members of the board, officers and employees

ANNUAL STATEMENT FOR THE YEAR ENDED: 31-Dec-2020

OF

License No……………………………………………………………………. Date of Issue……………………………

S.E.C. Registration No…………………………………………………………………………………… Date of Issue……………………………

Tax Identification No………………………………………………………………………..

Incorporated on…………………………………………………………………..…………………… Commenced business on……………

Home Office…………………………………………………………………………………… Mail Address……………………………

Telephone No………………………………………………………………… Fax No……………………………………

Email Address………………………………………………………………………..

MEMBERS OF THE BOARD, OFFICERS AND EMPLOYEES

Members of the Board and Officers were elected on……..………………………………………………………………

Term of office to expire on……………………………………………………………………………………………………

Key Officers or Equivalent Positions (note 1)

Name

Chairman…………………………………………...………………………………………………...…

Vice-Chairman…………………………………………………………………………………...…

Trustees (note 1)

…………………………………………………………………………………...………………………

Independent Trustees (note 1)

……………………………………………………………………………………………

President……………………………………………………………………………………………………………………………………………………………..

Vice President………………………………………………………………………………………………………………………………………………………………..

Secretary………………………………………………………………………………………………………………………………………………………………………..

Treasurer………………………………………………………………………………………………………………………………………………………………………

General Manager……………………………………………………………………………………………………………………………………………………………..

Chief Financial Officer…………………………………………………………………………………………………………………………………………………………….

Actuary………………………………………………………………………………………………………………………………………………………………………….

Department Heads:

Underwriting…………………………………………………………………………………………………………………………………………………………

Sales…………………………………………………………………………………………………………………………………………………………

Investments…………………………………………………………………………………………………………………………………………………………

Administration…………………………………………………………………………………………………………………………………………………………

Claims…………………………………………………………………………………………………………………………………………………………

Chief Accountant………………………………………………………………………………………………………………………………………………………………………….

Internal Auditor………………………………………………………………………………………………………………………………………………………………………….

External Auditor………………………………………………………………………………………………………………………………………………………………………….

Compliance Officers………………………………………………………………………………………………………………………………………………………………………….

No. of salaried officers………………………………………………………………………………………………………………………………………..……

No. of members…………………………………………………………………………………………………………………………………………………………. No. of employees……………………………………….

No. of branches / service offices……………………………………………………………………………………………………………………………………………… No. of agents / solicters…………………………………….

(Specify locations as attachment)

Please, do not print below this line (Type below required information)

Name of MBA

Period covered- For the year ended

Report Date

NOTES & INSTRUCTIONS:

1) Please insert rows if needed.

2) Complete fields marked in light tan background. Additional notes may be added in work areas to the right and below the exhibit.

Exchange

ratePEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

2009-23-0 October 5, 2009

CN200815441 September 30,2008

[email protected]

May 11, 2019

266-045002

August 20, 2008 August 20,2008

Purok 4A, Brgy. 5, San Francisco, Agusan del Sur Purok 4A, Bargy 5,

San Francisco Agusan Del Sur

Arnold Arbutante B. Arbutante Filipino

Rosemarie T. Maureal Filipino

Juliana I. Babao Filipino

May 14, 2022

Nationality

Judith I. Literatus Filipino

Berny V. Amoy Filipino

Genalyn O. Hegina Filipino

Judith I. Literatus Filipino

Roger J. Calamba Filipino

Linda Grace B. Arevalo Filipino

Jeirlyn T. Coquilla Filipino

Panfilo P. Dela Paz Filipino


Arnold Arbutante B. Arbutante Filipino

Genalyn O. Hegina Filipino

Ethel S. Lovitos Filipino

Neliza E. Aquilam Filipino

None

None


Quilab & Garsuta CPAs Filipino



None

None

1 2

PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

31-Dec-2020

10

17,960 10

mailto:[email protected]




ANNEX

Domestic Foreign Total

NCR - - - - - - - - - -

1. Manila -

2. Mandaluyong -

3. Marikina -

4. Pasig -

5. San Juan -

6. Quezon City -

7. Caloocan City -

8. Malabon -

9. Navotas -

10. Valenzuela -

11. Las Pinas -

12. Makati -

13. Muntinlupa -

14. Pasay City -

15. Taguig City -

16. Pateros -

17. Parañaque -

CAR - - - - - - - - - -

1. Abra -

2. Apayao -

3. Benguet -

4. Baguio City -

5. Ifugao -

6. Kalinga -

7. Mountain Province -

Region I - - - - - - - - - -

1. Ilocos Norte

2. Ilocos Sur -

3. La Union -

4. Pangasinan -

5. Dagupan City -

Region II - - - - - - - - - -

1. Batanes -

2. Cagayan -

3. Isabela -

4. Nueva Vizcaya -

5. Quirino -

6. Santiago -

Region III - - - - - - - - - -

1. Aurora -

2. Bataan -

3. Bulacan -

4. Nueva Ecija -

5. Pampanga -

6. Angeles City -

7. Tarlac -

8. Zambales -

9. Olongapo City -

Region IV - A - - - - - - - - - -

1. Batangas -

2. Cavite -

3. Laguna -

4. Quezon -

5. Lucena City -

6. Rizal -

MIMAROPA - - - - - - - - - -

1. Marinduque -

2. Occidental Mindoro -

3. Oriental Mindoro -

4. Palawan -

5. Puerto Princesa City -

6. Romblon -

Region V - - - - - - - - - -

1. Albay -

2. Camarines Norte -

3. Camarines Sur -

4. Catanduanes -

5. Masbate -

6. Naga City

7. Sorsogon -

Region VI - - - - - - - - - -

1. Aklan -

2. Antique -

3. Capiz -

4. Negros Occidental -

5. Bacolod City -

6. Guimaras -

7. Iloilo -

Insurance

Agents

General

Agents

ANNUAL STATEMENT OF PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION, INC. FOR THE YEAR ENDED DECEMBER 31, 2020

Annex A to Page 1

Provinces by Region

N u m b e r O f

Branches Extension

Office

Service

Office

Satellite

Office

Salaried

Officers

Salaried

Employees

http://els.insurance.gov.ph:7001/els/licenseApplication/agentLicense/main.xhtml



8. Iloilo City -

Region VII - - - - - - - - - -

1. Bohol -

2. Cebu -

3. Cebu City -

4. Lapu-Lapu -

5. Mandaue City -

6. Negros Oriental -

7. Siquijor -

Region VIII - - - - - - - - - -

1. Biliran -

2. Eastern Samar -

3. Leyte -

4. Tacloban City -

5. Northern Samar -

6. Southern Leyte -

7. Samar (Western Samar)

8. Ormoc City -

Region IX - - - - - - - - - -

1. Zamboanga del Norte -

2. Zamboanga del Sur -

3. Zamboanga City -

4. Zamboanga Sibugay -

5. City of Isabela -

Region X - - - - - - - - - -

1. Bukidnon -

2. Camiguin -

3. Lanao del Norte -

4. Iligan City -

5. Misamis Occidental -

6. Misamis Oriental -

7. Cagayan de Oro City -

Region XI - - - - - - - - - -

1. Davao del Norte -

2. Davao del Sur -

3. Davao City -

4. Davao Oriental -

5. Compostela Valley -

6. Davao Occidental -

Region XII - - - - - - - - - -

1. North Cotabato -

2. Sarangani -

3. South Cotabato -

4. General Santos City -

5. Sultan Kudarat -

Region XIII - - #VALUE! - 1 - - 10 2 -

1. Agusan del Norte -

2. Butuan City -

3. Agusan del Sur N/A N/A #VALUE! N/A 1 N/A N/A 10 2 N/A

4. Surigao del Norte -

5. Surigao del Sur -

6. Dinagat Islands -

BARMM - - - - - - - - - -

1. Basilan -

2. Lanao del Sur -

3. Maguindanao -

4. Sulu -

5. Tawi-tawi -

6. Cotabato City -

GRAND TOTAL - - #VALUE! - 1 - - 10 2 -

Note and Instruction:

1. Data should tally with Page 1, i.e. - No. of Salaried Officers, No. of Salaried employees, No. of Branches, etc.

A/S FOR YEAR ENDED 12/31/2020 OF PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC PAGE 2

ASSETS

FUND CODE===> GenF MBF OBmi OBregMicroinsurance, Regular, or Both? Set in sheet p2b===> mix mi mi reg

CURRENT ASSETS

2.1 2.1 111000 Cash and cash equivalents 6,509,298.23 15,303,334.72 4,192,358.44 - 26,004,991 37,703,881.07

2.2 2.2 112100 Financial assets at amortized cost (FAAC) - current - - - - - -

2.3 2.3 113000 Financial assets at fair value (FAFV) - P&L - 431,130.33 - - 431,130 335,879.45

2.4 2.4 114100 Members' fees and dues receivable - - - - - -

2.5 2.5 114200 Members' contributions due and uncollected - - - - - -

2.6 2.6 114300 Net premiums due and uncollected - - - - - -

2.7 2.7 114400 Unremitted members' contributions, dues and fees 38,214.00 8,418.96 5,534.10 - 52,167 -

2.8 2.8 114500 Unremitted premiums - - 5,003.95 - 5,004 -

2.9 2.9 114600 Amounts recoverable from reinsurers - net - - - - - -

2.10 2.10 114700 Members' assessment receivable - net - - - - - -

2.11 2.11 114800 Accrued income - 1,468.75 - - 1,469 513,743.06

2.12 2.12 114900 Other current receivables - net 4,420.93 9,241,872.95 4.62 - 9,246,299 9,318,685.83

2.13 2.13 115000 Due to/from other Funds - - - - - -

2.14 2.14 116000 Payments and other current assets 81,584.25 - - - 81,584 40,707.25

2.15 2.15 117000 Short-term financial assets - 5,029,156.00 - - 5,029,156 -

2.16 2.16 TOTAL CURRENT ASSETS 6,633,517 30,015,382 4,202,901 - 40,851,800 47,912,897

NON-CURRENT ASSETS

2.17 2.16 121100 Financial assets at amortized cost (FAAC) - non-current - 17,237,445.62 - - 17,237,445.62 17,132,002.40

2.18 2.17 122000 Financial assets at fair value (FAFV) - other comprehensive income (OCI) - 2,281,332.51 - - 2,281,332.51 2,180,377.81

2.19 2.18 131000 Loans receivable - net - - - - - -

2.20 2.19 141000 Investment in associates - - - - - -

2.21 2.20 142000 Investments in subsiduaries - - - - - -

2.22 2.21 143000 Investment in joint venture - - - - - -

2.23 2.22 151000 Investment in property - net - - - - - -

2.25 2.23 161000 Property and Equipment- net 1,844,620.42 5,109,310.00 - - 6,953,930.42 7,750,166.23

2.26 2.25 171000 Other Non-Current Assets - net - - - - - -

2.27 2.26 181000 Right of use assets - net - - - - - -

2.28 2.27 TOTAL NON-CURRENT ASSETS 1,844,620 24,628,088 - - 26,472,709 27,062,546

2.29 2.29 TOTAL ASSETS 8,478,138 54,643,470 4,202,901 - 67,324,508 74,975,443

LIABILITIES AND FUND BALANCE

LIABILITIESCURRENT LIABILITIES

2.30 2.30 211000 Liability on individual equity value - 35,250,166.12 - - 35,250,166 39,674,685.89

2.31 2.31 212000 Basic contingency benefits reserve - 6,579.30 - - 6,579 25,336.93

2.32 2.32 213000 Optional benefit reserve - - 561,744.89 - 561,745 393,883.49

2.33 2.33 214000 Claims payable on basic contingent benefit - 43,186.28 - - 43,186 201,575.54

2.34 2.34 215000 Claims payable on optional benefits - - 370,254.89 - 370,255 343,807.79

2.35 2.35 216000 Other benefits on Basic Policies - - - - - 3,891.00

2.36 2.36 217000 Other Benefits on Optional Policies - - - - - -

2.37 2.37 221000 Members Contributions Received in Advance - current - 46,666.32 - - 46,666 152,562.02

2.38 2.38 222000 Premiums Received in Advance- current - - - - - -

2.39 2.39 223000 Unearned Income - - - - - -

2.40 2.40 224000 Amount due to Reinsurers - - - - - -

2.41 2.41 225000 Loans Payable - Cuurent - - - - - -

2.42 2.42 226000 Accounts Payable 87,890.98 304,284.19 387,122.68 - 779,298 325,548.10

2.43 2.43 227000 Grants Held in Trust - - - - -

2.44 2.44 231000 Accrued Expenses - - - - - 43,786.60

2.45 2.45 TOTAL CURRENT LIABILITIES 87,891 35,650,882 1,319,122 - 37,057,896 41,165,077

NON-CURRENT LIABILITIES

2.46 2.46 251000 Members'Contribution Received in Advance - non-current - - - - - -

2.47 2.47 252000 Premiums Received in Advance - non-current - - - - - -

2.48 2.48 253000 Net Pension Liability - - - - - -

2.49 2.49 254000 Long-term Loans Payable - - - - - -

2.50 2.50 255000 Lease Liability - - - - - -

2.51 2.51 256000 Other Long-term Liabilities - - - - - -

2.52 2.52 TOTAL NON-CURRENT LIABILITIES - - - - - -

2.53 2.53 TOTAL LIABILITIES 87,890.98 35,650,882.21 1,319,122.46 - 37,057,896 41,165,077.36

FUND BALANCE2.54 2.54 310000 Free and Unassigned Fund Balance 5,744,595.36- 17,930,804.26 1,864,404.03 - 14,050,613 17,739,670.82

2.55 2.55 320000 Assigned Fund Balance - 14,408,014.67 1,526,652.91 - 15,934,667.58 16,052,413.08

2.56 2.56 321000 Funds Assigned for Guaranty Fund - 10,728,014.67 1,526,652.91 - 12,254,668 12,212,413.08

2.57 2.57 322000 Funds Assigned For Member Benefits - 3,680,000.00 - - 3,680,000 3,840,000.00

2.58 2.58 323000 Funds Assigned For Community Development - - - - - -

2.59 2.59 330000 Revaluation Increment / Surplus - 281,332.51 - - 281,333 18,282.00

2.60 2.60 PRIOR YEAR ADJUSTMENTS - - - - - -

2.61 2.61 TOTAL FUND BALANCE 5,744,595.36- 32,620,151.44 3,391,056.94 - 30,266,613.02 33,810,365.90

2.62 2.62 TOTAL LIABILITIES AND FUND BALANCE 5,656,704.38- 68,271,033.65 4,710,179.40 - 67,324,509 74,975,443.26

FUND BALANCE2.63 2.63 Fund Balance, beginning 2,643,210.69- 32,167,626.13 4,269,159.47 - 33,793,574.91 33,993,974.57

2.64 2.64 Net Surplus for the year 3,101,384.67- 452,525.31 878,102.53- - 3,526,961.89- 595,044.02-

2.65 2.65 Prior Year Adjustments - - - - - 411,435.36

2.66 2.66 Fund Balance, ending 5,744,595.36- 32,620,151.44 3,391,056.94 - 30,266,613 33,810,365.91


1) Legend: 0

Enter data in cells with black font and light tan background, as applicable 9,999.00

Cells with blue font and gray background may be linked to other areas in the workbook and are READ-ONLY. 9,999.00

STATEMENT OF FINANCIAL CONDITION

GENERAL

FUND

MUTUAL

BENEFIT FUND

OPTIONAL

BENEFIT FUND

(MICRO)

OPTIONAL

BENEFIT FUND

(REGULAR)

TOTAL FUND

CURRENT YEAR

TOTAL FUND

PREVIOUS

YEAR

A/S FOR YEAR ENDED 12/31/2020 OF PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

FUND CODE===> GenF MBF OBmi OBreg

Microinsurance, Regular, or Both? Set in sheet p2b===> mix mi mi reg

L 1 211000 Liability on individual equity value 35,250,166.12 35,250,166.12

L 2 212000 Basic contingency benefits reserve 6,579.30 6,579.30

L 3 213000 Optional benefit reserve - - 561,744.89 - 561,744.89

213100 Optional Benefit Reserve- Regular -

213200 Optional Benefit Reserve- Micro 561,744.89 561,744.89

L 4 214000 Claims payable on basic contingent benefit - 43,186.28 - - 43,186.28

214100 Due and Unpaid -

214200 In course of Settlement -

214300 Claims Resisted -

214400 Incurred But not yet Reported (IBNR) 43,186.28 43,186.28

L 5 215000 Claims payable on optional benefits - - 370,254.89 - 370,254.89

215100 Optional Benefit Reserve- Regular - - - - -




215340 Incurred But not yet Reported (IBNR) -

215200 Optional Benefit Reserve- Micro - - 370,254.89 - 370,254.89




215340 Incurred But not yet Reported (IBNR) 370,254.89 370,254.89

L 6 216000 Other benefits on Basic Policies - -

L 7 217000 Other Benefits on Optional Policies - - - - -

217100 Other Benefits on Optional Policies- Regular -

217200 Other Benefits on Optional Policies- Micro -

L 8 221000 Members Contributions Received in Advance - current 46,666.32 46,666.32

L 9 251000 Members Contributions Received in Advance - Non- current -

L 10 222000 Premiums Received in Advance - - - - -

222100 Premiums Received in Advance-Current- Regular -

222200 Premiums Received in Advance-Current- Micro -

252100 Premiums Received in Advance-Non- current- Regular -

252200 Premiums Received in Advance-Non- current- Micro -

L 11 223000 Unearned Income -

L 12 224000 Amount due to Reinsurers -

L 13 225000 Loans Payable - Current -

L 14 226000 Accounts Payable 87,890.98 304,284.19 387,122.68 - 779,297.85

226100 Accounts Payable- Minor Beneficiary -

226200 Withholding Taxes Payable -

226300 SSS/ECC/Pag-ibig/Philheath Contributions payable -

226400 SSS/Pag-ibig loan payable -

226500 Other Accounts Payable 87,890.98 304,284.19 387,122.68 779,297.85

L 15 227000 Grants Held in Trust

L 16 231000 Accrued Expenses - - - - -

231100 Accrued Utilities - -

231200 Accrued Services -

231300 Accrual for Unused Compensated Absences -

231400 Accrued Interest Expenses -

231500 Other Accrued Expenses -

L 17 253000 Net Pension Liability -

L 18 254000 Long-Term Loans Payable -

L 19 255000 Lease Liability

L 20 256000 Other Long-Term Liabilities -

21 TOTAL LIABILITIES 87,890.98 35,650,882.21 1,319,122.46 - 37,057,895.65

F 22 320000 Assigned Fund Balance - 14,408,014.67 1,526,652.91 - 15,934,667.58

321000 Funds Assigned for Guaranty Fund 10,728,014.67 1,526,652.91 12,254,667.58

322000 Funds Assigned for Members' Benefits - 3,680,000.00 - - 3,680,000.00

322100 Incremental Benefit for Individual Equity Value -

322200 Education and Training -

322300 Other Members'Benefit 3,680,000.00 3,680,000.00

323000 Funds Assigned for Community Development -

Sub-total Assigned Fund Balance - 14,408,014.67 1,526,652.91 - 15,934,667.58

F 23 310000 Free and Unassigned Fund Balance 5,744,595.36- 17,930,804.26 1,864,404.03 14,050,612.93

F 24 330000 Revaluation Increment (net of changes) - 281,332.51 - - 281,332.51

25 300000 TOTAL FUND BALANCE 5,744,595.36- 32,620,151.44 3,391,056.94 - 30,266,613.02

26 TOTAL LIABILITIES AND FUND BALANCE 5,656,704.38- 68,271,033.65 4,710,179.40 - 67,324,508.67

NOTES & INSTRUCTIONS: 67,324,508.67

1) Legend:



FUND BALANCE


GENERAL FUND

MUTUAL

BENEFIT FUND

OPTIONAL

BENEFIT FUND

(MICRO)

OPTIONAL

BENEFIT

FUND

(REGULAR)

TOTAL FUND

CURRENT YEAR

39,674,685.89

25,336.93

393,883.49

393,883.49

201,575.54

10,000.00

191,575.54

343,807.79

-

343,807.79

5,100.00

338,707.79

3,891.00

-

152,562.02

-

325,548.10

325,548.10

43,786.60

28,786.60

15,000.00

41,165,077.36

16,052,413.08

12,212,413.08

3,840,000.00

3,840,000.00

16,052,413.08

17,739,670.82

18,282.00

33,810,365.90

74,975,443.26

74,975,443.26

TOTAL FUND

PREVIOUS YEAR

A/S FOR YEAR ENDED 12/31/2020 OF PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INCPAGE 4

PARTICULARS



1 1 411000 Members' Fees/Dues 91,000 91,000 138,000.00

2 2 Net Members' Contributions - 477,336 - - 477,336 5,149,105

2.1 2.1 412000 Members' contributions 502,459 502,459 5,420,110

2.2 2.2 Less: 412100 Members' contributions ceded to (re)insurers -

2.3 Less: Contribution to Guaraty Fund (25,123) (271,006)

3 3 413000 Net Premiums - - 325,500 - 325,500 5,409,565

3.1 3.1 Pemiums - regular (413100) and micro (413200) 342,631 342,631 6,008,597

3,2 3.2 Less: Premiums Ceded, regular (413111) and micro (413112) - (298,602)

3.3 Less: Contribution to Guaraty Fund (17,132) (17,132) (300,430)

4 4 414000 Reinsurance Commissions -

5 5 Other Income 23,787 163,817 161 - 187,764 482,086

5.1 5.1 415000 Experience Refund 23,787 3,116 26,902 317,000.00

5.2 5.2 416000 Penalties and Surcharges 701 161 862 5,086.42

5.3 5.3 430000 Donations and Contributions Received 160,000 160,000 160,000.00

6 6 GROSS REVENUES 114,787 641,153 325,661 - 1,081,600 11,178,756

7 7 - 566,075 1,143,800 - 1,709,874 6,608,760

7.1 7.1 Net Benefits/Claims Expenses - 5,003,653 957,397 - 5,961,050 9,028,814

7.1.1 7.1.1 511000 Benefits/claims expenses - 5,053,256 651,519 - 5,704,774 8,669,282

7.1.1.1 Benefits/claims expenses -Basic Benefits 222,002 222,002 1,893,521

Refund of Members Equity 4,831,254 4,831,254 3,894,561

7.1.1.2 Benefits/claims expenses -Optional -Regular - -

Benefits/claims expenses -Optional -Micro 651,519 651,519 2,881,200

7.1.2 7.1.2 511001 Benefits/claims recovery - (49,602) 305,878 - 256,276 359,532

Benefit/claims recovery - Basic Benefits (49,602) (49,602) 15,724

Benefit/claims recovery - Optioal - Regular - -

Benefit/claims recovery - Optional - Micro 305,878 305,878 343,808

7.2 7.2 512000 Allocation for Liability on Individual Equity Value (50%) (4,424,520) (4,424,520) -

7.3 7.3 513100 Inc/(Dec) in Reserve for Basic Contingent Benefit (18,758) (18,758) (957,812)

(82,618)

7.5 7.5 513200 Inc/(Dec) in Reserve for Optional Benefit - - 167,861 - 167,861 (2,023,394)

