Filedwiththemaryland Insurance Administration

FORMFENTERPRISERISKREPORT

FiledwiththeMaryland Insurance Administration

By:

______

NameofRegistrant

OnBehalfof/Related to theFollowingInsuranceCompanies:

NameAddress

______

______

______

______

Date:,20

Name,Title,addressandtelephonenumberofIndividualtowhomNoticesandCorrespondenceconcerningthisStatement shouldbeaddressed:

______

______

______

______

ITEM1. ENTERPRISERISK

TheRegistrant/Applicant,tothebestofitsknowledgeandbelief,shallprovideinformationregardingthefollowingareasthatcouldproduceenterpriseriskasdefinedinInsurance Article, §7-101(d), Annotated Code of Maryland,providedsuchinformationisnotdisclosedintheInsuranceHoldingCompanySystemAnnualRegistrationStatementfiledonbehalfofitselforanotherinsurerforwhichitistheultimatecontrollingperson:

(a)Anymaterialdevelopmentsregardingstrategy,internalauditfindings,complianceorriskmanagementaffectingtheinsuranceholdingcompanysystem;

(b)Acquisition or disposal of insurance entities and reallocating of existing financial orinsuranceentitieswithintheinsuranceholdingcompanysystem;

(c)Anychangesof shareholdersof theinsuranceholdingcompanysystemexceedingtenpercent(10%)ormoreof votingsecurities;

(d)Developmentsinvariousinvestigations,regulatoryactivitiesorlitigationthatmayhaveasignificantbearingorimpactontheinsuranceholdingcompanysystem;

(e)Businessplanoftheinsuranceholdingcompanysystemandsummarizedstrategiesfornext12months;

(f)Identification ofmaterialconcernsoftheinsurance holdingcompanysystemraised bysupervisorycollege,ifany,inlastyear;

(g)Identificationofinsuranceholdingcompanysystemcapitalresourcesandmaterialdistributionpatterns;

(h)Identificationofanynegativemovement,ordiscussionswithratingagencieswhichmayhavecaused,ormaycause,potentialnegativemovementinthecreditratingsandindividualinsurerfinancialstrengthratingsassessmentoftheinsuranceholdingcompanysystem(includingboththeratingscoreandoutlook);

(i)Informationoncorporateorparentalguaranteesthroughouttheholdingcompanyandtheexpectedsourceofliquidityshouldsuchguaranteesbecalledupon;and

(j)Identificationofanymaterialactivityordevelopmentoftheinsuranceholdingcompanysystemthat,intheopinionofseniormanagement,couldadverselyaffecttheinsuranceholdingcompanysystem.

TheRegistrant/ApplicantmayattachtheappropriateformmostrecentlyfiledwiththeU.S.Securities andExchangeCommission,providedtheRegistrant/Applicantincludesspecificreferencesto thoseareaslistedinItem1forwhichtheformprovidesresponsiveinformation.IftheRegistrant/ApplicantisnotdomiciledintheU.S.,itmayattachitsmostrecentpublicauditedfinancialstatementfiled initscountryofdomicile,providedtheRegistrant/ApplicantincludesspecificreferencestothoseareaslistedinItem1forwhichthefinancialstatementprovidesresponsiveinformation.

ITEM2: OBLIGATIONTOREPORT

IftheRegistrant/Applicanthasnotdisclosedanyinformationpursuantto Item1,theRegistrant/Applicantshallincludeastatementaffirmingthat,tothebestofitsknowledgeandbelief,ithasnotidentifiedenterpriserisksubjecttodisclosurepursuanttoItem1.

ITEM3.SIGNATUREANDCERTIFICATION

Signature and Certification required as follows:

SIGNATURE

Pursuant to the requirements of Subtitle 6of the Maryland Insurance Acquisitions Disclosure and Control Act, (Registrant) has caused this Enterprise Risk Report to be duly signed on its behalf in the Cityof and State of on the dayof ______20 .

(SEAL) ______

Name of Registrant

(BY)

(Name) (Title)

Attest:

______

(Signature of Officer)

______

(Title)

The undersigned deposes and says that he has duly executed the attached application dated

, 20 ___ for and on behalf of; that (s)he is the

(Title of Officer) of such company, and that (s)he is authorized to execute and file such instrument. Deponent further says that (s)he is familiar with such instrument and the contents thereof, and that the facts therein set forth are true to the best of his knowledge, information and belief.

(Signature) ______

(Type or print name beneath) ______

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