[For insurance companies]
| Column A | Column B | Column C | Column D | Column E | Column F | Column G | Column H | Column I | Column J | Column K |
| Segment1 | Deferred policy acquisition cost (caption 7) | Future policy benefits, losses, claims and loss expenses (caption 13-a-1) | Unearned premiums (caption 13-a-2) | Other policy claims and benefits payable (caption 13-a-3) | Premium revenue (caption 1) | Net investment income (caption 2)3 | Benefits, claims, losses, and settlement expenses (caption 5) | Amortization of deferred policy acquisition costs4 | Other operating expenses3 4 | Premiums written2 |
| Total5 |
1 Segments shown should be the same as those presented in the footnote disclosures called for by generally accepted accounting principles.
2 Does not apply to life insurance or title insurance. This amount should include premiums from reinsurance assumed, and be net of premiums on reinsurance ceded.
3 State the basis for allocation of net investment income and, where applicable, other operating expenses.
4 The total of columns I and J should agree with the amount shown for statement of comprehensive income caption 7.
5 Totals should agree with the indicated balance sheet and statement of comprehensive income caption amounts, where a caption number is shown.