513210 Increase/(Decrease) in Reserve for Optional Benefit - Regular -

513220 Increase/(Decrease) in Reserve for Optional Benefit - Micro 167,861 167,861 (2,023,394)

7.6 7.6 514000 Incremental Benefit on Individual Equity Value - -

7.7 7.7 515000 Other Member Benefit Expense - -

7.8 7.8 516000 Membership Enrollment and Marketing Expense - -

7.9 7.9 517000 Collection Fees 5,699 18,541 24,240 643,771

7.10 7.10 518000 Research and Development Expense - -

8 8 NET SURPLUS BEFORE OPERATING EXPENSES 114,787 75,078 (818,139) - (628,275) 4,569,995

9 9 LESS: 520000 OPERATING EXPENSES 3,833,338 - - - 3,833,338 6,547,670

9.1 521000 Salaries, Wages and Benefits - -

9.2 521010 Salaries and Wages 1,029,692 1,029,692 1,330,825

9.3 521020 13th month/ Bonuses/Incentives 95,929 95,929 214,371

9.4 521030 SSS/EC/Pagibig/Philhealth Contributions 180,960 180,960 150,348

9.5 521040 Post- Employment Benefit Cost - -

9.6 521050 Other Employee Welfare and Benefits 194,500 194,500 278,090

9.7 522000 Professional and Technical Development - -

9.8 523010 Annual General Assembly - 83,311

9.9 523020 Meetings and Conferences 86,681 86,681 211,763

9.10 523030 Board Honorarium, Allowances and Benefits - -

9.11 523040 Travel Expenses 58,711 58,711 257,641

9.12 523050 Representation Expense 20,593 20,593 16,617

9.13 524000 Social and Community Service Expenses - 166,009

9.14 525010 Technical and Professional Fees 84,000 84,000 67,200

9.15 525020 Service Fees 162,500 162,500 79,300

9.16 526010 MBA Dues and Subscriptions 133,002 133,002 513,618

9.17 526110 Office Supplies 41,683 41,683 96,522

9.18 526210 Rent/Lease Expense - -

9.19 526220 Utilities Expense 281,269 281,269 523,884

9.20 526300 Repairs and Maintenance 115,913 115,913 41,465

9.21 526400 Admin Expense on Insurance 88,956 88,956 115,629

9.22 527000 Depreciation 827,536 - - - 827,536 830,623

527020 Depreciation - Building and Building Improvements 160,000 160,000 160,000

527030 Depreciation - Leasehold Improvement - -

527040 Depreciation -IT Equipment 326,597 326,597 329,438

527050 Depreciation - Transportation Equipment 323,660 323,660 323,660

527060 Depreciation - Office Furniture, Fixtures and Equipment 17,279 17,279 17,525

527070 Depreciation - Other Equipment - -

527110 Depreciation -Investment Property - -

527120 Depreciation -Right of Use Asset

9.23 528100 Taxes, Licenses and Fees 424,150 424,150 372,868

9.24 528210 Investment Management Fees -

9.25 528220 Bank and Other Charges 350 350 4,748

9.26 528230 Interest Expenses and Financing Charges 1,487 1,487 63,409

9.27 529000 Provision for Probable Losses/ Loan Impairment Loss - 317,840

529010 Loan Impairment Loss -

529020 Provision for Probable Losses - Accounts Receivable - -

529030 Provision for Probable Losses - Foreclosed Properties -

9.28 529100 Loss on disposal of assets - 803,657

9.29 529200 Miscellaneous Expense 5,426 5,426 7,932

10 10 NET SURPLUS (DEFICIT) BEFORE INVESTMENT (3,718,551) 75,078 (818,139) - (4,461,612) (1,977,674)

11 11 Add: Investments and Other Income

11.1 11.1 Investment Revenues 481,615 410,335 7,698 - 899,648 1,214,969.79

421000 Interest Income 481,615 410,335 7,698 899,648 1,201,336.47

422000 Dividend Income - -

441100 Gain on Sale of Investment - -

441200 Gain on Sale of Property and Equipment - 13,633.32 11.2 11.2 Less: Investment Expenses

11.2.1 11.2.1 Investment Management Fees - - 11.2.2 11.2.2 Depreciation on Property Investment - - 11.2.3 11.2.3 Other Investment Expenses - - 11.2.4 11.2.4 Total Investment Expenses - - - - - -

11.3 11.3 Net Returns from Investment 481,615 410,335 7,698 - 899,648 1,214,970

12 12 NET SURPLUS (DEFICIT) BEFORE OTHER REVENUE (EXPENSES) (3,236,936) 485,413 (810,441) - (3,561,964) (762,704)

13.0 13 Add (Less): Other Non-Operating Revenues (Expenses)

13.1 13.1 499999 Miscellaneous Income 35,002.01 35,002 5,564

13.2 13.2 -

14 14 Net Non-Operating Revenues (Expenses) 35,002 - - - 35,002 5,564

15 599999 Provision for Final Tax - - - - -

15 16 NET SURPLUS (DEFICIT) (3,201,934) 485,413 (810,441) - (3,526,962) (757,140)

16 17 ADD: 600000 OTHER COMPREHENSIVE REVENUES - 100,954 - - 100,954 162,096

16. 17.1 610000 Unrealized Gain on Financial Assets - -

17.2 LESS:650000 Unrealized Losses on Financial Assets - -

17.3 610009 Unrealized Gain on Financial AssetsOther Comprehensive Revenues 100,954 100,954 162,096.00

LESS: 510000 BENEFIT EXPENSES

SUMMARY OF OPERATIONS

GENERAL FUND

MUTUAL

BENEFIT

FUND

OPTIONAL

BENEFIT

FUND

(MICRO)

OPTIONAL

BENEFIT FUND

(REGULAR)

TOTAL FUND

CURRENT YEAR

TOTAL FUND

PREVIOUS YEAR

16.2 17.4 650009 Other Comprehensive Expenses - -

17 17 (3,201,934) 586,367 (810,441) - (3,426,008) (595,044)


1) Legend:



NET COMPREHENSIVE SURPLUS (DEFICIT)

A/S FOR YEAR ENDED 12/31/2020 OF PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INCPAGE 5

CHANGES IN FUND BALANCE

CHANGES IN FUND BALANCE

FUND CODE===> GenF MBF OBmi OBregMicroinsurance, Regular, or Both? Set in sheet p2b===> mix mi mi reg

FUND BALANCE FROM OPERATIONS

1 Fund Balance from Operations, Beginning of the year 1,142,230.35 27,192,642.88 2,236,008.76 30,570,881.99 29,999,446.63

2 Net Surplus (Deficit) before Investment Returns - -

3 Other Comprehensive Surplus 100,953.89 100,953.89 571,435.36

4 Fund Balance from operations, End of the year 1,142,230.35 27,293,596.77 2,236,008.76 - 30,671,835.88 30,570,881.99

FUND BALANCE FROM INVESTMENT ACTIVITIES

5 Fund Balance from Investment Activities, Beginning of the year -

6 Net Returns from Investment -

7 Fund Balance from Investment Activities, End of the year - - - - - -

TOTAL FUND BALANCE

8 Fund Balance, Beginning of the year 2,643,210.69- 32,167,626.13 4,269,159.47 33,793,574.91 33,993,974.57

9 Net Surplus (Deficit) from operations 3,101,384.67- 452,525.31 878,102.53- 3,526,961.89- 595,044.66-

10 Net Returns from Investment -

11 Other Comprehensive Surplus - 411,435.36

12 PRIOR YEAR ADJUSTMENTS -

13 FUND BALANCE, END OF THE YEAR (Page2, line 2.62) 5,744,595.36- 32,620,151.44 3,391,056.94 - 30,266,613.02 33,810,365.27

check: - - - -


1) Legend:

Enter data in cells with black font and light tan background, as applicable

Cells with blue font and gray background may be linked to other areas in the workbook and are READ-ONLY.

TOTAL FUND

PREVIOUS

YEAR

GENERAL

FUND

MUTUAL

BENEFIT FUND

OPTIONAL

BENEFIT

FUND

(MICRO)

OPTIONAL

BENEFIT

FUND

(REGULAR)

TOTAL FUND

CURRENT

YEAR

A/S FOR YEAR ENDED 12/31/2020 OF PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC PAGE 6

RECEIPTS



1. CASH FLOWS FROM OPERATING ACTIVITIES

2. Net comprehensive surplus for the year (page 4 line 17) (3,201,934) 485,413 (810,441) - (3,526,962) (595,044)

3. Add: Depreciation (page 4 line 9.20) 827,536 - - - 827,536 830,623

4. Less: Net Returns from Investment (page 4 line 11.3) (481,615) (410,335) (7,698) - (899,648) (1,214,970)

5. Operating revenue before working capital changes (2,856,012.97) 75,077.87 (818,139.01) - (3,599,074.11) (979,390.79)

6. Changes in assets and liabilities:

6.1. Decrease (increase) in assets:

Current

6.1.1. 114100 Members' Fees and Dues Receivable -

6.1.2. 114200 Members' Contributions Due and Uncollected -

6.1.3. 114300 Other Loans Receivable -

6.1.4. 114400 Unremitted Members' Contributions, Dues and Fees -

6.1.5. 114500 Unremitted Premiums -

6.1.6. 114600 Amounts Recoverable from Reinsurers - net - 67,000

6.1.7. 114700 Members' Assessment Receivable - net -

6.1.8. 114800 Accrued Income 512,274 512,274 (319,057)

6.1.9. 114900 Other Current Receivables - net 22,965 (57,748) (34,783)

6.1.10 114910 Advances to Officers and Employees 50,000 50,000 (54,300)

6.1.11. 114920 Due from Officers and Employees -

6.1.12. 114930 Lease Receivables -

6.1.13. 114940 Receivable - Others - net - 3,787,282

6.1.14. 115000 Due to/ from Other Funds -

6.1.15. 116000 Prepayments and Other Current Assets -

6.1.16. 116100 Prepaid Expenses -

6.1.17 116200 Unused Stationery and Supplies (40,877) (40,877) (21,507)

6.1.18. 116300 Other Current Assets - 317,840

Non- Current -

6.1.19. 131000 Loans Receivable -net -

6.1.15. 131100 Membership Certificate Loans - net -

6.1.16. 131200 Policy Loans - net -

6.1.17. 131300 Other Loans Receivable - net -

6.1.18. 171000 Other Non- Current Assets -

6.1.19. 171200 Rental Deposit -

6.1.20. 171300 Foreclosed Properties - net -

6.1.21. 171500 Net Pension Asset -

6.1.22. 171600 Miscellaneous non-current assets -

6.2. Increase (decrease) in liabilities:

Current

6.2.1. 211000 Liability on Individual Equity Value (4,424,520) (4,424,520) (957,812)

6.2.2. 212000 Basic Contingent Benefit Reserve (18,758) (18,758) (82,618)

6.2.3. 213000 Optional Benefit Reserve 167,862 167,862 (2,023,395)

6.2.4. 214000 Claims Payable on Basic Contingent Benefit (131,942) (131,942) 3,129

6.2.5. 215000 Claims Payable on Optional Benefit -

6.2.6. 216000 Other Benefits Payable on Basic Policies -

6.2.7. 217000 Other Benefits Payable on Optional Policies -

6.2.8. 221000 Members' Contributions Received in Advance - Current - (441,476)

6.2.9. 222000 Premiums Received in Advance - Current -

6.2.10. 223000 Unearned Income -

6.2.11. 224000 Amount Due to Reinsurers -

6.2.12. 226000 Accounts Payable 38,498 367,575 406,073 (365,943)

6.2.13. 226500 Other Accounts Payable -

6.2.14. 231000 Accrued Expenses -

Non-Current -

6.2.16. 251000 Members' Contribution Received in Advance - Non-current (105,896) (105,896)

6.2.17. 252000 Premiums Received in Advance -

6.2.18. 253000 Net Pension Liability -

6.2.19. 255000 Other Long-term Liabilities -

7. Cash provided by operations (2,785,426.97) (3,783,937.13) (650,277.01) - (7,219,641.11) (1,070,247.79)

8. Add: Net Returns from Investment (page 4 line 11.3) 481,614.72 410,335.28 7,698.14 - 899,648.14 1,201,336.47

9. Net cash provided by operationg activities (2,303,812.25) (3,373,601.85) (642,578.87) - (6,319,992.97) 131,088.68

10. CASH FLOWS FROM INVESTING ACTIVITIES

10.1. Acquisition of:

Current

10.1.1. 112100 FAAC - Investment in Bonds/ Debt Securities -

10.1.2. 113100 FAFV (P & L) - Investment in Bonds/ Debt Securities -

10.1.3. 113200 FAFV (P & L) - Investment in Stocks/ Equities -

10.1.4 117000 Short - term Financial Asset (5,029,156) (5,029,156)

Non- Current


10.1.6. 122100 FAFV (OCI) - Investment in Bonds/ Debt Securities -

10.1.7. 122200 FAFV (OCI) - Investment in Stocks/ Equities -

10.1.8. 122300FAFV (OCI) - Mutual, Unit Investment Trust, Real Estate Unit

Ivestment Trust, Other Funds (200,696) (200,696)

10.1.9. 141000 Investment in Associates -

10.1.10. 142000 Investment in Subsidiaries -

10.1.11. 143000 Investment in Joint Venture -

10.1.12. 151000 Investment in Property -

10.1.13. 161000 Property and Equipment (31,300) (31,300) (4,500)

10.2. Sale/ Disposal of:

Current

10.2.1. 112100 FAAC - Investment in Bonds/ Debt Securities - 10,620,463

10.2.2. 113100 FAFV (P & L) - Investment in Bonds/ Debt Securities - (335,879)

10.2.3. 113200 FAFV (P & L) - Investment in Stocks/ Equities -

Non- Current


10.2.5. 122100 FAFV (OCI) - Investment in Bonds/ Debt Securities - 713,104

10.2.6. 122200 FAFV (OCI) - Investment in Stocks/ Equities -

10.2.7 122300FAFV (OCI) - Mutual, Unit Investment Trust, Real Estate Unit

Ivestment Trust, Other Funds-

10.2.8. 141000 Investment in Associates -

10.2.9. 142000 Investment in Subsidiaries -

10.2.10. 143000 Investment in Joint Venture -

10.2.11. 151000 Investment in Property -

10.2.12. 161000 Property and Equipment - - 25,000

11 Net cash used in investing activities (31,300.00) (5,229,852.00) - - (5,261,152.00) 11,018,188.00

CASH FLOWS

GENERAL

FUND

MUTUAL

BENEFIT FUND

OPTIONAL

BENEFIT

FUND

(MICRO)

OPTIONAL

BENEFIT FUND

(REGULAR)

TOTAL FUND

CURRENT YEAR

TOTAL FUND

PREVIOUS YEAR

12. CASH FLOWS FROM FINANCING ACTIVITIES

12.1. Decrease (increase) in assets:

12.1.1. Net (Decrease) increase in appropriated Special Fund (160,000) (160,000) (160,000)

12.1.1. Increase in Contibution to Guaranty Fund 25,123 17,132 42,255 571,435

12.2. Increase (decrease) in liabilities:

Current

12.2.1. 225000 Loans Payable - Current -

Non-Current

12.2.5. 254000 Long-Term Loans Payable -

13 Net cash used in financing activities - (134,877.07) 17,131.57 - (117,745.50) 411,435.00

14 NET INCREASE IN CASH (2,335,112.25) (8,738,330.92) (625,447.30) - (11,698,890.47) 11,560,711.68

15 CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR (8,881,241) 40,474,481 6,110,640 - 37,703,880 26,143,168

16 CASH AND CASH EQUIVALENTS, END OF YEAR (11,216,353.69) 31,736,150.36 5,485,192.85 - 26,004,989.52 37,703,879.68


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2) Legend:



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======== ============== ======================================================= ================ ================ ============= =============== ================ =================

A/S FOR YEAR ENDED December 31, 2020 OF PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

PARTICULARS

FUND CODE===>

Microinsurance, Regular, or Both? Set in sheet p2b===>

1 NET INVESTMENT INCOME (Net Return from Investments-Page 4, Line 11.3)

2 Net Invested Assets previous year

3 Net Invested Assets current year

4 Net Investment Yield Rate = (2 X Item 1)/((Item 2+Item3)-Item 1)



2) Legend:



NET INVESTMENT INCOME

EXHIBIT 1 (PAGE 7)


GenF MBF OBmi OBreg

mix mi mi reg

481,614.72 410,335.28 7,698.14 - 899,648.14

1,460,430.47 40,581,531.39 5,870,934.80 47,912,896.66

6,633,517.41 30,015,381.71 4,202,901.11 - 40,851,800.23

6.327% 0.585% 0.076% 0.000% 1.024%

9,999.00


NET INVESTMENT INCOME

GENERAL

FUND

MUTUAL

BENEFIT FUND

OPTIONAL

BENEFIT

FUND

(MICRO)

OPTIONAL

BENEFIT

FUND

(REGULAR)

TOTAL FUND

CURRENT

YEAR

EXHIBIT 2 (PAGE 8)


Collected Earned

Collected Unearned Due Earned but earned Current Non

During the and and but not yet Previous Year Admitted Admitted

Year Collected Uncollected due Years (1-2+3+4-5-6) (for RBC) (for RBC)

(1) (2) (3) (4) (6) (7) (8) (9)

1a. Interest on Bonds (totals from sched A) 52,931 52,931 1,468.75

1b. …amount allocated to microinsurance (totals from sched A) - -

2a. Interest on T-Bills (totals from sched B) 638,677 638,677 -

2b. …amount allocated to microinsurance (totals from sched B) - -

3a. Dividends on Stocks (totals from sched C) 122,450 122,450 -

3b. …amount allocated to microinsurance (totals from sched C) - -

4a. Income on Real Estate (totals from sched D) - -

4b. …amount allocated to microinsurance (totals from sched D) - -

5a. Income from Cash and Cash Equivalents (totals from sched E) 85,590 85,590 -

5b. …amount allocated to microinsurance (totals from sched E) - -

6.

0 6. Other Income (Specify)

6.

1 6.1 Loan Receivable

6.

2 6.2

6.

3 6.3

6.

5 7 Totals 899,648.14 - - - - 899,648.14 1,468.75 -

NOTE :

1. INTEREST INCOME WAS BOOKED AT 100% EXCEPT FOR LONG TERM TIME DEPOSITES BUT ACCRUAL OF INTEREST PER BALANCE SHEET IS AT 80% EXCEPT FOR DOLLAR TIME DEPOSIT (NET OF 20% FINAL TAX).

2. RECORDED EARNED BUT NOT YET DUE AMOUNT FOR STOCKS ARE NOT RECORDED AS ACCRUED INTEREST INCOME B'COZ IT IS ALREADY TAKE UP IN THE BALANCES OF INVESTMENT IN ASSOCIATES.

3. UNEARNED INCOME DOES NOT REFLECT THE DUE TO THERE ARE BALANCES THAT ARE PREVIOUSLY RECORDED AS UNEARNED INCOME FOR RENTALS.



2) Legend:



Current year Accrued Income

PARTICULARS

INTEREST, DIVIDENDS, AND OTHER INVESTMENT INCOME


RESERVE LIABILITIES

RESERVE DESCRIPTION

A A. Basic Contingent Benefits Reserve 17,960 / 17,960

B. B. Optional products

B.1 B.1 Regular

B.1.1.0 B.1.1 Individual Plans

B.1.1.1 B.1.1.1

B.1.1.2 B.1.1.2

B.1.1.3 B.1.1.3

B.1.1.4 B.1.1.4

B.1.1.5 B.1.1.5

B.1.2.0 B.1.2 Group Plans

B.1.2.1 B.1.2.1 CREDIT LIFE 1 / 1,733

B.1.2.2 B.1.2.2

B.1.2.3 B.1.2.3 HAPI PLAN 10,840 /10,840

B.1.2.4 B.1.2.4

B.1.2.5 B.1.2.5

B.1.2.6 B.1.2.6

B.1.2.7 B.1.2.7

B.2 B.2 Regular

B.2.1.0 B.2.1 Individual Plans

B.2.1.1 B.2.1.1

B.2.1.2 B.2.1.2

B.2.1.3 B.2.1.3

B.2.2.0 B.2.2 Group Plans

B.2.2.1 B.2.2.1

B.2.2.2 B.2.2.2

B.2.2.3 B.2.2.3

D. D. TOTALS xxxxxxxxxxxxxx

Number of

Policies /

Certificates


RESERVE LIABILITIES

502,459 502,459 616,573,000 616,573,000 6,579

72,018 72,018 111,408,111 111,408,111 486,058

270,613 270,613 58,536,000 58,536,000 75,686

845,090 845,090 786,517,111 786,517,111 568,324

2) For RBC C2, classify life and annuity products as:

C2inp - Individual Life, non-par

C2ip - Individual Life, par or adjustable premium

C2gbl - group, basic life business

C2gcl - group, credit life business

C2la - Life Annuity

C2da - Disability - active, all types including TPD

C2dd - Disability, disabled lives

C2acc - Accident

C2h - Health

C2ah - Accident & Health

C2ci - Critical Illness

C2o - Other risks

Gross PremiumPremium net of

cession

Face Amount

gross of

reinsurance

Face Amount net

of reinsurance

Reserves,

gross of

reinsurance

EXHIBIT 3 (PAGE 9)

6,579

486,058

75,686

568,324 x x x x x x x

2) For RBC C2, classify life and annuity products as:

C2inp - Individual Life, non-par

C2ip - Individual Life, par or adjustable premium

C2gbl - group, basic life business

C2gcl - group, credit life business

C2la - Life Annuity

C2da - Disability - active, all types including TPD

C2dd - Disability, disabled lives

C2acc - Accident

C2ah - Accident & Health

C2ci - Critical Illness

C2o - Other risks

Reserves, net

of

reinsurance

RBC code

(note 3)

EXHIBIT 4 (PAGE 10)


A 1 111000 Cash and Cash Equivalents 26,004,991 - - 26,004,991

111100 Cash on Hand 10,000 - - 10,000

111200 Petty Cash Fund 2,000 - - 2,000

111300 Cash in Banks 22,579,941 - - 22,579,941

111400 Cash Equivalents 3,413,050 - - 3,413,050

A 2 112000 Financial Assets at Amortized Cost (FAAC) 17,237,445.62 - - 17,237,445.62

112100 FAAC - Investment in Bonds/Debt Securities- CURRENT - - - -

112110 Investment in Bonds- Government Securities - - - -

112120 Investment in Bonds- Corporate Issues - - - -

112130 Investment in Bonds- Others (ie. Foreign Issues) - - - -

121100 FAAC - Investment in Bonds/Debt Securities- NON CURRENT 17,237,446 - - 17,237,446

121110 Investment in Bonds- Government Securities 12,237,446 - - 12,237,446

121120 Investment in Bonds- Corporate Issues 5,000,000 - - 5,000,000

121130 Investment in Bonds- Others (ie. Foreign Issues) - - - -

A 3 122000 Financial Assets at Fair Value (FAFV)-Other Comprehensive Income 2,281,332.51 - - 2,281,332.51

122100 FAFV (OCI)-Investment in Bonds/Debt Securities - - - -

122110 Investment in Bonds/Debt Securities- Government Securities - - - -

122120 Investment in Bonds/Debt Securities- Corporate Issues - - - -

122130 Investment in Bonds/Debt Securities- Others (ie. Foreign Issues) - - - -

122200 FAFV (OCI) - Investment in Stocks/Equities - - - -

122210 FAFV (OCI) Investment in Stocks/Equities- Common/Ordinary - - - -

122220 FAFV (OCI) Investment in Stocks/Equities- Preferred/Preference - - - -

122230 FAFV (OCI) Investment in Stocks/Equities- Others (ie. Foreign ) - - - -

122300 FAFV (OCI) - Mutual, Unit Investment Trust, Real Estate Investment Trusts and Other Funds2,281,333 - - 2,281,333

A 4 113000 Financial Assets at Fair Value (FAFV)- Profit and Loss (P&L) 431,130.33 - - 431,130.33

113100 FAFV (P&L) - Investment in Bonds/Debt Securities - - - -

113110 FAFV (P&L) Investment in Bonds- Government Securities - - - -

113120 FAFV (P&L) Investment in Bonds- Corporate Issues - - - -

113130 FAFV (P&L) Investment in Bonds- Others (ie. Foreign Issues) - - - -

113200 FAFV (P&L) - Investment in Stocks/Equities - - - -

113210 FAFV (P&L) Investment in Stocks/Equities- Common/Ordinary - - - -

113220 FAFV (P&L) Investment in Stocks/Equities- Preferred/Preference - - - -

113230 FAFV (P&L) Investment in Stocks/Equities- Others (ie. Foreign ) - - - -

113300 FAFV (P&L) - Mutual, Unit Investment Trust, Real Estate Investment Trusts and Other Funds431,130 - - 431,130

A 5 114100 **Member's Fees and Dues Receivable - - - -

A 6 114200 **Member's Contributions Due and Uncollected - - - -

114300 ***Net Premiums Due and Uncollected - - - -

A 8 114400 ***Unremitted Member's Contributions, Dues and Fees 52,167 - - 52,167

A 9 114500 ***Unremitted Premiums 5,004 - - 5,004

A 10 114600 Net Amounts Recoverable from Reinsurers - - - -

114600 Amounts Recoverable from Reinsurers 626,300 - 626,300 -

114610 Allowance for Probable Losses-Reinsurers (626,300) - (626,300) -

A 11 114700 Net Members'Assessment Receivable - - - -

A 12 114800 Accrued Income 1,468.75 - - 1,468.75

114810 Accrued Interest Income 1,469 - - 1,469

Accrued Interest Income -Cash and Cash Equivalents 1,469 - 1,469

Accrued Interest Income -Bonds - - -

Accrued Interest Income -Mutual, Unit Investment Trust Fund, Real Estate Investment Trust and Other Funds- - -

Accrued Interest Income -Short Term Financial Asset - - -

114820 Accrued Dividend Income - - - -

Accrued Dividend Income- Common/Ordinary Shares - - -

Accrued Dividend Income- Preferred/ Preference Shares - - -

Accrued Dividend Income- Others - - -

114830 Other Accrued Income - - - -

A 13 114900 Other Current Receivables- NET 9,246,299 - - 9,246,299

114910 Advances to Officers and Employees 1,980 - - 1,980

114920 Due from Officers and Employees - - - -

114930 Lease Receivables - - - -

114940 Other Receivables 9,244,319 - - 9,244,319

A 14 115000 Due to/From Other Funds - - - -

A 15 116000 Prepayments and Other Current Assets 81,584.25 - - 81,584.25

116100 Prepaid Expenses - - - -

116200 Unused Stationery and Supplies 81,584 - - 81,584

116300 Other Assets - - - -

A 16 117000 Short-term Financial Assets 5,029,156 - - 5,029,156

A 17 131000 Loans Receivables- NET - - - -

131100 Membership Certificate Loans - - - -

131200 Policy Loans - - - -

131300 Other Loans - - - -

A 18 141000 Investment in Associates - - - -

A 19 142000 Investment in Subsidiaries - - - -

A 20 143000 Investment in Joint Venture - - - -

A 21 151000 Investment In Property- NET - - - -

151100 Investment Property - Land - - - -

151210 Investment Property- Building(s) - - - -

151220 Investment Property- Building Improvements - - - -

151310 Investment Property-Under Construction- Building - - - -

151320 Investment Property-Under Construction- Building Improvements - - - -

A 22 161000 Property and Equipment NET 6,953,930.42 - - 6,953,930.42

161100 Land 1,429,310.00 - - 1,429,310

161210 Building 3,680,000.00 - - 3,680,000

161220 Building Improvements - - - -

161300 Leasehold Improvements - - - -

161400 IT Equipments 1,001,583.02 - - 1,001,583

161500 Transportation Equipments 809,149.90 - - 809,150

161600 Office Furniture and Fixtures 33,887.50 - - 33,888

161700 Other Equipments - - - -

A 23 171000 Other Non-Current Assets - - - -

171100 Other Funds and Deposits - - - -

171200 Rental Deposits - - - -

171300 Foreclosed Properties, Net - - - -

171500 Net Pension Asset - - - -

171600 Miscellaneous Non-Current Assets - - - -

A 24 181000 Right of Use Assets, Net - - - -

TOTAL ASSETS 67,324,509 - - 67,324,509


1) All contra asset accounts such as allowances and depreciations should be presented in a negative balance.

