Year In Which Losses

Were Incurred

Losses Unpaid On

Reported Claims

As of

Difference

a)  12/31/84,

b) 12/31/85,

b)   –   a)

Prior to 1978

1978

1979

1980

1981

1982

1983

1984

1985

x

x

TOTALS

Year In Which Losses

Were Incurred

Losses Unpaid On Incurred

But Not Reported Claims

As of

Difference

a)  12/31/84,

b) 12/31/85,

b)   –   a)

Prior to 1978

1978

1979

1980

1981

1982

1983

1984

1985

x

x

TOTALS

Year In Which Losses

Were Incurred

Other Unpaid Losses

As of

Difference

a)  12/31/84,

b) 12/31/85,

b)   –   a)

Prior to 1978

1978

1979

1980

1981

1982

1983

1984

1985

x

x

TOTALS

General Instructions

The above information is due on June 1, 1986 and on June 1 every year thereafter as may be required by the Director.  For subsequent due dates of June 1, 1987, June 1, 1988 etc., all years shown in this Illustration should be advanced by one, two etc.