims in payment (1)      Sch VII, Column 1, Line (7)                       0         0.5%               0                       0
Disability claims in payment (2)      Sch VII, Column 1, Line (8)                       0         0.5%               0                       0
Group Life                            Sch VII, Column 1, Line (9)                       0         0.5%               0                       0
Group Disability                      Sch VII, Column 1, Line (10)                      0         0.5%               0                       0
Group Health                          Sch VII, Column 1, Line (11)                      0         0.5%               0                       0
Stop Loss                             Sch VII, Column 1, Line (12)                      0         2.0%               0                       0
Rider                                 Sch VII, Column 1, Line (13)                      0         2.0%               0                       0

(a) REQUIRED CAPITAL FOR OTHER INSURANCE RISK                                           0                            0                       0

                                                      ACCOUNT VALUE                            NET                        USER       USER
                                                                                                          STANDARD
                                                  Volatility               Volatility       AMOUNT AT     REQUIRED       CAPITAL   REQUIRED
                                                (0%,10.0%]                 >10.0%             RISK         CAPITAL       FACTOR     CAPITAL
Variable Annuity Guarantee Risk

GMAB <5 years to maturity                                            -              -              -                 0                       0

GMAB >5 years to maturity                                            -              -              -                 0                       0

GMDB Return of Premium                                               -              -              -                 0                       0

GMDB Enhanced Benefits                                               -              -              -                 0                       0

GMIB                                                                 -              -              -                 0                       0

GMWB                                                                 -              -              -                 0                       0

GEEB                                                                 -              -              -                 0                       0

(a) REQUIRED CAPITAL FOR VARIABLE ANNUITY GUARANTEE RISK                                                            0                        0

REQUIRED CAPITAL AND SURPLUS

Fixed Income Investment Risk                                                                                         0                       0
Equity Investment Risk                                                                                               0                       0
Interest Rate / Liquidity Risk                                                                                       0                       0
Credit Risk                                                                                                          0                       0
Mortality                                                                                                            0                       0
Morbidity and Disability                                                                                             0                       0
Longevity                                                                                                            0                       0
Stop Loss                                                                                                            0                       0
Riders                                                                                                               0                       0
Other Insurance Risk                                                                                                 0                       0
Variable Annuity Guarantee Risk                                                                                      0                       0
BSCR (Prior to Covariance Adjustment)                                                                                0                       0
BSCR (After Covariance Adjustment)                                                                                   0                       0
Operational risk charge (%)                                                                                    10%
Operational risk capital charge ($)                                                                                  0                       0
Capital add-on / reduction (BMA assessment)
BSCR   0   0
01/01/2012
12/31/2012

								
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