2) Legend:



3.) ** The sum of the two accounts should equal to page 29 column 14 Line 1.2

4.) *** The sum of the two accounts should equal to page 30 column 20 Line 1.2

LEDGER

ASSETS

NON-LEDGER

ASSETS

NON-

ADMITTED

ASSETS

NET

ADMITTED

ASSETS ASSETS

EXHIBIT 5 (PAGE 11)


L 1 211000 Liability on individual equity value 35,250,166.12 - 35,250,166.12

L 2 212000 Basic contingency benefits reserve 6,579.30 - 6,579.30

L 3 213000 Optional benefit reserve 561,744.89 - 561,744.89

213100 Optional Benefit Reserve- Regular

213200 Optional Benefit Reserve- Micro 561,744.89 561,745

L 4 214000 Claims payable on basic contingent benefit 43,186.28 - 43,186.28

214100 Due and Unpaid

214200 In course of Settlement

214300 Claims Resisted

214400 Incurred But not yet Reported (IBNR) 43,186.28 43,186

L 5 215000 Claims payable on optional benefits 370,254.89 - 370,254.89

215100 Optional Benefit Reserve- Regular - - -




215340 Incurred But not yet Reported (IBNR) -

215200 Optional Benefit Reserve- Micro 370,255 - 370,255




215340 Incurred But not yet Reported (IBNR) 370,254.89 370,255

L 6 216000 Other benefits on Basic Policies - - -

L 7 217000 Other Benefits on Optional Policies - - -

217100 Other Benefits on Optional Policies- Regular

217200 Other Benefits on Optional Policies- Micro

L 8 221000 Members Contributions Received in Advance - current 46,666.32 - 46,666.32

L 9 251000 Members Contributions Received in Advance - Non- current - - -

L 10 222000 Premiums Received in Advance - - -

222100 Premiums Received in Advance-Current- Regular

222200 Premiums Received in Advance-Current- Micro

252100 Premiums Received in Advance-Non- current- Regular

252200 Premiums Received in Advance-Non- current- Micro

L 11 223000 Unearned Income - - -

L 12 224000 Amount due to Reinsurers - - -

L 13 225000 Loans Payable - Current - - -

L 14 226000 Accounts Payable 779,297.85 - 779,297.85

226100 Accounts Payable- Minor Beneficiary

226200 Withholding Taxes Payable

226300 SSS/ECC/Pag-ibig/Philheath Contributions payable

226400 SSS/Pag-ibig loan payable

226500 Other Accounts Payable 779,297.85 779,297.85

L 15 227000 Grants Held in Trust

L 16 231000 Accrued Expenses - - -

231100 Accrued Utilities - -

231200 Accrued Services

231300 Accrual for Unused Compensated Absences

231400 Accrued Interest Expenses

231500 Other Accrued Expenses

L 17 252000 Members Contribution Received in Advance - optional-non-current

L 18 253000 Net Pension Liability - - -

L 19 254000 Long-Term Loans Payable - - -

L 20 255000 Lease Liability

L 21 256000 Other Long-Term Liabilities - - -

TOTAL LIABILITIES 37,057,896 - 37,057,896

F 22 320000 Assigned Fund Balance 15,934,667.58 - 15,934,667.58

321000 Funds Assigned for Guaranty Fund 12,254,668 - 12,254,668

322000 Funds Assigned for Members' Benefits 3,680,000 - 3,680,000

322100 Incremental Benefit for Individual Equity Value

322200 Education and Training

322300 Other Members'Benefit 3,680,000.00 3,680,000

323000 Funds Assigned for Community Development

Sub-total Assigned Fund Balance 19,614,668 - 19,614,668

F 23 310000 Free and Unassigned Fund Balance 14,050,612.93 - 14,050,612.93

F 24 330000 Revaluation Increment (net of changes) 281,332.51 - 281,332.51

300000 TOTAL FUND BALANCE 30,266,613 - 30,266,613

TOTAL LIABILITIES AND FUND BALANCE 67,324,509 - 67,324,509



2) Legend:



TOTAL

LEDGER

LIABILITIES

FUND BALANCE

LEDGER

LIABILITIES

NON-

LEDGER

LIABILITIES



PARTICULARS

1. Total Verified Liabilities

2. Multiply by: Required limit

20% thereof

3. Free and Unassigned Fund Balance per Association

3. Excess


1) Legend:



FREE AND UNASSIGNED FUND BALANCE

EXHIBIT 6 (PAGE 12)


37,057,895.65 41,165,077

7,411,579.13 8,233,015.47

14,050,612.93 17,739,670.82

6,639,033.80 9,506,655.35


FREE AND UNASSIGNED FUND BALANCE

CURRENT YEAR PREVIOUS YEAR


PARTICULARS

FUND CODE===>

Microinsurance, Regular, or Both? Set in sheet p2b===>

1. Guaranty Fund, beginning of the year

2. Add: Required increase

2.1 Members' Contributions/Premiums for the year

2.2 5% thereof

3. Guaranty Fund, End of the year

Deposited under Insurance Commission (Investment Services Division) (Note 3)

Type

(Note 4) Serial Number Value Date Date Issued

1 Time Deposit 207919 11/15/2018 11/15/2018

2 Treasury BondsPIID0321F092 12/03/2018 12/03/2018

3

4

5



2) Legend:



3) Insert rows for additional rows needed

4) Indicate the type (e.g Time Deposit, Investment in Bonds, Held to Maturity)

GUARANTY FUND


25,122.94 17,131.57

GenF MBF OBmi OBreg

mix mi mi reg

10,702,892 1,509,521

- 502,459 342,631 -

- 25,123 17,132 -

- 10,728,014.68 1,526,652.91 -

Deposited under Insurance Commission (Investment Services Division) (Note 3)

Maturity Date Face Value Fair Market Value Amortized Costs

Automatic Renew 1,000,000 1,013,050 1,013,050

06/13/2021 12,256,000 12,237,446 12,237,446

13,256,000 13,250,496 13,250,496

Measurement @ Face Value 13,256,000

Measurement @ Fair Market Value 13,250,496

Measurement @ Amortized Costs 13,250,496

Guaranty Fund per Book 12,254,668

Difference 995,828

9,999.00


GUARANTY FUND

GENERAL FUND

MUTUAL

BENEFIT FUND

OPTIONAL

BENEFIT FUND

(MICRO)

OPTIONAL

BENEFIT FUND

(REGULAR)

EXHIBIT 7 (PAGE 13)

12,212,413 11,640,978

845,090 11,157,701

42,255 557,885

12,254,667.59 12,198,863.27

GUARANTY FUND

TOTAL FUND

CURRENT YEAR

TOTAL FUND

PREVIOUS YEAR

EXHIBIT 8 (PAGE 14)

IV. BUSINESS DONE

No. of PoliciesNo. of

Certificates

No. of Members

(Insured Lives)

Amount of

InsuranceNo. of Policies

No. of

Certificates

No. of Members

(Insured Lives)No. of Dependents

Total Amount of


No. of

Certificates

No. of Members


Total Amount of

Insurance(1) (2) (3) (4) (5) (6) (7) (8) (9) (1 +5) (2 + 6) (3 + 7) (8) (4 + 9)

1) Beginning Balance - - - - 44,355.00 44,355.00 41,508.00 64,917.00 1,204,585,431.15 44,355.00 44,355.00 41,508.00 64,917.00 1,204,585,431.15

2) New Business - - - - - - - - - - - - - -

a. New Issues - - - - 1,192.00 1,192.00 1,192.00 2,275.00 18,420,500.00 1,192.00 1,192.00 1,192.00 18,420,500.00

b. Renewal - - - - - - - - - - - - - -

c. Reinstated - - - - - - - - - - - - - -

d. Others - - - - - - - - - - - - - -

Total New Business - - - - 1192 1192 1192 2275 18,420,500.00 1,192.00 1,192.00 1,192.00 - 18,420,500.00

3 )Terminations - - - - - - - - - - - - - -

a. Deaths - - - - 14.00 14.00 14.00 28.00 475,000.00 14.00 14.00 14.00 28.00 475,014.00

b. Surrenders - - - - 2,705.00 2,705.00 2,705.00 8,115.00 102,698,000.00 2,705.00 2,705.00 2,705.00 8,115.00 102,700,705.00

c. Lapsed - - - - 5,808.00 5,808.00 5,808.00 23,272.00 244,408,000.00 5,808.00 5,808.00 5,808.00 23,272.00 244,413,808.00

d. Matured - - - - 2,448.00 2,448.00 - - 147,443,819.70 2,448.00 2,448.00 - - 147,446,267.70

e. Others - - - - - - - - - - - - - -

Total terminations - - - - 10975 10975 8527 31415 495,024,819.70 10,975.00 10,975.00 8,527.00 31,415.00 495,035,794.70

4) Total of In-force policies as

of the end of the Year

(line1 + line2 - line3) - - - - 34572 34572 34173 35777 727,981,111.45 34,572.00 34,572.00 34,173.00 33,502.00 727,970,136.45


Certificates

No. of Members

(Insured Lives)

Amount of


No. of

Certificates

No. of Members


Total Amount of


No. of

Certificates

No. of Members


Total Amount of

Insurance(1) (2) (3) (4) (5) (6) (7) (8) (9) (1 +5) (2 + 6) (3 + 7) (8) (4 + 9)

1) Beginning Balance 26,032.00 26,032.00 26,032.00 64,917.00 958,796,000.00 26,032.00 26,032.00 26,032.00 64,917.00 958,796,000.00

2) New Business

a. New Issues 455.00 455.00 455.00 2,275.00 5,358,000.00 455.00 455.00 455.00 2,275.00 5,358,000.00

b. Renewal

c. Reinstated

d. Others

Total New Business - - - - 455.00 455.00 455.00 2,275.00 5,358,000.00 455.00 455.00 455.00 2,275.00 5,358,000.00

3 )Terminations

a. Deaths 14 14 14 28 475,000.00 14 14 14 28 475,000.00

b. Surrenders 2705 2705 2705 8115 102,698,000.00 2705 2705 2705 8115

c. Lapsed 5808 5808 5808 23272 244,408,000.00 5808 5808 5808 23272

d. Matured

e. Others

Total terminations - - - - 8,527.00 8,527.00 8,527.00 31,415.00 347,581,000.00 8,527.00 8,527.00 8,527.00 31,415.00 475,000.00

A. Basic Fund INDIVIDUAL INSURANCE GROUP INSURANCE T O T A L

A/S FOR YEAR ENDED 12/31/2020 OF MUTUAL BENEFIT ASSOCIATION,INC

Total FundINDIVIDUAL INSURANCE GROUP INSURANCE T O T A L

4) Total of Basic In-force

policies as of the end of the

Year

(line1 + line2 - line3) - - - - 17,960.00 17,960.00 17,960.00 35,777.00 616,573,000.00 17,960.00 17,960.00 17,960.00 35,777.00 963,679,000.00

616,573,000 -


Certificates

No. of Members

(Insured Lives)

Amount of


No. of

Certificates

No. of Members


Total Amount of


No. of

Certificates

No. of Members


Total Amount of

Insurance(1) (2) (3) (4) (5) (6) (7) (8) (9) (1 +5) (2 + 6) (3 + 7) (8) (4 + 9)

CREDIT LIFE INSURANCE

1) Beginning Balance 18,323.00 18,323.00 15,476.00 245,789,431.15 149,560,331.15

2) New Business

a. New Issues 737.00 737.00 737.00 13,062,500.00 13,062,500.00

b. Renewal

c. Reinstated

d. Others

Total New Business - - - - 737.00 737.00 737.00 - 13,062,500.00 - - - - 13,062,500.00

3 )Terminations

a. Deaths

b. Surrenders

c. Lapsed

d. Matured 2,448.00 2,448.00 147,443,819.70 147,443,819.70

e. Others

Total terminations - - - - 2,448.00 2,448.00 - - 147,443,819.70 - - - - 147,443,819.70

B. Optional Fund

CLIP

INDIVIDUAL INSURANCE GROUP INSURANCE T O T A L

MBA NAME:PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

YEAR ENDEDDecember 31,2020

Showing All Balances (According to MBA Records) Carried In Each Bankor Trust Company on the Last Day of Each Month of the Current Year

MONTHLY BALANCES OF ACCOUNTS FOR CALENDAR YEAR 2019- Translated in PHP

ORIGINAL Incumbrance January February March April May June July August September October November December Ledger Non-Ledger NOT NET RBC FUND

ACCOUNT NAME AND LOCATION OF BANK BANK ACCOUNT CURRENCY Assets Assets Admitted Admitted code code

CODE OR TRUST COMPANY NUMBER (In Peso

or Foreign)

( 1 ) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22)

CASH ON HAND

GRACELYN G. SEBELRO 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 CoH GenF

-

-

Sub-Total Microinsurance xxxxxxxxxxx - - - - - - - - - - - - - - - - - xxxxxxxxxxxxxxxxxxxxxx

# Total Cash on Hand xxxxxxxxxxx - 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 - - 10,000.00 xxxxxxxxxxxxxxxxxxxxxx

PETTY CASH FUND

PBC MBAI_PETTY CASH FUND_GRACELYN G. SEBLERO 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000 2,000 2,000 2,000 CoH GenF

-

-

-

-

Sub-Total Microinsurance xxxxxxxxxxx - - - - - - - - - - - - - - - - - xxxxxxxxxxxxxxxxxxxxxx

# Total Petty Cash Fund xxxxxxxxxxx - 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 - - 2,000.00 xxxxxxxxxxxxxxxxxxxxxx

CASH IN BANKS (CIB)

a.) CIB-SAVINGS

LAND BANK OF THE PHILLIPINES - General Fund SA - San Francisco Branch 0971-2037-14 6,172,727.88 6,172,728 6,172,728 6,172,728 DepBT GenF

PHILIPPINES NATIONAL BANK-Regular Savings - San Franciso Branch 508839500015 3,440,786.89 3,440,787 3,440,787 3,440,787 DepBT MBF

BANK OF THE PHILIPPINE ISLANDS - Butuan Branch 008683-8162-57 50,499.42 50,512 50,512 50,512 DepBT MBF

METROBANK- San Francisco Branch 148-3-14816293-0 1,923,696.17 1,923,696 1,923,696 1,923,696 DepBT MBF

PSBC: PBC MBA MAIN - San Francisco Branch 004-21-0090598 225,528.68 225,529 225,529 225,529 DepBT MBF

PSBC: MBA CLIP MO - San Francisco Branch 004-21-0095499 887,678.77 887,679 887,679 887,679 DepBT Obmi

PSBC: HAPI, PLAN MAIN - San Francisco Branch 004-30-9000193 400,932.84 400,933 400,933 400,933 DepBT Obmi

PSBC: PBC MBA - GENERAL FUND - San Franciso Branch 004-30-9000126 324,570.35 324,570 324,570 324,570 DepBT GenF

PSBC: PBC-MUTUAL BENEFIT ASSOC.LIFE - Bayugan Branch 002-21-1019811 87,792.67 87,793 87,793 87,793 DepBT MBF

PSBC: PBC - MBA LIFE - Cabadbaran Branch 012-20-0000602 61,966.12 61,966 61,966 61,966 DepBT MBF

PSBC: PBC-MBA-LIFE - Compostela Branch 009-20-0004718 193,727.06 193,727 193,727 193,727 DepBT MBF

PSBC: PBC-MBA, LIFE - Digos Branch 011-20-0005615 1,405,212.05 1,405,212 1,405,212 1,405,212 DepBT MBF

PSBC: PBC MBA - LIFE - Kapalong Branch 010-21-0016957 270,114.73 270,115 270,115 270,115 DepBT MBF

PSBC: PBC-MBA, LIFE - Lupon Branch 007-21-0010227 392,516.47 392,516 392,516 392,516 DepBT MBF

PSBC: PBC-MBA, LIFE - Oroquieta Branch 008-20-0007930 617,939.14 618,251 618,251 618,251 DepBT MBF

PSBC: PBC MBA-LIFE - Prosperidad Branch 003-21-0000093 526,197.81 526,198 526,198 526,198 DepBT MBF

PSBC: PBC MBA-LIFE - Sibagat Branch 005-21-0021096 108,100.87 108,101 108,101 108,101 DepBT MBF

PSBC: PBC- MBA LIFE -Sta. Josefa Branch 006-21-5270204 263,684.26 263,684 263,684 263,684 DepBT MBF

PSBC: PBC MBA-LIFE - Talacogon Branch 001-21-0010157 66,070.85 66,071 66,071 66,071 DepBT MBF

PSBC: PBC-MBA, LIFE SF - San Francisco Branch 004-21-0093005 387,614.96 387,615 387,615 387,615 DepBT MBF

PSBC: PBC-MUTUAL BENEFIT ASSOC.CLIP - Bayugan Branch 002-21-102079-4 45,487.30 45,487 45,487 45,487 DepBT Obmi

PSBC: PBC - MBA CLIP COLLECTION - Cabadbaran Branch 012-30-0004028 32,050.19 32,050 32,050 32,050 DepBT Obmi

PSBC: PBC-MBA CLIP, COLLECTIONS - Digos Branch 011-20-000949-7 195,589.11 195,589 195,589 195,589 DepBT Obmi

PSBC: PBC-MBA CLIP COLLECTION - Prosperidad Branch 003-21-5100386 325,341.63 325,342 325,342 325,342 DepBT Obmi

PSBC: PBC MBA-CLIP COLLECTION - Sibagat Branch 005-21-0023577 30,886.06 30,886 30,886 30,886 DepBT Obmi

PSBC: PBC CLIP COLLECTION - Talacogon Branch 001-20-9002876 65,209.20 65,209 65,209 65,209 DepBT Obmi

PSBC: PBC-MUTUAL BENEFIT ASSOC.HAPI - Bayugan Branch 002-20-0103531 35,580.97 35,585 35,585 35,585 DepBT Obmi

PSBC: PBC - MBA HAPI - Cabadbaran Branch 012-21-5103892 40,757.27 40,757 40,757 40,757 DepBT Obmi

PSBC: PBCMBA HAPI PLAN - Compostela Branch 009-20-0104339 232,547.04 232,547 232,547 232,547 DepBT Obmi

PSBC: PBC MBA HAPI - Digos Branch 011-21-9000205 626,083.24 626,083 626,083 626,083 DepBT Obmi

PSBC: PBC-MBA HAPI - Kapalong Branch 010-21-5200080 300,192.69 300,193 300,193 300,193 DepBT Obmi

PSBC: PBC MBA HAPI - Lupon Branch 007-21-6100015 273,797.87 273,798 273,798 273,798 DepBT Obmi

PSBC: PBC-MBA HAPI - Prosperidad Branch 003-20-9907595 120,766.13 120,766 120,766 120,766 DepBT Obmi

PSBC: PBC MBA-HAPI - Sibagat Branch 005-21-9000535 117,280.47 117,280 117,280 117,280 DepBT Obmi

PSBC: BLIP CLAIMS - Sta. Josefa Branch 006-21-5270529 145,977.99 145,978 145,978 145,978 DepBT Obmi

PSBC: PBC MBA HAPI - Talacogon Branch 001-21-9908835 36,940.55 36,941 36,941 36,941 DepBT Obmi

PSBC: MBA-HAPI- SF - San Francisco Branch 004-20-9007790 279,254.89 279,255 279,255 279,255 DepBT Obmi

PSBC: PBC - MBA CAGWAIT 301-21-0000013 1,000.00 1,000 1,000 1,000 DepBT MBF

PSBC: PBC - MBA TANDAG 321-30-0001647 1,000.00 1,000 1,000 1,000 DepBT MBF

PSBC: PBC - MBA TALACOGON 318-20-0000092 1,000.00 1,000 1,000 1,000 DepBT MBF

PSBC: PBC - MBA LAPAZ 309-21-0006116 1,000.00 1,000 1,000 1,000 DepBT MBF

SCHEDULE OF CASH AND CASH EQUIVALENTS

Cash and Cash Equivalents

PAGE 13 27




MONTHLY BALANCES OF ACCOUNTS FOR CALENDAR YEAR 2019- Translated in PHP

ORIGINAL Incumbrance January February March April May June July August September October November December Ledger Non-Ledger NOT NET RBC FUND

ACCOUNT NAME AND LOCATION OF BANK BANK ACCOUNT CURRENCY Assets Assets Admitted Admitted code code

CODE OR TRUST COMPANY NUMBER (In Peso

or Foreign)

( 1 ) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22)


PSBC: PBC - MBA SAN LUIS 310-30-5401189 1,000.00 1,000 1,000 1,000 DepBT MBF

PSBC: PBC - MBA LIBERTAD 312-30-0025121 20,068.07 20,068 20,068 20,068 DepBT MBF

PSBC: PBC - MBA GINGOOG 302-30-0024885 20,039.33 20,052 20,052 20,052 DepBT MBF

PSBC: PBC - MBA MAWAB 306-30-0000017 20,024.62 20,025 20,025 20,025 DepBT MBF

PSBC PBC - MBA PANABO 315-21-0000017 1,000.00 1,000 1,000 1,000 DepBT MBF

PSBC: PBC - MBA MATI 314-20-0014430 1,000.00 1,000 1,000 1,000 DepBT MBF

- -

-

Sub-Total Microinsurance xxxxxxxxxxx - - - - - - - - - - - - 14,281,275.68 14,281,275.68 - - 14,281,275.68 xxxxxxxxxxxxxxxxxxxxxx

Sub-Total Cash in Bank- Savings xxxxxxxxxxx - - - - - - - - - - - - 20,778,573.91 20,778,573.91 - - 20,778,573.91 xxxxxxxxxxxxxxxxxxxxxx

c.) CIB-CURRENT

LAND BANK OF THE PHILLIPINES-Current - San Francisco Branch 0972-1222-20 1,776,367.08 1,776,367.08 1,776,367 1,776,367 DepBT MBF

ASIA UNITED BANK- SAN FRANCISCO BRANCH 330-01-000026-5 25,000.00 25,000.00 25,000 25,000 DepBT MBF

-

-

-

-

-

-

-

-

-

-

-


Sub-Total Cash in Bank- Current xxxxxxxxxxx - - - - - - - - - - - - 1,801,367.08 1,801,367.08 - - 1,801,367.08 xxxxxxxxxxxxxxxxxxxxxx


# Total Cash in Bank xxxxxxxxxxx - - - - - - - - - - - - 22,579,940.99 22,579,940.99 - - 22,579,940.99 xxxxxxxxxxxxxxxxxxxxxx

CASH EQUIVALENTS

a.) TIME DEPOSITS

PRODUCER SAVINGS BANK _OROQUIETA BRANCH 008-73-0000041 900,000.00 900,000 900,000 900,000 DepBT MBF

PRODUCER SAVINGS BANK _BAYUGAN BRANCH 002-73-0000097 1,500,000.00 1,500,000 1,500,000 1,500,000 DepBT MBF

LAND BANK OF THE PHILIPPINES 0973-0015-23 1,000,000.00 1,013,050 1,013,050 1,013,050 DepBT MBF

-

-

-


Sub-Total Time Deposits xxxxxxxxxxx - - - - - - - - - - - - 3,413,050.06 3,413,050.06 - - 3,413,050.06 xxxxxxxxxxxxxxxxxxxxxx

GRAND TOTAL Microinsurance - - - - - - - - - - - - 19,495,693 19,495,693 - - 19,495,693 xxxxxxxxxxxxxxxxxxxxxx

GRAND TOTALS- Cash and Cash Equivalents - 12,000 12,000 12,000 12,000 12,000 12,000 12,000 12,000 12,000 12,000 12,000 22,591,941 22,591,941 - - 22,591,941 xxxxxxxxxxxxxxxxxxxxxx


PAGE 13 28




ACCOUNT NAME AND LOCATION OF BANK

CODE OR TRUST COMPANY

( 1 )

CASH ON HAND

GRACELYN G. SEBELRO

Sub-Total Microinsurance

# Total Cash on Hand

PETTY CASH FUND

PBC MBAI_PETTY CASH FUND_GRACELYN G. SEBLERO


# Total Petty Cash Fund

CASH IN BANKS (CIB)

a.) CIB-SAVINGS

LAND BANK OF THE PHILLIPINES - General Fund SA - San Francisco Branch

PHILIPPINES NATIONAL BANK-Regular Savings - San Franciso Branch

BANK OF THE PHILIPPINE ISLANDS - Butuan Branch

METROBANK- San Francisco Branch

PSBC: PBC MBA MAIN - San Francisco Branch

PSBC: MBA CLIP MO - San Francisco Branch

PSBC: HAPI, PLAN MAIN - San Francisco Branch

PSBC: PBC MBA - GENERAL FUND - San Franciso Branch

PSBC: PBC-MUTUAL BENEFIT ASSOC.LIFE - Bayugan Branch

PSBC: PBC - MBA LIFE - Cabadbaran Branch

PSBC: PBC-MBA-LIFE - Compostela Branch

PSBC: PBC-MBA, LIFE - Digos Branch

PSBC: PBC MBA - LIFE - Kapalong Branch

PSBC: PBC-MBA, LIFE - Lupon Branch

PSBC: PBC-MBA, LIFE - Oroquieta Branch

PSBC: PBC MBA-LIFE - Prosperidad Branch

PSBC: PBC MBA-LIFE - Sibagat Branch

PSBC: PBC- MBA LIFE -Sta. Josefa Branch

PSBC: PBC MBA-LIFE - Talacogon Branch

PSBC: PBC-MBA, LIFE SF - San Francisco Branch

PSBC: PBC-MUTUAL BENEFIT ASSOC.CLIP - Bayugan Branch

PSBC: PBC - MBA CLIP COLLECTION - Cabadbaran Branch

PSBC: PBC-MBA CLIP, COLLECTIONS - Digos Branch

PSBC: PBC-MBA CLIP COLLECTION - Prosperidad Branch

PSBC: PBC MBA-CLIP COLLECTION - Sibagat Branch

PSBC: PBC CLIP COLLECTION - Talacogon Branch

PSBC: PBC-MUTUAL BENEFIT ASSOC.HAPI - Bayugan Branch

PSBC: PBC - MBA HAPI - Cabadbaran Branch

PSBC: PBCMBA HAPI PLAN - Compostela Branch

PSBC: PBC MBA HAPI - Digos Branch

PSBC: PBC-MBA HAPI - Kapalong Branch

PSBC: PBC MBA HAPI - Lupon Branch

PSBC: PBC-MBA HAPI - Prosperidad Branch

PSBC: PBC MBA-HAPI - Sibagat Branch

PSBC: BLIP CLAIMS - Sta. Josefa Branch

PSBC: PBC MBA HAPI - Talacogon Branch

PSBC: MBA-HAPI- SF - San Francisco Branch

PSBC: PBC - MBA CAGWAIT

PSBC: PBC - MBA TANDAG

PSBC: PBC - MBA TALACOGON

PSBC: PBC - MBA LAPAZ


Micro

insurance

True/False

(23)

mix

ERROR

ERROR

-

xxxxxxxxxxx

ERROR

mix

ERROR

ERROR

ERROR

ERROR

-

xxxxxxxxxxx

ERROR

mix

mi

mi

mi

mi

mi

mi

mix

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

miCash and Cash Equivalents

PAGE 13 29






( 1 )

CASH ON HAND


PSBC: PBC - MBA SAN LUIS

PSBC: PBC - MBA LIBERTAD

PSBC: PBC - MBA GINGOOG

PSBC: PBC - MBA MAWAB

PSBC PBC - MBA PANABO

PSBC: PBC - MBA MATI


Sub-Total Cash in Bank- Savings

c.) CIB-CURRENT

LAND BANK OF THE PHILLIPINES-Current - San Francisco Branch

ASIA UNITED BANK- SAN FRANCISCO BRANCH


Sub-Total Cash in Bank- Current


# Total Cash in Bank

CASH EQUIVALENTS

a.) TIME DEPOSITS

PRODUCER SAVINGS BANK _OROQUIETA BRANCH

PRODUCER SAVINGS BANK _BAYUGAN BRANCH

LAND BANK OF THE PHILIPPINES


Sub-Total Time Deposits

GRAND TOTAL Microinsurance

GRAND TOTALS- Cash and Cash Equivalents

Micro

insurance

True/False

(23)

mi

mi

mi

mi

mi

mi

ERROR

ERROR

45.00

xxxxxxxxxxx

mi

mi

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

2.00

xxxxxxxxxxx

47.00

xxxxxxxxxxx

ERROR

ERROR

mi

mi

mi

ERROR

ERROR

ERROR

3.00

xxxxxxxxxxx

50

xxxxxxxxxxx


PAGE 13 30






( 1 )

CASH ON HAND

GRACELYN G. SEBELRO


# Total Cash on Hand

PETTY CASH FUND

PBC MBAI_PETTY CASH FUND_GRACELYN G. SEBLERO


# Total Petty Cash Fund

CASH IN BANKS (CIB)

a.) CIB-SAVINGS

LAND BANK OF THE PHILLIPINES - General Fund SA - San Francisco Branch

PHILIPPINES NATIONAL BANK-Regular Savings - San Franciso Branch

BANK OF THE PHILIPPINE ISLANDS - Butuan Branch

METROBANK- San Francisco Branch

PSBC: PBC MBA MAIN - San Francisco Branch

PSBC: MBA CLIP MO - San Francisco Branch

PSBC: HAPI, PLAN MAIN - San Francisco Branch

PSBC: PBC MBA - GENERAL FUND - San Franciso Branch

PSBC: PBC-MUTUAL BENEFIT ASSOC.LIFE - Bayugan Branch

PSBC: PBC - MBA LIFE - Cabadbaran Branch

PSBC: PBC-MBA-LIFE - Compostela Branch

PSBC: PBC-MBA, LIFE - Digos Branch

PSBC: PBC MBA - LIFE - Kapalong Branch

PSBC: PBC-MBA, LIFE - Lupon Branch

PSBC: PBC-MBA, LIFE - Oroquieta Branch

PSBC: PBC MBA-LIFE - Prosperidad Branch

PSBC: PBC MBA-LIFE - Sibagat Branch

PSBC: PBC- MBA LIFE -Sta. Josefa Branch

PSBC: PBC MBA-LIFE - Talacogon Branch

PSBC: PBC-MBA, LIFE SF - San Francisco Branch

PSBC: PBC-MUTUAL BENEFIT ASSOC.CLIP - Bayugan Branch

PSBC: PBC - MBA CLIP COLLECTION - Cabadbaran Branch

PSBC: PBC-MBA CLIP, COLLECTIONS - Digos Branch

PSBC: PBC-MBA CLIP COLLECTION - Prosperidad Branch

PSBC: PBC MBA-CLIP COLLECTION - Sibagat Branch

PSBC: PBC CLIP COLLECTION - Talacogon Branch

PSBC: PBC-MUTUAL BENEFIT ASSOC.HAPI - Bayugan Branch

PSBC: PBC - MBA HAPI - Cabadbaran Branch

PSBC: PBCMBA HAPI PLAN - Compostela Branch

PSBC: PBC MBA HAPI - Digos Branch

PSBC: PBC-MBA HAPI - Kapalong Branch

PSBC: PBC MBA HAPI - Lupon Branch

PSBC: PBC-MBA HAPI - Prosperidad Branch

PSBC: PBC MBA-HAPI - Sibagat Branch

PSBC: BLIP CLAIMS - Sta. Josefa Branch

PSBC: PBC MBA HAPI - Talacogon Branch

PSBC: MBA-HAPI- SF - San Francisco Branch

PSBC: PBC - MBA CAGWAIT

PSBC: PBC - MBA TANDAG

PSBC: PBC - MBA TALACOGON

PSBC: PBC - MBA LAPAZ

SCHEDULE OF CASH AND CASH EQUIVALENTS PAGE 15

I N T E R E S T / D I V I D E N D S

Collected Earned

Annual Collected Unearned Due Earned but earned Current

Rate (if During the and and but not yet Previous Year Admitted Non-Admitted

applicable) Year Collected Uncollected due Years 30=25-26+27+28-29

(24) (25) (26) (27) (28) (29) (30) (31) (32) (33)

-

-

-

xxxxxxxxxxxxxx - - - - - - - -


-

-

-

-

-

-

-



4,684 4,684

327 327

85 85

2,670 2,670

783 783

782

2,113

998

92

137

149

2,364

444

674

825

960

212

569

99

629

38

39

375

24

54

49

67

156

715

331

279

187

147

162

51

319

Current Year Accrued Income Earned during the

year but not yet

collected


PAGE 13 31






( 1 )

CASH ON HAND


PSBC: PBC - MBA SAN LUIS

PSBC: PBC - MBA LIBERTAD

PSBC: PBC - MBA GINGOOG

PSBC: PBC - MBA MAWAB

PSBC PBC - MBA PANABO

PSBC: PBC - MBA MATI


Sub-Total Cash in Bank- Savings

c.) CIB-CURRENT

LAND BANK OF THE PHILLIPINES-Current - San Francisco Branch

ASIA UNITED BANK- SAN FRANCISCO BRANCH


Sub-Total Cash in Bank- Current


# Total Cash in Bank

CASH EQUIVALENTS

a.) TIME DEPOSITS

PRODUCER SAVINGS BANK _OROQUIETA BRANCH

PRODUCER SAVINGS BANK _BAYUGAN BRANCH

LAND BANK OF THE PHILIPPINES


Sub-Total Time Deposits

GRAND TOTAL Microinsurance

GRAND TOTALS- Cash and Cash Equivalents

PAGE 15

I N T E R E S T / D I V I D E N D S

Collected Earned

Annual Collected Unearned Due Earned but earned Current

Rate (if During the and and but not yet Previous Year Admitted Non-Admitted

applicable) Year Collected Uncollected due Years 30=25-26+27+28-29

(24) (25) (26) (27) (28) (29) (30) (31) (32) (33)

Current Year Accrued Income Earned during the

year but not yet

collected

68

48

25

4

-

xxxxxxxxxxxxxx 17,053.96 - - - - 3,865.77 - -

xxxxxxxxxxxxxx 22,735.94 - - - - 8,549.81 - -

2,808 2,808

-

-

-

-

-

-

-

-

-

-

-

-

xxxxxxxxxxxxxx 2,808.01 - - - - 2,808.01 - -

xxxxxxxxxxxxxx 2,808.01 - - - - 2,808.01 - -

-

xxxxxxxxxxxxxx 19,861.97 - - - - 6,673.78 - -

xxxxxxxxxxxxxx 25,543.95 - - - - 11,357.82 - -

1.76% - 1,312.50 1,312.50

1.25% 33,069 33,069 156.25 156.25

1.00% -

-

-

-

xxxxxxxxxxxxxx 33,068.85 - - - - 33,068.85 1,468.75 1,468.75 -

xxxxxxxxxxxxxx 33,068.85 - - - - 33,068.85 1,468.75 1,468.75 -

52,931 - - - - 39,743 1,469 1,469 -

x x x x x x 25,543.95 - - - - 11,357.82 - - -


PAGE 13 32

MBA NAME: PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

YEAR ENDED December 31,2020

Fair Market Unearned

CATEGORY of Incumbrances Where Kept Underwriting Acquisition or Discount / Ledger

Acquired Issued Maturity Serial No. Per Cert. Total (if any) Discount / Cost Book (Premium) Assets(Pesos) (Pesos) (Premium) Value on Dec 31

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

121000 FINANCIAL ASSETS AT AMORTIZED COST (FAAC)

CURRENT- FAAC

SUB-TOTAL - Microinsurance xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -

SUB-TOTAL - FAAC (Government Securities) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -

CURRENT- FAAC


SUB-TOTAL - FAAC (Corporate Issues) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -

CURRENT- FAAC


SUB-TOTAL - FAAC (Foreign Issues) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -

NON-CURRENT FAAC

112110 Investment in Bonds- Government Securities

ROSS ACCOUNT (LAND BANK OF THE PHIL.,Sec. Type:RTB03-09,ISIN: PIID0321F092) 12/03/2018 12/03/2018 6/13/2021 4.88% ISIN: PIID0321F092 12,256,000 INSURANCE COMMISSION 11,999,582 12,237,446 12,237,446

SUB-TOTAL - Microinsurance xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - 12,256,000 xxxxxxxxxxx xxxxxxxxxxx - 11,999,582 12,237,446 - 12,237,446

SUB-TOTAL - FAAC (Government Securities xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - 12,256,000 xxxxxxxxxxx xxxxxxxxxxx - 11,999,582 12,237,446 - 12,237,446

NON- CURRENT FAAC

112120 Investment in Bonds- Corporate Issues

PHILIPPINE NATIONAL BANK_LTNCD_PNB 3.25% LTNCD 2022 11/28/2016 11/28/2016 06/06/2022 3.25% PNBLTNCD2022 3,000,000 3,000,000 3,000,000 3,000,000

PHILIPPINE NATIONAL BANK_SM PRIME BONDS_SMPH2FBD2024 18/05/2017 18/05/2017 5/18/2024 5.17% SMPH2FBD2024 2,000,000 2,000,000 2,000,000 2,000,000

112130 Investment in Bonds- Others (ie. Foreign Issues)

112120 Investment in Bonds- Corporate Issues

112110 Investment in Bonds- Government Securities

SCHEDULE OF BONDS

Account

No.

Annual

Rate

DATE CERTIFICATES

Face Value

insert here

insert here

insert here

insert here

insert here

N/A

N/A

N/A

SUB-TOTAL - Microinsurance xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - 5,000,000 xxxxxxxxxxx xxxxxxxxxxx - 2,000,000 2,000,000 - 5,000,000

SUB-TOTAL - FAAC (Corporate Issues) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - 5,000,000 xxxxxxxxxxx xxxxxxxxxxx - 2,000,000 2,000,000 - 5,000,000

NON- CURRENT- FAAC


SUB-TOTAL - FAAC (Foreign Issues) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -

122000 FINANCIAL ASSETS AT FAIR VALUE (FAFV)-OTHER COMPREHENSIVE INCOME (OCI)


SUB-TOTAL - FAFV OCI (Government Securities) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -


SUB-TOTAL - FAFV OCI (Corporate Issues) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -


SUB-TOTAL - FAFV OCI (Foreign Issues) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -

113000 FINANCIAL ASSETS AT FAIR VALUE (FAFV)- PROFIT AND LOSS (P&L)


SUB-TOTAL - FAFV P&L (Government Securities) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -

122120 Investment in Bonds/Debt Securities- Corporate Issues

122130 Investment in Bonds/Debt Securities- Others (ie. Foreign Issues)

113120 FAFV (P&L) Investment in Bonds- Corporate Issues

113110 FAFV (P&L) Investment in Bonds- Government Securities

112130 Investment in Bonds- Others (ie. Foreign Issues)

122110 Investment in Bonds/Debt Securities- Government Securities

insert here

insert here

insert here

insert here

insert here

insert here

N/A

N/A

N/A

N/A

N/A

N/A


SUB-TOTAL - FAFV P&L (Corporate Issues) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -


SUB-TOTAL - FAFV P&L (Foreign Issues) xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxx - - - - -

SUMMARY

121000 Financial Assets at Amortized Cost (FAAC) xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - 17,256,000.00 xxxxxxx xxxxxxx - ########### 14,237,445.62 - 17,237,445.62

112100 FAAC - Investment in Bonds/Debt Securities- CURRENT xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - - xxxxxxx xxxxxxx - - - - -

121100 FAAC - Investment in Bonds/Debt Securities- NON CURRENT xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - 17,256,000.00 xxxxxxx xxxxxxx - ########### 14,237,445.62 - 17,237,445.62

122000 Financial Assets at Fair Value (FAFV)-Other Comprehensive Income xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - - xxxxxxx xxxxxxx - - - - -

113000 Financial Assets at Fair Value (FAFV)- Profit and Loss (P&L) xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - - xxxxxxx xxxxxxx - - - - -

GRAND TOTAL xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - 17,256,000.00 xxxxxxx xxxxxxx - ########### 14,237,445.62 - 17,237,445.62

MICROINSURANCE

121000 Financial Assets at Amortized Cost (FAAC) xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - 17,256,000.00 xxxxxxx xxxxxxx - ########### 14,237,445.62 - 17,237,445.62

112100 FAAC - Investment in Bonds/Debt Securities- CURRENT xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - - xxxxxxx xxxxxxx - - - - -

121100 FAAC - Investment in Bonds/Debt Securities- NON CURRENT xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - 17,256,000.00 xxxxxxx xxxxxxx - ########### 14,237,445.62 - 17,237,445.62

122000 Financial Assets at Fair Value (FAFV)-Other Comprehensive Income xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - - xxxxxxx xxxxxxx - - - - -

113000 Financial Assets at Fair Value (FAFV)- Profit and Loss (P&L) xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - - xxxxxxx xxxxxxx - - - - -

GRAND TOTAL xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx - 17,256,000.00 xxxxxxx xxxxxxx - ########### 14,237,445.62 - 17,237,445.62

NOTES AND INSTRUCTIONS:

1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances, you may refer to the arrows indicated. 6) RBC codes: 7) FUND codes:

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested. GLC - Government, in local currency GenF - General Fund

3) The SERIAL No. should be properly filled-up. This should match with the indicated ISIN number in the NROSS Statement and PDTC Report. GFC - Government, in foreign currency MBF - Mutual Benefit Fund

4) Bonds should be arranged in accordance with the presentation of the supporting documents (NROSS and PDTC) IG - Investment Grade OBreg - Mutual Benefit Fund (regular)

5) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template BIG - Below Investment Grade OBmi - Mutual Benefit Fund (micro)

ND - Near default

113130 FAFV (P&L) Investment in Bonds- Others (ie. Foreign Issues)

insert here

insert here

N/A

N/A

MicroNon-Ledger NOT NET RBC Fund insurance

Assets Admitted Admitted code code True/False(with droplist) (with droplist)

(16) (17) (18) (19) (20) (21)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

- - - xxxxxxxxxxx xxxxxxxxxxx -

- - - xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx

ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



12,237,446 MBF mi

ERROR

ERROR

ERROR

ERROR

- - 12,237,446 xxxxxxxxxxx xxxxxxxxxxx 1.00

- - 12,237,446 xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx

3,000,000 MBF mi

2,000,000 MBF mi

ERROR

ERROR

ERROR

- - 5,000,000 xxxxxxxxxxx xxxxxxxxxxx 2.00

- - 5,000,000 xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx

ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



- - 17,237,445.62 xxxxxxx xxxxxxx xxxxxxx

- - - xxxxxxx xxxxxxx xxxxxxx

- - 17,237,445.62 xxxxxxx xxxxxxx xxxxxxx




- - 17,237,445.62 xxxxxxx xxxxxxx 3.00

- - - xxxxxxx xxxxxxx -

- - 17,237,445.62 xxxxxxx xxxxxxx 3.00



- - 17,237,445.62 xxxxxxx xxxxxxx 3.00

index

MUTUAL FUNDS, UNIT INVESTMENT TRUSTS, REAL ESTATE INVESTMENT TRUSTS AND OTHER FUNDS

MBA NAME PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

YEAR ENDED:

TYPE OF FUND Investment Where Certificate

Manager Kept No.

(Company)

(1) (2) (4) (6)

Financial Asset at Fair Value through Other Comprehensive Income (FAFVOCI)

Mutual Funds (MF)

a. MF

b. MF

c. MF

Subtotal-Microinsurance

Subtotal MF

Unit Investment Trusts (UITF)

a. UITF BPI_UNIT INVESTMENT TRUST FUND_ACCT#.3226347BPI ACCT#.3226347

b. UITF

c. UITF


Subtotal UITF

Real Estate Investment Trusts (REIT)

a. REIT

b. REIT

c. REIT


Subtotal REIT

Other Funds (OF)

1. IMA

a. IMA

b. IMA

c. IMA


Subtotal IMA

2. Others

a. OF

b. OF

c. OF


Subtotal Others


Subtotal Financial Asset @ FVOCI

Financial Assets Designated at FVPL (FAFVPL)

Mutual Funds (MF)

a. MF MUTUAL SECURITY FUND_ACCT#:PH1C032001UNIONBANK PH1C032001 b. MF

c. MF


Subtotal MF

Unit Investment Trusts (UITF)

December 31,2020

N/A

N/A

a. UITF

b. UITF

c. UITF


Subtotal UITF

Real Estate Investment Trusts (REIT)

a. REIT

b. REIT

c. REIT


Subtotal REIT

Other Funds (OF)

1. IMA

a. IMA

b. IMA

c. IMA


Subtotal IMA

2. Others

a. OF

b. OF

c. OF


Subtotal Others


Subtotal FAFVFPL

Total Microinsurance

GRAND TOTAL


1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances, you may refer to the arrows indicated.

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested.

3) The SERIAL No. should be properly filled-up. This should match with the indicated ISIN number in the NROSS Statement and PDTC Report.

4) Bonds should be arranged in accordance with the presentation of the supporting documents (NROSS and PDTC)

5) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template

N/A

N/A

MUTUAL FUNDS, UNIT INVESTMENT TRUSTS, REAL ESTATE INVESTMENT TRUSTS AND OTHER FUNDS


Net Asset

Number Value Exchange

Incumbrance Date How of per Unit Rate

(if any) Acquired Acquired Units at at

at Acquisition Acquisition Acquisition

(7) (8) (9) (10) (11) (12)

- - -

- - -

- - -

ACCT#.3226347 10/31/2018 20312.82 98.46 -

- - -

- - -

- - -

- - -

- - -

- -

- -

- -

- -

- -

- -

7/28/2016 - -

- - -

- - -

December 31,2020

N/A

N/A

- - -

- - -

- - -

- - -

- - -

- - -

- -

- -

- -

- -

- -

- -

6) RBC codes: 7) FUND codes:

OInv1 - AAA GenF - General Fund

OInv2 - BBB MBF - Mutual Benefit Fund

3) The SERIAL No. should be properly filled-up. This should match with the indicated ISIN number in the NROSS Statement and PDTC Report. OBreg - Optional Benefit Fund (regular)

4) Bonds should be arranged in accordance with the presentation of the supporting documents (NROSS and PDTC) OBmi - Optional Benefit Fund (micro)


N/A

N/A

Number Number Number Number

Acquisition of of Units of Units of

Cost Units Purchased Redeemed Units

Beginning During the year during the year Ending

(13) = (10)*(11)*(12) (17)=(14)+(15)-(16)

(13) (14) (15) (16) (17)

- - - - -

- - - - -

- - - - -

-

-

1,999,999.99 20,312.82 - 20,312.82

- - - - -

- - - - -

-

1,999,999.99

- - - - -

- - - - -

- - - - -

-

-

-

-

-

-

-

-

-

-

-

-

-

1,999,999.99

- - - - -

- - - - -

- - - - -

-

-

- - - - -

- - - - -

- - - - -

-

-

- - - - -

- - - - -

- - - - -

-

-

- - - -

- - - -

- - - -

-

-

- - - -

- - - -

- - - -

-

-

-

-

-

1,999,999.99

OBreg - Optional Benefit Fund (regular)

OBmi - Optional Benefit Fund (micro)

Net Asset

Value Exchange

per Unit Rate Year-end Ledger Non-Ledger NOT

at at value Assets Assets Admitted

Year End Year End

(17)=(14)*(15)*(16)

(18) (19) (20) (21) (22) (23)

- - - - - -

- - - - - -

- - - - - -

- - - -

- - - -

112.31 - 2,281,332.51 2,281,332.51 - -

- - - - - -

- - - - - -

- - - -

2,281,332.51 2,281,332.51 - -

- - - - - -

- - - - - -

- - - - - -

- - - -

- - - -

- - - - - -

- - - - - -

- - - - - -

- - - -

- - - -

- - - - - -

- - - - - -

- - - - - -

- - - -

- - - -

- - - -

2,281,332.51 2,281,332.51 - -

- - - 431,130.33 - -

- - - - - -

- - - - - -

- - - -

- 431,130.33 - -

- - - - - -

- - - - - -

- - - - - -

- - - -

- - - -

- - - - - -

- - - - - -

- - - - - -

- - - -

- - - -

- - - - - -

- - - - - -

- - - - - -

- - - -

- - - -

- - - - - -

- - - - - -

- - - - - -

- - - -

- - - -

- - - -

- 431,130.33 - -

- - - -

2,281,332.51 2,712,462.84 - -

NET RBC Fund Microinsurance

Admitted Code Code True/False

(24)=(21)+(22)-(23) (Note 6) (Note 7)

(24)

- ERROR

- ERROR

- ERROR

- xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx


2,281,332.51 OInv1 MBF mi

- ERROR

- ERROR


2,281,332.51 xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx

- ERROR

- ERROR

- ERROR



- ERROR

- ERROR

- ERROR



- ERROR

- ERROR

- ERROR





431,130.33 OInv1 MBF mi

- ERROR

- ERROR


431,130.33 xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx

- ERROR

- ERROR

- ERROR



- ERROR

- ERROR

- ERROR



- ERROR

- ERROR

- ERROR



- ERROR

- ERROR

- ERROR




431,130.33 xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx



index

Collected Earned prior year(s) Earned during the Earned prior year(s) Earned during the

during and collected year and collected but not year but not

the year during the year during the year yet collected yet collected

(25)=(26)+(27)

(25) (26) (27) (28) (29)

-

-

-

- - - - -

- - - - -

100,955 100,955

-

-

- - - - -

100,954.70 - 100,954.70 - -

-

-

-

- - - - -

- - - - -

-

-

-

- - - - -

- - - - -

-

-

-

- - - - -

- - - - -

- - - - -

100,954.70 - 100,954.70 - -

21,496 21,496

-

-

- - - - -

21,495.66 - 21,495.66 - -

Investment Income

-

-

-

- - - - -

- - - - -

-

-

-

- - - - -

- - - - -

-

-

-

- - - - -

- - - - -

-

-

-

- - - - -

- - - - -

- - - - -

21,495.66 - 21,495.66 - -

- - - - -

122,450.36 - 122,450.36 - -

Earned

NOT NET during

Admitted Admitted the year

(33)=(30)+(31)-(32) (34)=(27)+(29)

(30) (31) (32) (33) (34)

- -

- -

- -

- - - - -

- - - - -

- - 100,955

- -

- -

- - - - -

- - - - 100,954.70

- -

- -

- -

- - - - -

- - - - -

- -

- -

- -

- - - - -

- - - - -

- -

- -

- -

- - - - -

- - - - -

- - - - -

- - - - 100,954.70

- 21,496

- -

- -

- - - - -

- - - - 21,495.66

Investment Income

LEDGER ASSETSNON-LEDGER

ASSETS

- -

- -

- -

- - - - -

- - - - -

- -

- -

- -

- - - - -

- - - - -

- -

- -

- -

- - - - -

- - - - -

- -

- -

- -

- - - - -

- - - - -

- - - - -

- - - - 21,495.66

- - - - -

- - - - 122,450.36

MBA NAME:

YEAR ENDED:

122200 FAFV (OCI) - Investment in Stocks/Equities

122210 Investments in Stocks/ Equities - Common/ Ordinary

122220 Investments in Stocks/ Equities - Preferred/ Preference

122230 Investments in Stocks/ Equities - Others (i.e Foreign)

SCHEDULE OF STOCKS

Account

No.

insert here

insert here

insert here

113200 FAFV (P&L) - Investment in Stocks/Equities


113220 Investment in Stocks/ Equities - Preferred/ Preference

113230 Investment in Stocks/ Equities - Others (i.e Foreign)

SUMMARY

B 122200

113200

MICROINSURANCE

B 122200

113200

insert here

insert here

insert here


December 31,2020

CATEGORY

(1)

122200 FAFV (OCI) - Investment in Stocks/Equities


SUB-TOTAL - Microinsurance

SUB-TOTAL - FAFV (OCI) - Common/ Ordinary

122220 Investments in Stocks/ Equities - Preferred/ Preference


SUB-TOTAL - FAFV (OCI) - Preferred/Preference

122230 Investments in Stocks/ Equities - Others (i.e Foreign)


SUB-TOTAL - FAFV (OCI) - Others (i.e Foreign)

SCHEDULE OF STOCKS

113200 FAFV (P&L) - Investment in Stocks/Equities



SUB-TOTAL - FAFV (P & L) - Common/ Ordinary

113220 Investment in Stocks/ Equities - Preferred/ Preference


SUB-TOTAL - FAFV (P&L)- Preferred/ Preference

113230 Investment in Stocks/ Equities - Others (i.e Foreign)


SUB-TOTAL - FAFV (P&L) - Others (i.e Foreign)

FAFV/ OCI - Investment in Stocks or Equities

FAFV (P&L) - Investment in Stocks/Equities

GRAND TOTAL

MICROINSURANCE

FAFV/ OCI - Investment in Stocks or Equities

FAFV (P&L) - Investment in Stocks/Equities

GRAND TOTAL


1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances.


3) It should be arranged in accordance with the presentation of the supporting documents (NROSS and PDTC)

(2) (3) (4) (5) (6)

xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx






Par ValueCertificate No. Date Acquired How Acquired Number of

Shares

N/A

N/A

N/A

N/A

N/A

N/A







xxxxxxx xxxxxxx xxxxxxx xxxxxxx xxxxxxx






1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances. 5) RBC codes:

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested. CS - Common Stocks

3) It should be arranged in accordance with the presentation of the supporting documents (NROSS and PDTC) PS - Preferred Stocks

N/A

N/A

N/A

N/A

N/A

N/A

4) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template PTR - Traded and Rated

PnTnR - Non-traded and Non-rated

Incumbrances Where Kept(if any)

(7) (8) (9) (10) (11)

- xxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxx -






Acquisition Cost Rate used to

obtain MV/ BV

Lower Market

Value/ Book

Value







- xxxxxxx xxxxxxx xxxxxxx -






6) FUND codes:

GenF - General Fund

MBF - Mutual Benefit Fund

OBreg - Mutual Benefit Fund (regular)

PnTnR - Non-traded and Non-rated OBmi - Mutual Benefit Fund (micro)

Ledger Non-Ledger NOTAssets Assets Admitted

(12) (13) (14) (15)

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

Value per

Company

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

MicroNET RBC Fund insurance

Admitted code code True/False(Note 6) (Note 7)

(16) (17) (18) (19)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

- xxxxxxxxxxx xxxxxxxxxxx -


ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR



- xxxxxxx xxxxxxx xxxxxxx






DIVIDEND

Current Year Collected

Collected Unearned Due Earned but earned

During the and and but not yet Previous

Year Collected Uncollected due Years

(20) (21) (22) (23) (24)

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

EarnedCurrent

Year Admitted Non-Admitted(20-21+22+23-24)

(25) (26) (27) (28)

- -

- -

- -

- -

- -

- -

- -

- - - -

- - - -

- -

- -

- -

- -

- -

- - - -

- - - -

- -

- -

- -

- -

- -

- - - -

- - -

Accrued Income

Earned during the

year but not collected

- -

- -

- -

- -

- -

- - -

- - -

- -

- -

- -

- -

- -

- - -

- - -

- -

- -

- -

- -

- -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

MBA NAME:

YEAR ENDED

117000

SCHEDULE OF SHORT TERM FINANCIAL ASSET

Account

No.

insert here


December 31,2020

CATEGORY

(1)

SHORT TERM FINANCIAL ASSET

METROBANK_Bureau of Treasury - Gov't Sec. (Retail Treasury Bills)

TOTAL - Microinsurance

TOTAL - Short Term Financial Asset







SCHEDULE OF SHORT TERM FINANCIAL ASSET

of

Acquired Issued Maturity Serial No.

(2) (3) (4) (5) (6)

05-Feb-20 03-Feb-21 MBTC TBill PIBL1220B052








DATE

Annual

Rate

CERTIFICATES

Incumbrances Where Kept Underwriting

Per Cert. Total (if any) Discount /

(Pesos) (Pesos) (Premium)

(7) (8) (9) (10) (11)

MBTC TBill PIBL1220B052 5,030,000 METROBANK

- 5,030,000 xxxxxxxxxxx xxxxxxxxxxx -

- 5,030,000 xxxxxxxxxxx xxxxxxxxxxx -


GLC - Government, in local currency GenF - General Fund

GFC - Government, in foreign currency MBF - Mutual Benefit Fund

IG - Investment Grade OBreg - Mutual Benefit Fund (regular)

BIG - Below Investment Grade OBmi - Mutual Benefit Fund (micro)

ND - Near default

Face Value

CERTIFICATES

Fair Market Unearned

Acquisition or Discount / Ledger Non-Ledger

Cost Book (Premium) Assets Assets

Value on Dec 31

(12) (13) (14) (15) (16)

5,029,156 5,029,156

- 5,029,156 - 5,029,156 -

- 5,029,156 - 5,029,156 -


OBmi - Mutual Benefit Fund (micro)

NOT NET RBC Fund

Admitted Admitted code code

(with droplist) (with droplist)

(17) (18) (19) (20)

5,029,156 GLC2 MBF

- 5,029,156 xxxxxxxxxxx xxxxxxxxxxx

- 5,029,156 xxxxxxxxxxx xxxxxxxxxxx

index

INVESTMENT INCOME

Micro Current Year

insurance Collected Unearned Due

True/False During the and and

Year Collected Uncollected

(21) (22) (23) (24)

mi 85,590

ERROR

ERROR

ERROR

ERROR

ERROR

1.00 85,590 - -

xxxxxxxxxxx 85,590 - -

INVESTMENT INCOME

Collected Earned

Earned but earned Current

but not yet Previous Year

due Years 27=22-23+24+25-26

(25) (26) (27) (28)

85,590

-

-

-

-

-

- - 85,590 -

- - 85,590 -

Earned during the

year but not collected

Admitted Non-Admitted

(29) (30)

-

-

-

-

-

-

- -

- -

Accrued Income

MBA NAME:

YEAR ENDED:

Lot No.

1) Title No. Encumbrance Where kept Area

2. City/Municipality if any Location of Lands

3) Prov/State Size & description

4)Country of buildings

(1) (2) (3) (4)

151000- Investment in Property

151100 Investment Property - Land

1.1 Sub-Total Microinsurance - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

1.2 SUB-TOTALS - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

151200 Investment in Property - Building(s) and Building Improvements

151210 Investment in Property - Buildings



151220 Investment in Property - Building Improvements



151300 Investment in Property - Under Construction - Building(s) and Building Improvements

151310 Investment in Property - Under Construction - Building(s)

SCHEDULE OF INVESTMENT PROPERTY

December 31,2020




151320 Investment in Property - Under Construction - Building Improvements

Sub-Total Microinsurance - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

SUB-TOTALS - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

GRAND TOTALS Microinsurance - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

GRAND TOTALS - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx




3) It should be arranged in accordance with the presentation of the supporting documents


Date of

Date Name of Original Market IC Approval Book

Acquired Vendor Cost Value/ on Appraisal/ Value

Appraised Revaluation

Value Increment

(5) (6) (7) (8) (9) (10) (11)

xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx - - - -

xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx - - - -





151300 Investment in Property - Under Construction - Building(s) and Building Improvements

SCHEDULE OF INVESTMENT PROPERTY

December 31,2020


Date

transferred

in the name

of the

company if

foreclosed

N/A

N/A

N/A

N/A



151320 Investment in Property - Under Construction - Building Improvements









N/A

N/A

Depreciation Accumulated

Current Depreciation Ledger Non-Ledger NOT NET

Year as of Assets Assets Admitted Admitted

Year-End

(12) (13) (14) (15) (16) (17)=(14)+(15)-(16)

- -

- -

- -

- -

- -

- - - - - -

- - - - - -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- - - - - -

- - - - - -

- -

- -

- -

- -

- -

- -

- - - - - -

- - - - - -

- -

- -

- -

- -

- -

- -

- - - - - -

- - - - - -

- -

- -

- -

- -

- -

- -

- -

- - - - - -

- - - - - -

- - - - - -

- - - - - -

5) RBC codes:

OCC - MBA occupied, up to quota

OCC -MBA-occupied, above quota

REF - Acquired in satisfaction of debt/foreclosed

REI - Investments in real estate

Micro Amount

RBC FUND insurance of Collected Unearned

code code True/False Insurance During the and

(Note 5) (Note 6) on Building Year Collected

(18) (19) (20) (21) (22) (23)

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxxxxxxxxxxxxxx - - - -

xxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx - - -

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx xxxxxxxxxxxx - - - -

xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx - - -

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR



Current Year

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR



ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR





4) Please complete / check the following fields:

6) FUND codes:

GenF - General Fund

MBF - Mutual Benefit Fund SUMMARY (used in Exhibit 12 and page 2:)

OBreg - Mutual Benefit Fund (regular) 1. Investments in Property - Land

OBmi - Mutual Benefit Fund (micro) 2. Investment in Properties - Building and Building Improvements

3. Under Construction - Building and Building Improvements

4. Accumulated Depreciation - Building and Building Improvements

5) Method used to determine Ledger Assets:

index

RENTAL INCOME

Collected Earned

Due Earned Not but earned Current

and but not yet Admitted Previous Year Admitted

Uncollected due Years (22-23+24+25-26-27)

(24) (25) (26) (27) (28) (29)

-

-

-

-

-

-

-

- - - - - -

- - - - - -

-

-

-

-

-

-

-

-

-

- - - - - -

- - - - - -

-

-

-

-

-

-

- - - - - -

- - - - - -

Current Year Accrued Income

-

-

-

-

-

-

- - - - - -

- - - - - -

-

-

-

-

-

-

-

- - - - - -

- - - - - -

- - - - - -

- - - - - -

4) Please complete / check the following fields:

Ledger Non-Ledger Not Admitted

SUMMARY (used in Exhibit 12 and page 2:) Basis Encumbrances Assets Assets Assets

1. Investments in Property - Land book - - - -

2. Investment in Properties - Building and Building Improvementsbook - - - -

3. Under Construction - Building and Building Improvementsbook - - - -

4. Accumulated Depreciation - Building and Building Improvementsbook

5) Method used to determine Ledger Assets:

Not

Admitted

(30)

-

-

-

-

-

-

Accrued Income

-

-

-

-

-

-

Net Admitted

Assets

-

-

-

MBA NAME:

YEAR ENDED:

Lot No.

1) Title No. Encumbrance Where kept Area

2. City/Municipality if any Location of Lands

3) Prov/State Size & description

4)Country of buildings

(1) (2) (3) (4)

161000- Property and Equipment

161100 Land

PBC - MBAI Residential Lot PBC - MBAI 3937, pl S-67



161200 Building(s) and Building Improvements

161210 Building

2 STOREY BUILDING



161220 Building Improvements



161300 Leasehold Improvements

SCHEDULE OF PROPERTY AND EQUIPMENT


December 31,2020



161500 Transportation Equipment2018 SUBARO XV 2.0is

PREMIUM ES PBC MBAI



161600 Office Furnitures and Fixtures

Filling Cabinet

Filling Cabinet

Filling Cabinet

Cash box

Storage Cabinet

Filling Cabinet w/ drawers lateral

Fax Machine

Printer HP Leserjet P1606dn (ESL)

Computer Dell Inspiron 660s 20" LED

Desktop

Projector

Peachtree (Sage50) OR#0071

Scanner: Epson Perfection V39

UPS: APC BR1500GI - APC UPS Pro 1500VA

Hard disk: ZN154KBP

Hard disk: ZN154J64

1 UNIT LAPTOP SN#NXHZ6SP002036061DC2300(MAGIC PURPLE)

1 ADAPTER_LGBA



161700 Other Equipments



SUMMARY OF PROPERTY AND EQUIPMENT

161100 Land - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

161210 Building - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

161220 Building Improvements - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

161300 Leasehold Improvement xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

161500 Transportation Equipment - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

161600 Office Furnitures and Fixtures - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

161700 Other Equipments - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

GRAND TOTALS Microinsurance - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

GRAND TOTALS - xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx






Date of

Date Name of Original Market IC Approval Book

Acquired Vendor Cost Value/ on Appraisal/ Value

Appraised Revaluation

Value Increment

(5) (6) (7) (8) (9) (10)

10/28/2014 PBCI 1,429,310 1,429,310 n/a 1,429,310

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx1,429,310.00 ######### xxxxxxxxxxxxxxxxxx#########

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx1,429,310.00 ######### xxxxxxxxxxxxxxxxxx#########

12/09/2016 4,000,000 n/a 3,680,000

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx4,000,000.00 - xxxxxxxxxxxxxxxxxx#########

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx4,000,000.00 - xxxxxxxxxxxxxxxxxx#########

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx - - xxxxxxxxxxxxxxxxxx -

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx - - xxxxxxxxxxxxxxxxxx -

SCHEDULE OF PROPERTY AND EQUIPMENT


December 31,2020

N/A

N/A


xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx - - xxxxxxxxxxxxxxxxxxx -

7/17/2018 1,618,300 n/a 1,618,300


xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx1,618,300.00 - xxxxxxxxxxxxxxxxxx#########

19/07/2011 9,000

15/01/2012 6,800

15/02/2012 12,000

01/03/2012 1,700

19/04/2012 12,000

19/04/2012 8,500

01/03/2012 8,500

30/09/2013 21,270

24/01/2014 30,000

05/11/2012 22,500

24/01/2014 29,900

20/04/2016 30,000

11/16/2018 7,000

11/16/2018 28,500

8/22/2019 2,250

8/22/2019 2,250

11/26/2020 29,500

12/11/2020 1,800


xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx263,470.00 - xxxxxxxxxxxxxxxxxx -

N/A

N/A



xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx1,429,310.00 ########## xxxxxxxxxxxxxxxxxx##########

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx4,000,000.00 - xxxxxxxxxxxxxxxxxx##########



xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx1,618,300.00 - xxxxxxxxxxxxxxxxxx##########

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx263,470.00 - xxxxxxxxxxxxxxxxxx -



xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx7,311,080.00 ######### xxxxxxxxxxxxxxxxxx#########





N/A

Depreciation Accumulated

Current Depreciation Ledger Non-Ledger NOT NET RBC

Year as of Assets Assets Admitted Admitted code

Year-End (note 5)

(11) (12) (13) (14) (15) (16) (17)

-

1,429,310 1,429,310 REI

- -

- -

- -

- -

- - ######### - - ######### xxxxxxxxxxxx

- - ######### - - ######### xxxxxxxxxxxxx

320,000 3,680,000 3,680,000 OCC

- -

- -

- -

- -

- - - - - - xxxxxxxxxxxx

- 320,000.00 ######### - - ######### xxxxxxxxxxxxx

- -

- -

- -

- -

- -

- -


- - - - - - xxxxxxxxxxxxx

- -

- -

- -

- -

- -

- -

- -



323,660 809,150 809,150 809,150 OCC

- -

- -

- -

- -


323,660.00 809,150.10 809,149.90 - - 809,149.90 xxxxxxxxxxxxx

9,000 - - OCC

6,800 - - OCC

12,000 - - OCC

1,700 - - OCC

12,000 - - OCC

8,500 - - OCC

8,500 - - OCC

21,270 - - OCC

30,000 - - OCC

22,500 - - OCC

29,900 - - OCC

30,000 - - OCC

3,033 3,967 3,967 OCC

28,500 - - OCC

2,250 - - OCC

2,250 - - OCC

1,229 28,271 28,271 OCC

150 1,650 1,650 OCC

- -

- -

- -

- -

- -

- -


- 229,582.50 33,887.50 - - 33,887.50 xxxxxxxxxxxxx

-

- -

- -

- -

- -

- -

- -



- - ########## - - ########## xxxxxxxxxxxx

- 320,000.00 ########## - - ########## xxxxxxxxxxxx



323,660.00 809,150.10 809,149.90 - - 809,149.90 xxxxxxxxxxxx

- 229,582.50 33,887.50 - - 33,887.50 xxxxxxxxxxxx



323,660.00 1,358,732.60 ######### - - ######### xxxxxxxxxxxxx

5) RBC codes:

OCC - MBA occupied, up to quota 6) FUND codes:

OCC -MBA-occupied, above quota GenF - General Fund

REF - Acquired in satisfaction of debt/foreclosed MBF - Mutual Benefit Fund

REI - Investments in real estate OBreg - Mutual Benefit Fund (regular)


Micro Amount

FUND insurance of

code True/False Insurance

(note 6) on Building

(18) (19) (20)

mbf mi

MBF mi

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx 1.00 -

xxxxxxxxxxxxx xxxxxxxxxxxxx -

MBF mi

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx 1.00 -


ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx - -


ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx - -


GenFmix

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx - -


GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

GenF mix

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx - -


ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx - -


xxxxxxxxxxxx ERROR

xxxxxxxxxxxx ERROR

xxxxxxxxxxxx ERROR

xxxxxxxxxxxx ERROR

xxxxxxxxxxxx ERROR

xxxxxxxxxxxx ERROR

xxxxxxxxxxxx ERROR

xxxxxxxxxxxx - -


index

6) FUND codes:

GenF - General Fund




MBA NAME:

YEAR ENDED:

Acquisition O.R.

Cost Date

(1) (2) (3)

A. HARDWARE

12 unit Desktop Computer Lenovo 372,000.00

12 unit UPS 74,400.00

RES61042BFSCRF Series II RAck42u

600x109057,420.00

CAS2P-4 Caster2.0 with palte kit (set of 4

casters)4,554.00

14240062 Liebert MPS Metere PDU 29,601.00

HP Proliant DL380p, Ge8E%-2620 1P

16GB-R P420i FF 460w PS Base server

& accessories

424,720.00

Sub-Total Microinsurance - xxxxxxxxxxxxxxxxxx

SUB-TOTALS 962,695.00 xxxxxxxxxxxxxxxxxxx

B.SOFTWARE

MBA Software 800,000

License 619,240

License 309,620

License 298,562

MIS office professionals plus 2013

installed to 15 units computer350,250

PARTICULARS

SCHEDULE OF I.T. EQUIPMENTS


December 31,2020

Sub-Total Microinsurance - xxxxxxxxxxxxxxxxxx

SUB-TOTALS 2,377,672.14 xxxxxxxxxxxxxxxxxxx

GRAND TOTALS Microinsurance - xxxxxxxxxxxxxxxxxx

GRAND TOTALS 3,340,367.14 xxxxxxxxxxxxxxxxxxx






Accumulated

O.R. Date Acquired Estimated Depreciation Ledger

No. for Depreciation Useful Life as of 12-31-2020 Assets

(4) (5) (6) (7) (8)

10 275,899.78 96,100

5 74,400.00 -

10 35,887.50 21,533

10 2,846.25 1,708

10 18,500.88 11,100

10 286,685.57

138,034

-

-

-

-

-

-

-

-

-

-

-

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx - -

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx694,219.98 268,475.02

10 600,000.22 200,000

10 407,666.15 211,574

10 206,413.52 103,206

10 194,065.51 104,497

10 236,418.75 113,831

-

-

-

-

SCHEDULE OF I.T. EQUIPMENTS


December 31,2020

-

-

-


xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx1,644,564.15 733,107.99


xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx2,338,784.12 1,001,583.02





Micro

Non-Ledger NOT NET RBC FUND insurance

Assets Admitted Admitted code code True/False

(note 5) (note 6)

(9) (10) (11) (12) (13) (14)

- mbf mi

96,100 HW GenF mix

- HW GenF mix

21,533 HWGenF

mix

1,708 HWGenF

mix

11,100 HW GenF mix

138,034 HW

GenFmix

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- - - xxxxxxxxxxxxxxxxxxxxxxxx -

- - 268,475.02 xxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx

200,000 SW GenF mix

211,574 SW GenF mix

103,206 SW GenF mix

104,497 SW GenF mix

113,831 SWGenF

mix

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR


- - 733,107.99 xxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx


- - 1,001,583.02 xxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx

index


HW- Hardware GenF - General Fund

SW-Software MBF - Mutual Benefit Fund



MBA NAME:

YEAR ENDED:

(note 1)

(1) (2) (3)

Foreclosed Properties1










Total Microinsurance xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx

TOTALS xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx






SCHEDULE OF FORECLOSED PROPERTIES


December 31,2020

ParticularsDocument Index No.

TCT/CCT No., Location

and Description of

Property (Area, Blk and

Lot No.)

N/A

Where Entry Registry City

Kept Date No. Province

(4) (5) (6) (7)

xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx

xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx

1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances. 5) RBC codes: 6) FUND codes:

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested. OCC - MBA occupied, up to quota GenF - General Fund

3) It should be arranged in accordance with the presentation of the supporting documents OCC -MBA-occupied, above quota MBF - Mutual Benefit Fund

4) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template REF - Acquired in satisfaction of debt/foreclosed OBreg - Mutual Benefit Fund (regular)

REI - Investments in real estate OBmi - Mutual Benefit Fund (micro)

SCHEDULE OF FORECLOSED PROPERTIES


December 31,2020

Record of Mortgage

N/A

Term of Loan

Encumbrance Date Date of Amount

Amount of Maturity of

Annotated Loan Principal

(8) (9) (10) (11)

- xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx -

- xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx -




Record of Mortgage

Annual Mode of Date

Down Rate Amortization of

Payment of Payment Foreclosure

Interest (Monthly, Quarterly,

Semi-Annual, Annual)

(12) (13) (14) (15)

xxxxxxxxxxxx xxxxxxxxxxxx xxxxxxxxxxxx xxxxxxxxxxxx

xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxx

Loan Allowance for

End of Balance Probable

Redemption at Losses Ledger

Date Date of Foreclosure Assets

(16) (17) (18) (19)

-

-

-

-

-

-

-

-

-

-

xxxxxxxxxxxx - - -

xxxxxxxxxxxx - - -

Non-Ledger NOT NET RBC

Assets Admitted Admitted Code

(22)=(19)+(20)-(21) (Note 5)

(20) (21) (22) (23)

-

-

-

-

-

-

-

-

-

-

- - - xxxxxxxxxxxx

- - - xxxxxxxxxxxx

LOAN INCOME

Fund Microinsurance Collected Unearned Due Earned

Code True/False During the and and but not yet

(Note 6) Year Collected Uncollected due

(26) (27) (28) (29)

(24) (25)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx - - - - -


index

Current Year

LOAN INCOME

Collected Earned

Not but earned Current Not

Admitted Previous Year Admitted Admitted

Years 32=26-27+28+29-30-31

(30) (31) (32) (33) (34)

-

-

-

-

-

-

-

-

-

-

-

- - - - -

- - - - -

Overdue Inv. Income Current Year

MBA NAME:

YEAR ENDED:

Membership Certificate

Number Membership

Date

(1) (2) (3)

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6

Member 7

Member 8

Member 9

Member 10

Total-Microinsurance xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx

Total xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx






Required:

Aging of Membership Certificate Loans (MCL)

Non-Admitted Assets

< 3 mos.

> 3 mos. & < 6 mos.

> 6 mos. & < 9 mos.

> 9 mos. & < 12 mos.

> 12 mos. & < 15 mos.

> 15 mos. & < 18 mos.

> 18 mos.

Total - -

Check Digit -

AgeNo. of Outstanding Policies

Amount

December 31,2020

NAME OF MEMBER

SCHEDULE OF MEMBERSHIP CERTIFICATE LOANS


N/A

Annual

Amount of DateDate of Amount Down Rate

Insurance of Maturity of Payment of

LoanPrincipal Interest

(4) (5) (6) (7) (8) (9)

- xxxxxxxxxxxxxxxxxxxxxxxxxx - - xxxxxxxx

- xxxxxxxxxxxxxxxxxxxxxxxxxxx - - xxxxxxxx

1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances. 5) RBC codes: 6) FUND codes:

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested.OFB - Of best security GenF - General Fund

AS - Adequately secured MBF - Mutual Benefit Fund

4) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the templateOCGO - Others OBreg - Mutual Benefit Fund (regular)


Admitted Assets

-

-

Amount

December 31,2020

SCHEDULE OF MEMBERSHIP CERTIFICATE LOANS


Term of Loan

N/A

Mode of

Amortization Beginning Additional Loan Payments Loan

Payment Loan Balance During the Year During the Balance

(Monthly, Quarterly, for the Year Year as of 12/31/2020

Semi-Annual, Annual)

(10) (11) (12) (13) (14)

-

-

-

-

-

-

-

-

-

-

xxxxxxxxxxxx - - - -

xxxxxxxxxxxx - - - -




Term of Loan

Allowance for Ledger Non-Ledger NOT NET

Impairment Assets Assets Admitted Admitted

as of 12/31/2020(20)=(17)+(18)-(19)

(15) (16) (17) (18) (19)

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- - - - -

- - - - -

MembershipRBC Fund Microinsurance

Collected

Equity Value Code Code True/False During the

as of 31 December

2020 (Note 5) (Note 6)Year

(20) (21) (22) (24) (25)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

- xxxxxxxxxx xxxxxxxxxxx - -

- xxxxxxxxxx xxxxxxxxxxxx xxxxxxxx -

index

INTEREST INCOME

Collected Earned

Unearned Due Earned Notbut earned Current Not

and and but not yet Admitted Previous Year Admitted

Collected Uncollected due Years

31=25-26+27+28-29-30

(26) (27) (28) (29) (30) (31) (32)

-

-

-

-

-

-

-

-

-

-

- - - - - - -

- - - - - - -

Current Year Overdue Inv. Income

Admitted

(33)

-

-

Overdue Inv. Income

MBA NAME:

YEAR ENDED: December 31,2020


(1) (2)

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6

Member 7

Member 8

Member 9

Member 10

Total-Microinsurance xxxxxxxxxxxxxxxxxx

Total xxxxxxxxxxxxxxxxxxx

Required:

Aging of Policy Loans

< 3 mos.

> 3 mos. & < 6 mos.

> 6 mos. & < 9 mos.

> 9 mos. & < 12 mos.

> 12 mos. & < 15 mos.

> 15 mos. & < 18 mos.

> 18 mos.

Total -

Check Digit

SCHEDULE OF POLICY LOANS


AgeNo. of Outstanding

Policies

NAME OF MEMBER

N/A

Policy Number Membership Policy/ Basic

Date Effectivity Date Benefit

(3) (4) (5) (6)

xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx -

xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx -

Amount

Non-Admitted Assets Admitted Assets

- -

- -

SCHEDULE OF POLICY LOANS


N/A

Annual

Amount of Date Date of Amount Down Rate

Insurance of Maturity of Payment of

LoanPrincipal Interest

(7) (8) (9) (10) (11) (12)

- xxxxxxxxxxx xxxxxxxxxxx - - -

- xxxxxxxxxxx xxxxxxxxxxx - - -






Term of Loan

Mode of Amortization

Payment Beginning Additional Loan Payments Loan

(Monthly, Quarterly, Loan Balance During the Year During the Balance

Semi-Annual, Annual) for the Year Year as of 12/31/2020

(13) (14) (15) (16) (17)

xxxxxxxxxxxxxxx - - - -



PL - All Member Equity or individual policy loans… GenF - General Fund

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested. MBF - Mutual Benefit Fund


4) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template OBmi - Mutual Benefit Fund (micro)

Term of Loan

Allowance Ledger Non-Ledger NOT NET

for Impairment Assets Assets Admitted Admitted

as of 12/31/202021=18+19-20

(18) (19) (20) (21) (22)

- - - - -

- - - - -

Cash Surrender Members' Equity Values Policy Reserves RBC

Value Code

as of 31 December

2020as of 31 December 2020

as of 31 December

2020 (Note 5)

(23) (24) (25) (26)

- - - xxxxxxxxxxxxxxx

- - - xxxxxxxxxxxxxxx

Fund Microinsurance Collected Unearned Due

Code True/False During the and and

(Note 6)Year

Collected Uncollected

(27) (28) (29) (30) (31)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR


xxxxxxxxxxxxxxx xxxxxxxxxxxxxxx - - -

index

Current Year

INTEREST INCOME

Collected Earned

Earned Not but earned Current Not

but not yet Admitted Previous Year Admitted Admitted

due Years 30=24-25+26+27-28-29

(32) (33) (34) (35) (36) (37)

- - - - - -

- - - - - -


SCHEDULE OF DepEd SALARY LOANS

MBA NAME:

YEAR ENDED:

Membership Certificate/

Policy Number

(1) (2)

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6

Total-Microinsurance xxxxxxxxxxxxxxxxxx

Total xxxxxxxxxxxxxxxxxx

Required:

Aging of DepEd Salary Loans

< 3 mos.

> 3 mos. & < 6 mos.

> 6 mos. & < 9 mos.

> 9 mos. & < 12 mos.

> 12 mos. & < 15 mos.

> 15 mos. & < 18 mos.

> 18 mos.

Total -

Check Digit

AgeNo. of Outstanding

Policies


December 31,2020

NAME OF MEMBER

N/A

Membership Policy/ DepEd Date

Date Effectivity Date Deduction Approved

Code by DepEd

(3) (4) (5) (6)



Amount

Non-Admitted Assets Admitted Assets

- -

- -


December 31,2020

N/A

Annual Mode of Amortization

Date Date of Amount Down Rate Payment

of Maturity of Payment of (Monthly, Quarterly,

Loan Principal Interest Semi-Annual, Annual)

(7) (8) (9) (10) (11) (12)

xxxxxxxxxx xxxxxxxxxx - - xxxxxxxxxx xxxxxxxxxxxxxxxxxx

xxxxxxxxxxx xxxxxxxxxxx - - xxxxxxxxxxx xxxxxxxxxxxxxxxxxx

Term of Loan

Beginning Additional Loan Payments Loan Allowance

Loan Balance During the Year During the Balance for Impairment

for the Year Year as of 12/31/2020 as of 12/31/2020

(13) (14) (15) (16) (17)

-

-

-

-

-

-

- - - - -

- - - - -

Ledger Non-Ledger NOT NET RBC

Assets Assets Admitted Admitted Code

(21)=(18)+(19)-(20) (Note 5)

(18) (19) (20) (21) (22)

- -

- -

- -

- -

- -

- -

- - - - xxxxxxxxxx

- - - - xxxxxxxxxxx

5) RBC codes:

OFB - Of best security

AS - Adequately secured

OCGO - Others

INTEREST INCOME

Fund Microinsurance Collected Unearned Due Earned

Code True/False During the and and but not yet

(Note 6) Year Collected Uncollected due

(23) (24) (25) (26) (27) (28)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxx - - - - -

xxxxxxxxxxx xxxxxxxxxxx - - - -

index

6) FUND codes:

GenF - General Fund




Current Year

INTEREST INCOME

Collected Earned

Not but earned Current Not

Admitted Previous Year Admitted Admitted

Years 31=25-26+27+28-29-30

(29) (30) (31) (31) (32)

-

-

-

-

-

-

- - - - -

- - - - -


SCHEDULE OF OTHER LOANS- REAL ESTATE LOANS

MBA NAME:

YEAR ENDED:

Policy/

Effectivity Date

(1) (2)

A.) HOUSING LOAN

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6

Sub-Total Microinsurance xxxxxxxxxxxxxxxxxx

SUB-TOTALS xxxxxxxxxxxxxxxxxx

B.) MORTGAGE LOAN

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6



C.) PURCHASE MONEY MORTGAGES

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6



C.) OTHER REAL ESTATE LOANS (Specify the loan type)

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6

NAME OF BORROWER


December 31,2020



TOTAL MICROINSURANCE xxxxxxxxxxxxxxxxxx

GRAND TOTAL OTHER LOANS xxxxxxxxxxxxxxxxxx






SCHEDULE OF OTHER LOANS- REAL ESTATE LOANS

TCT/CCT No. Address/Location DateDate of

of Maturity

Loan

(3) (4) (5) (6)

xxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxx

xxxxxxxxxxxxxxx xxxxxxxxxxxxxxx xxxxxxxxxxxx xxxxxxxxxxxx






December 31,2020

Term of Loan

N/A

N/A

N/A

N/A

Annual Mode of Amortization/

Amount Down Rate Payment

of Payment of (Monthly, Quarterly,

Principal Interest Semi-Annual, Annual)

(7) (6) (7) (6)

- - xxxxxxxxxxxx xxxxxxxxxxxxxxxxxx






Term of Loan






OFB - Of best security GenF - General Fund


OCGO - Others OBreg - Mutual Benefit Fund (regular)


Market

Value of LandSound Value of Beginning Additional Loan

Mortgaged Buiding Loan Balance During the Year

for the Year

(7) (6) (7) (6)

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -




Payments Loan Allowance Ledger

During the Balance for Impairment Assets

Year As of 12/31/2019 As of 12/31/2019

(7) (8) (9) (10)

- -

- -

- -

- -

- -

- -

- - - -

- - - -

- -

- -

- -

- -

- -

- -

- - - -

- - - -

- -

- -

- -

- -

- -

- -

- - - -

- - - -

- -

- -

- -

- -

- -

- -

- - - -

- - - -

- - - -

- - - -

Non-Ledger NOT NET RBC

Assets Admitted Admitted Code

(13)=(10)+(11)-(12) (Note 5)

(11) (12) (13) (14)

-

-

-

-

-

-

- - - xxxxxxxxxx

- - - xxxxxxxxxxx

-

-

-

-

-

-

- - - xxxxxxxxxx

- - - xxxxxxxxxxx

-

-

-

-

-

-

- - - xxxxxxxxxx

- - - xxxxxxxxxxx

-

-

-

-

-

-

- - - xxxxxxxxxx

- - - xxxxxxxxxxx

- - - xxxxxxxxxx

- - - xxxxxxxxxxx

Fund MicroinsuranceCollected Unearned

Code True/False During the and

(Note 6) Year Collected

(15) (16) (17) (18)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxx - - -

xxxxxxxxxxx xxxxxxxxxxx - -

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxx - - -


ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxx - - -


ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

Current Year

xxxxxxxxxx - - -


xxxxxxxxxx - - -


index

INTEREST INCOME

Due Earned NotEarned Current Year

and but not yet Admitted

Uncollected due 23=17-18+19+20-21-22

(19) (20) (21) (22) (23)

-

-

-

-

-

-

- - - - -

- - - - -

-

-

-

-

-

-

- - - - -

- - - - -

-

-

-

-

-

-

- - - - -

- - - - -

-

-

-

-

-

-

Collected and

Earned Previous

Year

Current Year

- - - - -

- - - - -

- - - - -

- - - - -

Not

Admitted Admitted

(24) (25)

- -

- -

- -

- -

- -

- -

Overdue Inv. Income

- -

- -

- -

- -

MBA NAME:

YEAR ENDED:

Membership Certificate/

Policy Number

(1) (2)

A.) FINANCIAL ASSISTANCE RECEIVABLE (FAR)

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6



B.) OTHER LOAN TYPE 1

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6



C.) OTHER LOAN TYPE 2

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6



TOTAL MICROINSURANCE xxxxxxxxxxxxxxxxxx

GRAND TOTAL OTHER LOANS xxxxxxxxxxxxxxxxxx




SCHEDULE OF OTHER LOANS


December 31,2020

NAME OF MEMBER/

BORROWER

Membership Policy/ Board Resolution No.

Date Effectivity Date

(3) (4) (5)

xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx










SCHEDULE OF OTHER LOANS


December 31,2020

N/A

N/A

N/A

OCGO - Others

Date of IC Approval DateDate of Amount

(Based on the Letter Issued

by IC)of

Maturity of

Loan Principal

(6) (7) (8) (9)

xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxx -


xxxxxxxxxxxxxxxxxx xxxxxxxxxxxx xxxxxxxxxxxx -


xxxxxxxxxxxxxxxxxx xxxxxxxxxxxx xxxxxxxxxxxxx -

xxxxxxxxxxxxxxxxxx xxxxxxxxxxxx xxxxxxxxxxxxx -

xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx -

xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx -


OFB - Of best security GenF - General Fund


Term of Loan

OCGO - Others OBreg - Mutual Benefit Fund (regular)


Annual Mode of Payment/

Down Rate Amortization Beginning Additional Loan

Payment of (Monthly, Quarterly, Loan Balance During the Year

Interest Semi-Annual, Annual) for the Year

(10) (11) (12) (13) (14)

- xxxxxxxxxxxx xxxxxxxxxxxxxx - -

- xxxxxxxxxxxx xxxxxxxxxxxxxx - -

- xxxxxxxxxxxx xxxxxxxxxxxx - -






Term of Loan

Payments Loan Allowance Ledger

During the Balance for Impairment Assets

Year as of 12/31/2020 as of 12/31/2020

(15) (16) (17) (18)

- -

- -

- -

- -

- -

- -

- - - -

- - - -

- -

- -

- -

- -

- -

- -

- - - -

- - - -

- -

- -

- -

- -

- -

- -

- - - -

- - - -

- - - -

- - - -

Non-Ledger NOT NET

Members' Equity Value as

of 31 December 2020

Assets Admitted Admitted

(21)=(18)+(19)-(20)

(19) (20) (21) (22)

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

RBC Fund MicroinsuranceCollected

Code Code True/FalseDuring the

(Note 5) (Note 6) Year

(23) (24) (25) (25)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxxxxxxxxxxxxxxxxxx - -

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx -

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxxxx xxxxxxxxxxx - -

xxxxxxxxxxxxxx xxxxxxxxxxxx xxxxxxxxxxxx -

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxxxx xxxxxxxxxx - -

xxxxxxxxxxxxxx xxxxxxxxxx xxxxxxxxxxx -

xxxxxxxxxxxx xxxxxxxxx - -

xxxxxxxxxxxx xxxxxxxxx xxxxxxxxxxxx -

index

INTEREST INCOME

Collected

Unearned Due Earned Notbut earned

and and but not yet Admitted Previous

Collected Uncollected due Years

(26) (27) (28) (29) (30)

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

Current Year

Earned

Current Not

Year Admitted Admitted

31=25-26+27+28-29-30 (for RBC) (for RBC)

(31) (32) (33)

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

Overdue Inv. Income

MBA NAME:

YEAR ENDED:

Based on IC Approved Rate as indicated in the IRR


Number Membership

Date

(1) (2) (3)

1.1 TOTAL MICROINSURANCE xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx

1.2 GRAND TOTAL - MEMBERS' FEES & DUES & CONTRIBUTIONS DUE & UNCOLLECTEDxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx






SCHEDULE OF MEMBERS' FEES & DUES RECEIVABLES & MEMBERS' CONTRIBUTIONS DUE & UNCOLLECTED

NAME OF MEMBER

N/A

Based on IC Approved Rate as indicated in the IRR

General Fund Basic Member's Fund General Fund Basic Member's Fund

Contributions

Members' Fees & Dues Members' Dues Contributions

(4) (5) (6) (7)

- - - -

- - - -


FDR - Fees/ Dues Receivable GenF - General Fund



4) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template OBmi - Mutual Benefit Fund (micro)

SCHEDULE OF MEMBERS' FEES & DUES RECEIVABLES & MEMBERS' CONTRIBUTIONS DUE & UNCOLLECTED

Balance PRIOR YEAR

General Fund Basic Member's Fund Allowance for

Probable Ledger

Members' Fees

& DuesContributions

Losses Assets

(8) (9) (10) (11)

-

-

-

-

-

-

-

- - - -

- - - -




Balance YEAR END

Non-Ledger NOT NETMembers' Equity Value

Assets Admitted Admittedas of 31 December 2020

(12) (13) (14)=(11)+(12)-(13) (15)

-

-

-

-

-

-

-

- - - -

- - - -

RBC Fund

Code Code Microinsurance

(Note 5) (Note 6) True/False

(16) (17) (18)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR


xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx

Index

MBA NAME:

YEAR ENDED: December 31, 2020


(1) (2) (3)

MOLD SASI, ADA U. SFB-13-2613

MOLD BENEDICTO, OFELIA P. MBA-MI-20-0000-0001

MOLD ADES, JOCELYN N. SFB-16-3977

MOLD NICOR, JOSE MBA-MI-20-0000-0002

MOLD NICOR, RIA U. SFB-11-0591

MOLD NOBLE, LEONORA N. MBA-MI-20-0000-0003

MOLD NOBLE, ESMENIA N. MBA-MI-20-0000-0004

MOLD CULLANTES, ELENA P. SFB-11-0894

MOLD PANES, ELIZABETH C. MBA-MI-20-0000-0005

MOLD OLIVER, MARIA RULI A. MBA-MI-20-0000-0006

MOLD AREGLO, JINA A. MBA-MI-20-0000-0007

MOLD SARAOSOS, ANGELITA C.MBA-MI-20-0000-0019-011

MOLD JOPSON, LEODEGARIA B.MBA-MI-20-0000-0008

MOLD CABRILLOS, HENRY F. MBA-MI-20-0000-0019-012

MOLD MONILLA, JOSIE C. MBA-MI-20-0000-0019-001

MOLD CABAHUG, CIRILA R. MBA-MI-20-0000-0019-002

MOLD ENOT, MELCHOR C. JR. MBA-MI-20-0000-0019-003

MOLD GUAZON, CONCEPCION M.MBA-MI-20-0000-0019-004

MOLD CANETE, FLORY VIC M. MBA-MI-20-0000-0019-005

MOLD LADESMA, TITO T. MBA-MI-20-0000-0019-006

MOLD PELOBILLO, MILANIE D. MBA-MI-20-0000-0019-007

MOLD UNABIA, NORMA T. MBA-MI-20-0000-0019-008

MOLD DAUHOG, FE MILAGROS C.MBA-MI-20-0000-0019-009

MOLD SABLAS, CONCEPCION L. MBA-MI-20-0000-0019-010

MOLD GORTINA, ROSALIE VERGAMBA-MI-20-0000-0009

MOLD BANTES, AMCEL PEARL C.MBA-MI-20-0000-0010

MOLD HAUM, NENITA M. MBA-MI-20-0000-0011

MOLD REBUCAS, REMEDIOS B. MBA-MI-20-0000-0012

MOLD CUASITO, MARLYN C. MBA-MI-20-0000-0013

MOLD SATO, LEA C. MBA-MI-20-0000-0014

MOLD SARIAS, HENRY M MBA-MI-20-0000-0015

MOLD BULAC, EDGARDO C. MBA-MI-20-0000-0016

MOLD LANTAJO, NINFA S. MBA-MI-20-0000-0017

SCHEDULE OF UNREMITTED MEMBERS' CONTRIBUTION/PREMIUMS , FEES & DUES


NAME OF COLLECTING AGENT

(Partner, Individual or Insitution)NAME OF MEMBER

MOLD CLARITO, JULIETA C. MBA-MI-20-0000-0018

MOLD TUSAY, MARIA D. MBA-MI-20-0000-0019

MOLD VEBAR, JANICE A. MBA-MI-20-0000-0019-013

MOLD MACALANGA, JULIE GRACE B.MBA-MI-20-0000-0019-014

MOLD PANDILI, JEFFREY R. MBA-MI-20-0000-0019-015

MOLD ABARCA, HELEN J. MBA-MI-20-0000-0019-016

MOLD SILVERIO, GREGORIA A. MBA-MI-20-0000-0019-017

MOLD SALILING, VERNALYN B. MBA-MI-20-0000-0019-018

MOLD LINAZA, GLORIFE T. MBA-MI-20-0000-0019-019

MOLD AYUCAN, AILYN I. MBA-MI-20-0000-0019-020

MOLD SILVERIO, MARICEL A. MBA-MI-20-0000-0019-021

MOLD MARTECION, ELVIE M. MBA-MI-20-0000-0019-022

MOLD JIMENEZ, DAISY M. MBA-MI-20-0000-0019-023

MOLD TOROBA, IRYN A. MBA-MI-20-0000-0019-024

MOLD PANDILI, JANE P. MBA-MI-20-0000-0019-025

MOLD CASTRO, LEE C. MBA-MI-20-0000-0019-026

MOLD FEROLINO, JULIET G. MBA-MI-20-0000-0019-027

MOLD PATAYON, LAILA L. MBA-MI-20-0000-0019-028

MOLD LISAYAN, JOEL W. MBA-MI-20-0000-0019-029

MOLD LISAYAN, BETTY N. MBA-MI-20-0000-0019-030

MOLD TAOC, BEN-JAY L. MBA-MI-20-0000-0019-031

MOLD GODGOD, JESIL M. MBA-MI-20-0000-0019-032

MOLD GODGOD, JINKY M. MBA-MI-20-0000-0019-033

MOLD DELOS SANTOS, MERLYN I.MBA-MI-20-0000-0019-034

MOLD TAOC, VIDAL D. MBA-MI-20-0000-0019-035

MOLD SILVOSA, PETRONILLA L. MBA-MI-20-0000-0019-036

MOLD AYALA, RAQUEL A. MBA-MI-20-0000-0019-037

MOLD CAPILOYAN, DEDITH R. MBA-MI-20-0000-0019-038

MOLD SALUDAGA, MARY GRACE B.MBA-MI-20-0000-0019-039

MOLD CLAMOR, LORLYN C. MBA-MI-20-0000-0019-040

MOLD RAMONAL, NOEMI G. MBA-MI-20-0000-0025-001

MOLD ROSETE, HILDA V. SFB-11-04-27

MOLD ROSETE, ROCELYN V. MBA-MI-20-0000-0025-002

MOLD LIZADA, MARICEL M. MBA-MI-20-0000-0025-003

MOLD RUGAS, JANETH A. SFB-15-3712

MOLD ALAG, NORYGENE L. SFB-11-0931

MOLD DELA CRUZ, JOCELYN N. SFB-11-0476-011

MOLD ALAG, LENY E. SFB-13-2421

MOLD ANCHETA, JOVELYN R. SFB-11-0355

MOLD EUSEBIO, GERALYN A. SFB-15-3719

MOLD REYES, CHERYL A. MBA-MI-20-0000-0025-004

MOLD CAMPOS, GERALDINE M.MBA-MI-20-0000-0025-005

MOLD DURANGO, HEZELMIE A. MBA-MI-20-0000-0025-006

MOLD ACERO, ELDA O. MBA-MI-20-0000-0020

MOLD FLORES, JINKY C. MBA-MI-20-0000-0021

MOLD GOC-ONG, TESIE P. MBA-MI-20-0000-0025-007

MOLD DURANGO, JESSIE P. MBA-MI-20-0000-0025-008

MOLD DURANGO, CRISTITA A. MBA-MI-20-0000-0022

MOLD DURANGO, EVANGELINE P.MBA-MI-20-0000-0024

MOLD PELAYO, MIRAFLOR D. SFB-14-2832-003

MOLD PALADO, ARCELITA P. MBA-MI-20-0000-0025-011

MOLD SEBOG, CHECHE F. MBA-MI-20-0000-0025

MOLD BAROT, MARY JEAN R. MBA-MI-20-0000-0025-012

MOLD ESPANA, MELINDA L. MBA-MI-20-0000-0025-013

MOLD APARENTE, LAURIANA B.SFB-16-4431

MOLD BERDERA, ROSALIE N. MBA-MI-20-0000-0025-016

MOLD LADEMORA, CRYSEL D. MBA-MI-20-0000-0025-018

MOLD DAPILAGA, NORLY M. MBA-MI-20-0000-0025-019

MOLD LACAZA, MAYLYN P. MBA-MI-20-0000-0023

MOLD NORIGA, CHRISTINA J. MBA-MI-20-0000-0025-020

MOLD LALISAN, SHARMYLENE MBA-MI-20-0000-0025-021

MOLD DURANGO, LANNY ENTRINAMBA-MI-20-0000-0025-023

MOLD LADEMORA, ERON CRIS JADE D.MBA-MI-20-0000-0025-025

MOLD PEREZ, SHEENAMAEBERN D.MBA-MI-20-0000-0038-001

MOLD DURANGO, ROCHELYN A.MBA-MI-20-0000-0038-002

MOLD RUBINOS, RAIZEL D. MBA-MI-20-0000-0031

MOLD BOSTON, MELODY D. MBA-MI-20-0000-0038-003

MOLD PELAYO, MARY JANE D. MBA-MI-20-0000-0038-004

MOLD BARRIOS, FLORDELITA M.MBA-MI-20-0000-0038-005

MOLD DESPOJO, JELAN B. MBA-MI-20-0000-0032

MOLD BARINA, AMORLINA P. MBA-MI-20-0000-0033

MOLD MARAVILLA, DAISY M. MBA-MI-20-0000-0034

MOLD BARRIOS, NORIE L. MBA-MI-20-0000-0038-006

MOLD SAMILLANO, SOPIA K. MBA-MI-20-0000-0038-007

MOLD MONDEJAR, MARILYN MBA-MI-20-0000-0038-008

MOLD GUELOS, JOCELYN C. MBA-MI-20-0000-0026

MOLD CAMPOS, ROWENA MBA-MI-20-0000-0038-009

MOLD DURANGO, LANNIE ESPANIAMBA-MI-20-0000-0027

MOLD CERBAS, GABRIEL L. MBA-MI-20-0000-0038-010

MOLD CERBAS, HARVEY L. MBA-MI-20-0000-0038-011

MOLD PELAYO, LISLIE R. MBA-MI-20-0000-0038-012

MOLD DESPOJO, ROSEMARIE B.MBA-MI-20-0000-0038-013

MOLD LONGNO, BEVERLY O. MBA-MI-20-0000-0038-014

MOLD MENENDEZ, DIOMEDES H.MBA-MI-20-0000-0038-015

MOLD PUDINAO, MYLENE M. MBA-MI-20-0000-0038-016

MOLD ANAS, AIZEL HOPE D. MBA-MI-20-0000-0028

MOLD MONTES, MELLYSA O. MBA-MI-20-0000-0038-017

MOLD MENENDEZ, ESTHER C. MBA-MI-20-0000-0038-018

MOLD ORCULLO, CARMEN E. MBA-MI-20-0000-0035

MOLD DURANGO, MERRY CRIS B.MBA-MI-20-0000-0036

MOLD BUTAYA, MADILENE M. MBA-MI-20-0000-0038-019

MOLD MENENDEZ, JESSA B. MBA-MI-20-0000-0037

MOLD DURANGO, CRISELDA C. MBA-MI-20-0000-0038

MOLD PARAO, MARGIE D. MBA-MI-20-0000-0029

MOLD CAALIM, MARIVEL M. MBA-MI-20-0000-0038-020

MOLD BERNALDO, GRISELA A. MBA-MI-20-0000-0030

MOLD PARAO, MICHELLE D. MBA-MI-20-0000-0038-022

MOLD MENENDEZ, SELVIRIO D. MBA-MI-20-0000-0072-009

MOLD BELLO, LYDIA S. SFB-12-1984-001

MOLD PEDROSO, OLINRECH A. MBA-MI-20-0000-0048-001

MOLD CABRIADAS, LUZMINDA S.SFB-18-4745

MOLD BARRETO, JANET D. MBA-MI-20-0000-0048-002

MOLD AMAR, AILEEN T. MBA-MI-20-0000-0048-003

MOLD EUCOGNAN, GIRLY BEBB P.MBA-MI-20-0000-0048-004

MOLD LEPASANA, ROSENE C. MBA-MI-20-0000-0039

MOLD SALDIVAR, MYRNA P. SFB-12-1923-015

MOLD FORDAN, LYNEL ANN D. MBA-MI-20-0000-0040

MOLD CABRIADAS, MARY JOIE S.SFB-18-4612

MOLD BACO, JEANEVIE O. MBA-MI-20-0000-0041

MOLD SEVILLA, RHENA L. SFB-18-4621

MOLD PACULANANG, EVELYN L.SFB-11-0257-001-01

MOLD VISCAYA, NOEL D. SFB-14-2961

MOLD ASIS, MYRLEN L. SFB-11-1325

MOLD AYALA, MILA L. MBA-MI-20-0000-0042

MOLD YPANTO, JESSICA B. MBA-MI-20-0000-0043

MOLD PENALOGA, MARIANITA A.MBA-MI-20-0000-0044

MOLD CAGUMAY, RODOLFO D. MBA-MI-20-0000-0045

MOLD FLORES, ROSENY R. MBA-MI-20-0000-0046

MOLD AYALA, ROCIL L. MBA-MI-20-0000-0047

MOLD SEMBRANO, MARICEL O.MBA-MI-20-0000-0048

MOLD RONGUILLO, PABLO S. MBA-MI-20-0000-0038-023

MOLD ANTONIANO, NOLI D. MBA-MI-20-0000-0038-024

MOLD LAURON, ROGINE INNA E.MBA-MI-20-0000-0049

MOLD ENAJADA, JENETTE MBA-MI-20-0000-0050

MOLD BIENVINIDA, ELREEN MAEMBA-MI-20-0000-0051

MOLD FORMIS, ESTEFANE MBA-MI-20-0000-0052

MOLD SACAY, GIRLIE C. MBA-MI-20-0000-0053

MOLD BAYBAYANON, MELVA MBA-MI-20-0000-0054

MOLD TORION, MARICHE M. MBA-MI-20-0000-0055

MOLD CLARIDO, MA. ELIZA P. MBA-MI-20-0000-0056

MOLD HOMECILLO, JULIBETH P.MBA-MI-20-0000-0057

MOLD ADLAON, REBECCA A. MBA-MI-20-0000-0058

MOLD MAGAN, NENITA MBA-MI-20-0000-0072-001

MOLD LUBAYAN, CONCEPCION MBA-MI-20-0000-0072-002

MOLD LUBAYAN, ADELINDA MBA-MI-20-0000-0072-003

MOLD EDLAY, EMELIE MBA-MI-20-0000-0072-004

MOLD PEDROZO, MARIFE MBA-MI-20-0000-0072-005

MOLD REDUERTO, QUEENIE MBA-MI-20-0000-0072-006

MOLD CAYNA, JEZEIL MBA-MI-20-0000-0072-007

MOLD TEMPORAS, JOVE MBA-MI-20-0000-0072-008

MOLD SELVINO, ROCHELLE L. MBA-MI-20-0000-0065

MOLD SILVINO, ROSANA A. MBA-MI-20-0000-0066

MOLD IBIT, JOVELYN S. MBA-MI-20-0000-0067

MOLD PAYAGAN, MELCHORA N.MBA-MI-20-0000-0072-010

MOLD RENDON, FRELYN N. MBA-MI-20-0000-0072-011

MOLD NUMANCIA, GLORIA B. MBA-MI-20-0000-0068

MOLD ALAG, JENNIFER D. MBA-MI-20-0000-0069

MOLD ALAG, JAY RYAN L. MBA-MI-20-0000-0070

MOLD TUBANG, AUGUST LOVE H.MBA-MI-20-0000-0072-012

MOLD BARRIOS, JOCELYN P. MBA-MI-20-0000-0059

MOLD ANCHETA, DIANA B. MBA-MI-20-0000-0072-013

MOLD CAMACHO, JECELYN M. MBA-MI-20-0000-0060

MOLD ARAIS, JOCELYN Q. MBA-MI-20-0000-0061

MOLD PANGADLAO, JOURNALYN J.MBA-MI-20-0000-0062

MOLD IBANEZ, EDNA D. MBA-MI-20-0000-0063

MOLD BARRIOS, MARY JEAN J. MBA-MI-20-0000-0071

MOLD MERCADO, TERESITA L. MBA-MI-20-0000-0072-014

MOLD IBANEZ, EDELYN D. MBA-MI-20-0000-0064

MOLD GOC-ONG, GERALDEN P.MBA-MI-20-0000-0072-015

DURANGO, SHAIRA KAY P.MBA-MI-20-0000-0072































MOLD MADAGMOS, JONALYN D.CVB-13-1890



















































MOLD LONGNO, YOLANDA M. MBA-MI-20-0000-0025-009

MOLD BARRIOS, DANILYN D. MBA-MI-20-0000-0025-010








MOLD LACAZA, MERILYN D. MBA-MI-20-0000-0025-014


MOLD EBORDE, NORMIE L. MBA-MI-20-0000-0025-015


MOLD MONTEROSO, LIZA R. MBA-MI-20-0000-0025-017






MOLD PELAYO, DELILAH L. MBA-MI-20-0000-0025-022


MOLD PELAYO, ELSIELITA R. MBA-MI-20-0000-0025-024



































MOLD DURANGO, MARY LUZ E.MBA-MI-20-0000-0038-021




















MOLD DURANGO, SHAIRA KAY P.MBA-MI-20-0000-0072



































MOLD CUASITO, ALOMA M. CVB-10-0307-027



MOLD PALARUAN, MARIFIEL CVB-10-0293-057

MOLD DANGO, JULIE D. CVB-10-0293-013

MOLD MACATUMBAS, MA. KRISTINA PEARL C.CVB-12-0981-005-06

MOLD MIRA, NELIE C. CVB-19-3510-002

MOLD GAMUEDA, NOEMI A. CVB-11-0457-040

MOLD PALARUAN, ROGELIO G. CVB-12-0981-005-25

MOLD CASIANO, ARACELI M. CVB-10-0293-012

MOLD GONZAGA, ROSARIO CVB-10-0290

MOLD DULAG, EFREN CVB-10-0288

MOLD GAMIL, ANECITA CVB-10-0293-035


MOLD MACALANGA, MA. MANALILY P.CVB-10-0284-004

















































MOLD ANTONIO, NOLI D. MBA-MI-20-0000-0038-024


































MOLD DURANGO, SHAIRA KAY P.MBA-MI-20-0000-0072






















































MOLD ANTONIO, NOLI D. MBA-MI-20-0000-0038-024












































Agent 2 Member 6

Member 7

Member 8

Member 9

Agent 3 Member 10

Member 11

Member 12

Member 13

1.1 TOTAL MICROINSURANCE xxxxxxxxxxxxx xxxxxxxxxxxxx

1.2 GRAND TOTAL UNREMITTED MEMBERS' CONTRIBUTIONS/PREMIUMS, FEES & DUESxxxxxxxxxxxxx xxxxxxxxxxxxx






General Fund Basic Member's Fund

Policy NumberDate pf

Membership

Date Members'Fees & Contributions

Dues

(4) (5) (12) (13)

SFB-13-2613 10/12/2020 200.00

MBA-MI-20-0000-0001 10/12/2020 200.00

SFB-16-3977 10/12/2020 200.00

MBA-MI-20-0000-0002 10/12/2020 200.00

SFB-11-0591 10/12/2020 200.00

MBA-MI-20-0000-0003 10/12/2020 200.00

MBA-MI-20-0000-0004 10/12/2020 200.00

SFB-11-0894 10/12/2020 200.00

MBA-MI-20-0000-0005 10/12/2020 200.00

MBA-MI-20-0000-0006 10/12/2020 200.00

MBA-MI-20-0000-0007 10/12/2020 200.00

MBA-MI-20-0000-0019-011 12/10/2020 200.00

MBA-MI-20-0000-0008 10/12/2020 200.00

MBA-MI-20-0000-0019-012 10/12/2020 200.00

MBA-MI-20-0000-0019-001 10/12/2020 200.00

MBA-MI-20-0000-0019-002 10/12/2020 200.00

MBA-MI-20-0000-0019-003 10/12/2020 200.00

MBA-MI-20-0000-0019-004 10/12/2020 200.00

MBA-MI-20-0000-0019-005 10/12/2020 200.00

MBA-MI-20-0000-0019-006 10/12/2020 200.00

MBA-MI-20-0000-0019-007 10/12/2020 200.00

MBA-MI-20-0000-0019-008 10/12/2020 200.00

MBA-MI-20-0000-0019-009 10/12/2020 200.00

MBA-MI-20-0000-0019-010 12/10/2020 200.00

MBA-MI-20-0000-0009 10/12/2020 200.00

MBA-MI-20-0000-0010 10/12/2020 200.00

MBA-MI-20-0000-0011 10/12/2020 200.00

MBA-MI-20-0000-0012 10/12/2020 200.00

MBA-MI-20-0000-0013 10/12/2020 200.00

MBA-MI-20-0000-0014 10/12/2020 200.00

MBA-MI-20-0000-0015 12/10/2020 200.00

MBA-MI-20-0000-0016 12/10/2020 200.00

MBA-MI-20-0000-0017 12/10/2020 200.00

Total Unremitted Balance YEAR END

SCHEDULE OF UNREMITTED MEMBERS' CONTRIBUTION/PREMIUMS , FEES & DUES


MBA-MI-20-0000-0018 12/10/2020 200.00

MBA-MI-20-0000-0019 12/10/2020 200.00

MBA-MI-20-0000-0019-013 12/14/2020 200.00

MBA-MI-20-0000-0019-014 12/14/2020 200.00

MBA-MI-20-0000-0019-015 12/14/2020 200.00

MBA-MI-20-0000-0019-016 12/14/2020 200.00

MBA-MI-20-0000-0019-017 12/14/2020 200.00

MBA-MI-20-0000-0019-018 12/14/2020 200.00

MBA-MI-20-0000-0019-019 12/14/2020 200.00

MBA-MI-20-0000-0019-020 12/14/2020 200.00

MBA-MI-20-0000-0019-021 12/14/2020 200.00

MBA-MI-20-0000-0019-022 12/14/2020 200.00

MBA-MI-20-0000-0019-023 12/14/2020 200.00

MBA-MI-20-0000-0019-024 12/14/2020 200.00

MBA-MI-20-0000-0019-025 12/14/2020 200.00

MBA-MI-20-0000-0019-026 12/14/2020 200.00

MBA-MI-20-0000-0019-027 12/14/2020 200.00

MBA-MI-20-0000-0019-028 12/14/2020 200.00

MBA-MI-20-0000-0019-029 12/14/2020 200.00

MBA-MI-20-0000-0019-030 12/14/2020 200.00

MBA-MI-20-0000-0019-031 12/14/2020 200.00

MBA-MI-20-0000-0019-032 12/14/2020 200.00

MBA-MI-20-0000-0019-033 12/14/2020 200.00

MBA-MI-20-0000-0019-034 12/14/2020 200.00

MBA-MI-20-0000-0019-035 12/14/2020 200.00

MBA-MI-20-0000-0019-036 12/14/2020 200.00

MBA-MI-20-0000-0019-037 12/14/2020 200.00

MBA-MI-20-0000-0019-038 12/14/2020 200.00

MBA-MI-20-0000-0019-039 12/14/2020 200.00

MBA-MI-20-0000-0019-040 12/14/2020 200.00

MBA-MI-20-0000-0025-001 12/17/2020 200.00

SFB-11-04-27 17/12/2020 200.00

MBA-MI-20-0000-0025-002 12/17/2020 200.00

MBA-MI-20-0000-0025-003 12/17/2020 200.00

SFB-15-3712 17/12/2020 200.00

SFB-11-0931 17/12/2020 200.00

SFB-11-0476-011 17/12/2020 200.00

SFB-13-2421 17/12/2020 200.00

SFB-11-0355 17/12/2020 200.00

SFB-15-3719 17/12/2020 200.00

MBA-MI-20-0000-0025-004 17/12/2020 200.00

MBA-MI-20-0000-0025-005 12/17/2020 200.00

MBA-MI-20-0000-0025-006 12/17/2020 200.00

MBA-MI-20-0000-0020 12/17/2020 200.00

MBA-MI-20-0000-0021 12/17/2020 200.00

MBA-MI-20-0000-0025-007 12/17/2020 200.00

MBA-MI-20-0000-0025-008 12/17/2020 200.00

MBA-MI-20-0000-0022 12/17/2020 200.00

MBA-MI-20-0000-0024 12/17/2020 200.00

SFB-14-2832-003 17/12/2020 200.00

MBA-MI-20-0000-0025-011 12/17/2020 200.00

MBA-MI-20-0000-0025 12/17/2020 200.00

MBA-MI-20-0000-0025-012 12/17/2020 200.00

MBA-MI-20-0000-0025-013 12/17/2020 200.00

SFB-16-4431 17/12/2020 200.00

MBA-MI-20-0000-0025-016 12/17/2020 200.00

MBA-MI-20-0000-0025-018 12/17/2020 200.00

MBA-MI-20-0000-0025-019 12/17/2020 200.00

MBA-MI-20-0000-0023 12/17/2020 200.00

MBA-MI-20-0000-0025-020 12/17/2020 200.00

MBA-MI-20-0000-0025-021 12/17/2020 200.00

MBA-MI-20-0000-0025-023 12/17/2020 200.00

MBA-MI-20-0000-0025-025 12/17/2020 200.00

MBA-MI-20-0000-0038-001 12/18/2020 200.00

MBA-MI-20-0000-0038-002 12/18/2020 200.00

MBA-MI-20-0000-0031 12/18/2020 200.00

MBA-MI-20-0000-0038-003 12/18/2020 200.00

MBA-MI-20-0000-0038-004 12/18/2020 200.00

MBA-MI-20-0000-0038-005 12/18/2020 200.00

MBA-MI-20-0000-0032 12/18/2020 200.00

MBA-MI-20-0000-0033 12/18/2020 200.00

MBA-MI-20-0000-0034 12/18/2020 200.00

MBA-MI-20-0000-0038-006 12/18/2020 200.00

MBA-MI-20-0000-0038-007 12/18/2020 200.00

MBA-MI-20-0000-0038-008 12/18/2020 200.00

MBA-MI-20-0000-0026 12/18/2020 200.00

MBA-MI-20-0000-0038-009 12/18/2020 200.00

MBA-MI-20-0000-0027 12/18/2020 200.00

MBA-MI-20-0000-0038-010 12/18/2020 200.00

MBA-MI-20-0000-0038-011 12/18/2020 200.00

MBA-MI-20-0000-0038-012 12/18/2020 200.00

MBA-MI-20-0000-0038-013 12/18/2020 200.00

MBA-MI-20-0000-0038-014 12/18/2020 200.00

MBA-MI-20-0000-0038-015 12/18/2020 200.00

MBA-MI-20-0000-0038-016 12/18/2020 200.00

MBA-MI-20-0000-0028 12/18/2020 200.00

MBA-MI-20-0000-0038-017 12/18/2020 200.00

MBA-MI-20-0000-0038-018 12/18/2020 200.00

MBA-MI-20-0000-0035 12/18/2020 200.00

MBA-MI-20-0000-0036 12/18/2020 200.00

MBA-MI-20-0000-0038-019 12/18/2020 200.00

MBA-MI-20-0000-0037 12/18/2020 200.00

MBA-MI-20-0000-0038 12/18/2020 200.00

MBA-MI-20-0000-0029 12/18/2020 200.00

MBA-MI-20-0000-0038-020 12/18/2020 200.00

MBA-MI-20-0000-0030 12/18/2020 200.00

MBA-MI-20-0000-0038-022 12/18/2020 200.00

MBA-MI-20-0000-0072-009 12/30/2020 200.00

SFB-12-1984-001 22/12/2020 200.00

MBA-MI-20-0000-0048-001 12/22/2020 200.00

SFB-18-4745 22/12/2020 200.00

MBA-MI-20-0000-0048-002 12/22/2020 200.00

MBA-MI-20-0000-0048-003 12/22/2020 200.00

MBA-MI-20-0000-0048-004 12/22/2020 200.00

MBA-MI-20-0000-0039 12/22/2020 200.00

SFB-12-1923-015 22/12/2020 200.00

MBA-MI-20-0000-0040 12/22/2020 200.00

SFB-18-4612 22/12/2020 200.00

MBA-MI-20-0000-0041 12/22/2020 200.00

SFB-18-4621 22/12/2020 200.00

SFB-11-0257-001-01 22/12/2020 200.00

SFB-14-2961 22/12/2020 200.00

SFB-11-1325 22/12/2020 200.00

MBA-MI-20-0000-0042 12/22/2020 200.00

MBA-MI-20-0000-0043 12/22/2020 200.00

MBA-MI-20-0000-0044 12/22/2020 200.00

MBA-MI-20-0000-0045 12/22/2020 200.00

MBA-MI-20-0000-0046 12/22/2020 200.00

MBA-MI-20-0000-0047 12/22/2020 200.00

MBA-MI-20-0000-0048 12/22/2020 200.00

MBA-MI-20-0000-0038-023 12/21/2020 200.00

MBA-MI-20-0000-0038-024 12/21/2020 200.00

MBA-MI-20-0000-0049 12/23/2020 200.00

MBA-MI-20-0000-0050 12/23/2020 200.00

MBA-MI-20-0000-0051 12/23/2020 200.00

MBA-MI-20-0000-0052 12/23/2020 200.00

MBA-MI-20-0000-0053 12/23/2020 200.00

MBA-MI-20-0000-0054 12/23/2020 200.00

MBA-MI-20-0000-0055 12/23/2020 200.00

MBA-MI-20-0000-0056 12/23/2020 200.00

MBA-MI-20-0000-0057 12/23/2020 200.00

MBA-MI-20-0000-0058 12/23/2020 200.00

MBA-MI-20-0000-0072-001 12/30/2020 200.00

MBA-MI-20-0000-0072-002 12/30/2020 200.00

MBA-MI-20-0000-0072-003 12/30/2020 200.00

MBA-MI-20-0000-0072-004 12/30/2020 200.00

MBA-MI-20-0000-0072-005 12/30/2020 200.00

MBA-MI-20-0000-0072-006 12/30/2020 200.00

MBA-MI-20-0000-0072-007 12/30/2020 200.00

MBA-MI-20-0000-0072-008 12/30/2020 200.00

MBA-MI-20-0000-0065 12/30/2020 200.00

MBA-MI-20-0000-0066 12/30/2020 200.00

MBA-MI-20-0000-0067 12/30/2020 200.00

MBA-MI-20-0000-0072-010 12/30/2020 200.00

MBA-MI-20-0000-0072-011 12/30/2020 200.00

MBA-MI-20-0000-0068 12/30/2020 200.00

MBA-MI-20-0000-0069 12/30/2020 200.00

MBA-MI-20-0000-0070 12/30/2020 200.00

MBA-MI-20-0000-0072-012 12/30/2020 200.00

MBA-MI-20-0000-0059 12/30/2020 200.00

MBA-MI-20-0000-0072-013 12/30/2020 200.00

MBA-MI-20-0000-0060 12/30/2020 200.00

MBA-MI-20-0000-0061 12/30/2020 200.00

MBA-MI-20-0000-0062 12/30/2020 200.00

MBA-MI-20-0000-0063 12/30/2020 200.00

MBA-MI-20-0000-0071 12/30/2020 200.00

MBA-MI-20-0000-0072-014 12/30/2020 200.00

MBA-MI-20-0000-0064 12/30/2020 200.00

MBA-MI-20-0000-0072-015 12/30/2020 200.00

MBA-MI-20-0000-0072 12/30/2020 200.00

SFB-13-2613 10/12/2020 12

MBA-MI-20-0000-0001 12/10/2020 12

SFB-16-3977 10/12/2020 12

MBA-MI-20-0000-0002 12/10/2020 12

SFB-11-0591 03/04/2011 12

MBA-MI-20-0000-0003 12/10/2020 12

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SFB-11-0894 10/12/2020 12

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MBA-MI-20-0000-0006 12/10/2020 12

MBA-MI-20-0000-0007 12/10/2020 12

MBA-MI-20-0000-0019-011 12/10/2020 12

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MBA-MI-20-0000-0019-012 12/10/2020 12

MBA-MI-20-0000-0019-001 12/10/2020 12

MBA-MI-20-0000-0019-002 12/10/2020 12

MBA-MI-20-0000-0019-003 12/10/2020 12

MBA-MI-20-0000-0019-004 12/10/2020 12

MBA-MI-20-0000-0019-005 12/10/2020 12

MBA-MI-20-0000-0019-006 12/10/2020 12

MBA-MI-20-0000-0019-007 12/10/2020 12

MBA-MI-20-0000-0019-008 12/10/2020 12

MBA-MI-20-0000-0019-009 12/10/2020 12

MBA-MI-20-0000-0019-010 12/10/2020 12

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MBA-MI-20-0000-0013 12/10/2020 12

MBA-MI-20-0000-0014 12/10/2020 12

CVB-13-1890 11/13/2013 724

MBA-MI-20-0000-0015 12/10/2020 12

MBA-MI-20-0000-0016 12/10/2020 12

MBA-MI-20-0000-0017 12/10/2020 12

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MBA-MI-20-0000-0019-013 12/14/2020 12

MBA-MI-20-0000-0019-014 12/14/2020 12

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MBA-MI-20-0000-0019-022 12/14/2020 12

MBA-MI-20-0000-0019-023 12/14/2020 12

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MBA-MI-20-0000-0019-039 12/14/2020 12

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SFB-15-3712 17/12/2020 12

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SFB-15-3719 17/12/2020 12

MBA-MI-20-0000-0025-004 12/17/2020 12

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MBA-MI-20-0000-0025-008 12/17/2020 12

MBA-MI-20-0000-0025-009 12/17/2020 212

MBA-MI-20-0000-0025-010 12/17/2020 212

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SFB-14-2832-003 17/12/2020 12

MBA-MI-20-0000-0025-011 12/17/2020 12

MBA-MI-20-0000-0025 12/17/2020 12

MBA-MI-20-0000-0025-012 12/17/2020 12

MBA-MI-20-0000-0025-013 12/17/2020 12

MBA-MI-20-0000-0025-014 12/17/2020 212

SFB-16-4431 17/12/2020 12

MBA-MI-20-0000-0025-015 12/17/2020 212

MBA-MI-20-0000-0025-016 12/17/2020 12

MBA-MI-20-0000-0025-017 12/17/2020 212

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MBA-MI-20-0000-0023 12/17/2020 12

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MBA-MI-20-0000-0025-021 12/17/2020 12

MBA-MI-20-0000-0025-022 12/17/2020 212

MBA-MI-20-0000-0025-023 12/17/2020 12

MBA-MI-20-0000-0025-024 12/17/2020 212

MBA-MI-20-0000-0025-025 12/17/2020 12

MBA-MI-20-0000-0038-001 12/18/2020 12

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MBA-MI-20-0000-0035 12/18/2020 12

MBA-MI-20-0000-0036 12/18/2020 12

MBA-MI-20-0000-0038-019 12/18/2020 12

MBA-MI-20-0000-0037 12/18/2020 12

MBA-MI-20-0000-0038 12/18/2020 12

MBA-MI-20-0000-0029 12/18/2020 12

MBA-MI-20-0000-0038-020 12/18/2020 12

MBA-MI-20-0000-0030 12/18/2020 12

MBA-MI-20-0000-0038-021 12/18/2020 212

MBA-MI-20-0000-0038-022 12/18/2020 12

MBA-MI-20-0000-0072-009 12/30/2020 12

SFB-12-1984-001 22/12/2020 12

MBA-MI-20-0000-0048-001 12/22/2020 12

SFB-18-4745 22/12/2020 12

MBA-MI-20-0000-0048-002 12/22/2020 12

MBA-MI-20-0000-0048-003 12/22/2020 12

MBA-MI-20-0000-0048-004 12/22/2020 12

MBA-MI-20-0000-0039 12/22/2020 12

SFB-12-1923-015 22/12/2020 12

MBA-MI-20-0000-0040 12/22/2020 12

SFB-18-4612 22/12/2020 12

MBA-MI-20-0000-0041 12/22/2020 12

SFB-18-4621 22/12/2020 12

SFB-11-0257-001-01 22/12/2020 12

SFB-14-2961 22/12/2020 12

SFB-11-1325 22/12/2020 12

MBA-MI-20-0000-0042 12/22/2020 12

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MBA-MI-20-0000-0038-023 12/21/2020 12

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MBA-MI-20-0000-0049 12/23/2020 12

MBA-MI-20-0000-0050 12/23/2020 12

MBA-MI-20-0000-0051 12/23/2020 12

MBA-MI-20-0000-0052 12/23/2020 12

MBA-MI-20-0000-0053 12/23/2020 12

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MBA-MI-20-0000-0055 12/23/2020 12

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MBA-MI-20-0000-0069 12/30/2020 12

MBA-MI-20-0000-0070 12/30/2020 12

MBA-MI-20-0000-0072-012 12/30/2020 12

MBA-MI-20-0000-0059 12/30/2020 12

MBA-MI-20-0000-0072-013 12/30/2020 12

MBA-MI-20-0000-0060 12/30/2020 12

MBA-MI-20-0000-0061 12/30/2020 12

MBA-MI-20-0000-0062 12/30/2020 12

MBA-MI-20-0000-0063 12/30/2020 12

MBA-MI-20-0000-0071 12/30/2020 12

MBA-MI-20-0000-0072-014 12/30/2020 12

MBA-MI-20-0000-0064 12/30/2020 12

MBA-MI-20-0000-0072-015 12/30/2020 12

MBA-MI-20-0000-0072 12/30/2020 12

SFB-13-2613 10/12/2020 12

MBA-MI-20-0000-0001 12/10/2020 12

SFB-16-3977 10/12/2020 12

MBA-MI-20-0000-0002 12/10/2020 12

SFB-11-0591 03/04/2011 12

MBA-MI-20-0000-0003 12/10/2020 12

MBA-MI-20-0000-0004 12/10/2020 6

SFB-11-0894 10/12/2020 12

MBA-MI-20-0000-0005 12/10/2020 12

MBA-MI-20-0000-0006 12/10/2020 6

MBA-MI-20-0000-0007 12/10/2020 12

MBA-MI-20-0000-0019-011 12/10/2020 12

MBA-MI-20-0000-0008 12/10/2020 12

MBA-MI-20-0000-0019-012 12/10/2020 12

CVB-13-1890 11/13/2013 12

MBA-MI-20-0000-0015 12/10/2020 12

MBA-MI-20-0000-0016 12/10/2020 12

MBA-MI-20-0000-0017 12/10/2020 12

MBA-MI-20-0000-0018 12/10/2020 12

MBA-MI-20-0000-0019 12/10/2020 12

MBA-MI-20-0000-0019-001 12/10/2020 12

MBA-MI-20-0000-0019-002 12/10/2020 12

MBA-MI-20-0000-0019-003 12/10/2020 12

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MBA-MI-20-0000-0019-010 12/10/2020 12

MBA-MI-20-0000-0011 12/10/2020 12

MBA-MI-20-0000-0012 12/10/2020 12

MBA-MI-20-0000-0013 12/10/2020 12

MBA-MI-20-0000-0014 12/10/2020 12

CVB-10-0307-027 01/06/2011 12

MBA-MI-20-0000-0009 12/10/2020 12

MBA-MI-20-0000-0010 12/10/2020 12

CVB-10-0293-057 01/13/2011 12

CVB-10-0293-013 01/06/2011 12

CVB-12-0981-005-06 01/04/2012 12

CVB-19-3510-002 01/08/2019 12

CVB-11-0457-040 01/06/2011 12

CVB-12-0981-005-25 01/04/2012 12

CVB-10-0293-012 01/06/2011 12

CVB-10-0290 01/06/2011 12

CVB-10-0288 01/06/2011 12

CVB-10-0293-035 01/13/2011 12

MBA-MI-20-0000-0019-013 12/14/2020 12

CVB-10-0284-004 01/06/2011 12

MBA-MI-20-0000-0019-014 12/14/2020 12

MBA-MI-20-0000-0019-015 12/14/2020 12

MBA-MI-20-0000-0019-016 12/14/2020 12

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MBA-MI-20-0000-0019-038 12/14/2020 12

MBA-MI-20-0000-0019-039 12/14/2020 12

SFB-13-2613 10/12/2020 12

MBA-MI-20-0000-0001 12/10/2020 12

SFB-16-3977 10/12/2020 12

MBA-MI-20-0000-0002 12/10/2020 12

SFB-11-0591 03/04/2011 12

MBA-MI-20-0000-0003 12/10/2020 12

MBA-MI-20-0000-0004 12/10/2020 6

SFB-11-0894 10/12/2020 12

MBA-MI-20-0000-0005 12/10/2020 12

MBA-MI-20-0000-0006 12/10/2020 6

MBA-MI-20-0000-0007 12/10/2020 12

MBA-MI-20-0000-0019-011 12/10/2020 12

MBA-MI-20-0000-0008 12/10/2020 12

MBA-MI-20-0000-0019-012 12/10/2020 12

CVB-13-1890 11/13/2013 12

MBA-MI-20-0000-0015 12/10/2020 12

MBA-MI-20-0000-0016 12/10/2020 12

MBA-MI-20-0000-0017 12/10/2020 12

MBA-MI-20-0000-0018 12/10/2020 12

MBA-MI-20-0000-0019 12/10/2020 12

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MBA-MI-20-0000-0011 12/10/2020 12

MBA-MI-20-0000-0012 12/10/2020 12

MBA-MI-20-0000-0013 12/10/2020 12

MBA-MI-20-0000-0014 12/10/2020 12

CVB-10-0307-027 01/06/2011 12

MBA-MI-20-0000-0009 12/10/2020 12

MBA-MI-20-0000-0010 12/10/2020 12

CVB-10-0293-057 01/13/2011 12

CVB-10-0293-013 01/06/2011 12

CVB-12-0981-005-06 01/04/2012 12

CVB-19-3510-002 01/08/2019 12

CVB-11-0457-040 01/06/2011 12

CVB-12-0981-005-25 01/04/2012 12

CVB-10-0293-012 01/06/2011 12

CVB-10-0290 01/06/2011 12

CVB-10-0288 01/06/2011 12

CVB-10-0293-035 01/13/2011 12

SFB-13-2613 10/12/2020 12

MBA-MI-20-0000-0001 12/10/2020 12

SFB-16-3977 10/12/2020 12

MBA-MI-20-0000-0002 12/10/2020 12

SFB-11-0591 03/04/2011 12

MBA-MI-20-0000-0003 12/10/2020 12

MBA-MI-20-0000-0004 12/10/2020 6

SFB-11-0894 10/12/2020 12

MBA-MI-20-0000-0005 12/10/2020 12

MBA-MI-20-0000-0006 12/10/2020 6

MBA-MI-20-0000-0007 12/10/2020 12

MBA-MI-20-0000-0019-011 12/10/2020 12

MBA-MI-20-0000-0008 12/10/2020 12

MBA-MI-20-0000-0019-012 12/10/2020 12

MBA-MI-20-0000-0025-001 12/17/2020 12

SFB-11-04-27 17/12/2020 12

MBA-MI-20-0000-0025-002 12/17/2020 12

MBA-MI-20-0000-0025-003 12/17/2020 12

SFB-15-3712 17/12/2020 12

SFB-11-0931 17/12/2020 12

SFB-11-0476-011 17/12/2020 12

SFB-13-2421 17/12/2020 12

SFB-11-0355 17/12/2020 12

SFB-15-3719 17/12/2020 12

MBA-MI-20-0000-0025-004 12/17/2020 12

MBA-MI-20-0000-0042 12/22/2020 12

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MBA-MI-20-0000-0048 12/22/2020 12

MBA-MI-20-0000-0020 12/17/2020 12

MBA-MI-20-0000-0028 12/18/2020 12

SFB-16-4431 17/12/2020 12

MBA-MI-20-0000-0033 12/18/2020 12

MBA-MI-20-0000-0025-012 12/17/2020 12

MBA-MI-20-0000-0025-010 12/17/2020 12

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MBA-MI-20-0000-0023 12/17/2020 12

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MBA-MI-20-0000-0034 12/18/2020 12

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MBA-MI-20-0000-0038-018 12/18/2020 12

MBA-MI-20-0000-0037 12/18/2020 12

MBA-MI-20-0000-0038-008 12/18/2020 12

MBA-MI-20-0000-0025-017 12/17/2020 12

MBA-MI-20-0000-0038-017 12/18/2020 12

MBA-MI-20-0000-0025-020 12/17/2020 12

MBA-MI-20-0000-0035 12/18/2020 12

MBA-MI-20-0000-0025-011 12/17/2020 12

MBA-MI-20-0000-0029 12/18/2020 12

MBA-MI-20-0000-0038-022 12/18/2020 12

MBA-MI-20-0000-0025-022 12/17/2020 12

MBA-MI-20-0000-0025-024 12/17/2020 12

MBA-MI-20-0000-0038-012 12/18/2020 12

MBA-MI-20-0000-0038-004 12/18/2020 12

SFB-14-2832-003 17/12/2020 12

MBA-MI-20-0000-0038-001 12/18/2020 12

MBA-MI-20-0000-0038-016 12/18/2020 12

MBA-MI-20-0000-0031 12/18/2020 12

MBA-MI-20-0000-0038-007 12/18/2020 12

MBA-MI-20-0000-0025 12/17/2020 12

MBA-MI-20-0000-0019-031 12/14/2020 12

MBA-MI-20-0000-0019-032 12/14/2020 12

MBA-MI-20-0000-0019-033 12/14/2020 12

MBA-MI-20-0000-0019-034 12/14/2020 12

MBA-MI-20-0000-0019-035 12/14/2020 12

MBA-MI-20-0000-0019-036 12/14/2020 12

MBA-MI-20-0000-0019-037 12/14/2020 12

MBA-MI-20-0000-0019-038 12/14/2020 12

MBA-MI-20-0000-0019-039 12/14/2020 12

MBA-MI-20-0000-0038-023 12/21/2020 12

MBA-MI-20-0000-0038-024 12/21/2020 12

MBA-MI-20-0000-0019-016 12/14/2020 12

MBA-MI-20-0000-0019-020 12/14/2020 12

MBA-MI-20-0000-0019-026 12/14/2020 12

MBA-MI-20-0000-0019-040 12/14/2020 12

MBA-MI-20-0000-0019-027 12/14/2020 12

MBA-MI-20-0000-0019-023 12/14/2020 12

MBA-MI-20-0000-0019-019 12/14/2020 12

MBA-MI-20-0000-0019-030 12/14/2020 12

MBA-MI-20-0000-0019-029 12/14/2020 12

MBA-MI-20-0000-0019-014 12/14/2020 12

MBA-MI-20-0000-0019-022 12/14/2020 12

MBA-MI-20-0000-0019-025 12/14/2020 12

MBA-MI-20-0000-0019-015 12/14/2020 12

MBA-MI-20-0000-0019-028 12/14/2020 12

MBA-MI-20-0000-0019-018 12/14/2020 12

MBA-MI-20-0000-0019-017 12/14/2020 12

MBA-MI-20-0000-0019-021 12/14/2020 12

MBA-MI-20-0000-0019-024 12/14/2020 12

MBA-MI-20-0000-0019-013 12/14/2020 12

SFB-11-04-27 17/12/2020 12

MBA-MI-20-0000-0025-002 12/17/2020 12

MBA-MI-20-0000-0025-003 12/17/2020 12

SFB-15-3712 17/12/2020 12

SFB-11-0931 17/12/2020 12

SFB-11-0476-011 17/12/2020 12

SFB-13-2421 17/12/2020 12

SFB-11-0355 17/12/2020 12

SFB-15-3719 17/12/2020 12

MBA-MI-20-0000-0025-004 12/17/2020 12

SFB-12-1984-001 22/12/2020 12

MBA-MI-20-0000-0048-001 12/22/2020 12

SFB-18-4745 22/12/2020 12

MBA-MI-20-0000-0048-002 12/22/2020 12

MBA-MI-20-0000-0048-003 12/22/2020 12

MBA-MI-20-0000-0048-004 12/22/2020 12

MBA-MI-20-0000-0039 12/22/2020 12

SFB-12-1923-015 22/12/2020 12

MBA-MI-20-0000-0040 12/22/2020 12

SFB-18-4612 22/12/2020 12

MBA-MI-20-0000-0041 12/22/2020 12

SFB-18-4621 22/12/2020 12

SFB-11-0257-001-01 22/12/2020 12

SFB-14-2961 22/12/2020 12

SFB-11-1325 22/12/2020 12

MBA-MI-20-0000-0049 12/23/2020 12

MBA-MI-20-0000-0050 12/23/2020 12

MBA-MI-20-0000-0051 12/23/2020 12

MBA-MI-20-0000-0052 12/23/2020 12

MBA-MI-20-0000-0053 12/23/2020 12

MBA-MI-20-0000-0054 12/23/2020 12

MBA-MI-20-0000-0055 12/23/2020 12

MBA-MI-20-0000-0056 12/23/2020 12

MBA-MI-20-0000-0057 12/23/2020 12

MBA-MI-20-0000-0058 12/23/2020 12

MBA-MI-20-0000-0019-001 12/10/2020 12

MBA-MI-20-0000-0019-002 12/10/2020 12

MBA-MI-20-0000-0019-003 12/10/2020 12

MBA-MI-20-0000-0019-004 12/10/2020 12

MBA-MI-20-0000-0019-005 12/10/2020 12

MBA-MI-20-0000-0019-006 12/10/2020 12

MBA-MI-20-0000-0019-007 12/10/2020 12

MBA-MI-20-0000-0019-008 12/10/2020 12

MBA-MI-20-0000-0019-009 12/10/2020 12

MBA-MI-20-0000-0019-010 12/10/2020 12

CVB-13-1890 11/13/2013 12

MBA-MI-20-0000-0015 12/10/2020 12

MBA-MI-20-0000-0016 12/10/2020 12

MBA-MI-20-0000-0017 12/10/2020 12

MBA-MI-20-0000-0018 12/10/2020 12

MBA-MI-20-0000-0019 12/10/2020 12

MBA-MI-20-0000-0009 12/10/2020 12

MBA-MI-20-0000-0010 12/10/2020 12

CVB-10-0293-057 01/13/2011 12

CVB-10-0293-013 01/06/2011 12

CVB-12-0981-005-06 01/04/2012 12

CVB-19-3510-002 01/08/2019 12

CVB-11-0457-040 01/06/2011 12

CVB-12-0981-005-25 01/04/2012 12

CVB-10-0293-012 01/06/2011 12

CVB-10-0290 01/06/2011 12

CVB-10-0288 01/06/2011 12

CVB-10-0293-035 01/13/2011 12

MBA-MI-20-0000-0011 12/10/2020 12

MBA-MI-20-0000-0012 12/10/2020 12

MBA-MI-20-0000-0013 12/10/2020 12

MBA-MI-20-0000-0014 12/10/2020 12

CVB-10-0307-027 01/06/2011 12

SFB-13-2613 10/12/2020

MBA-MI-20-0000-0001 12/10/2020

SFB-16-3977 10/12/2020

MBA-MI-20-0000-0002 12/10/2020

SFB-11-0591 03/04/2011

MBA-MI-20-0000-0003 12/10/2020

MBA-MI-20-0000-0004 12/10/2020

SFB-11-0894 10/12/2020

MBA-MI-20-0000-0005 12/10/2020

MBA-MI-20-0000-0006 12/10/2020

MBA-MI-20-0000-0007 12/10/2020

MBA-MI-20-0000-0019-011 12/10/2020

MBA-MI-20-0000-0008 12/10/2020

MBA-MI-20-0000-0019-012 12/10/2020

MBA-MI-20-0000-0019-001 12/10/2020

MBA-MI-20-0000-0019-002 12/10/2020

MBA-MI-20-0000-0019-003 12/10/2020

MBA-MI-20-0000-0019-004 12/10/2020

MBA-MI-20-0000-0019-005 12/10/2020

MBA-MI-20-0000-0019-006 12/10/2020

MBA-MI-20-0000-0019-007 12/10/2020

MBA-MI-20-0000-0019-008 12/10/2020

MBA-MI-20-0000-0019-009 12/10/2020

MBA-MI-20-0000-0019-010 12/10/2020

MBA-MI-20-0000-0009 12/10/2020

MBA-MI-20-0000-0010 12/10/2020

CVB-10-0293-057 01/13/2011

CVB-10-0293-013 01/06/2011

CVB-12-0981-005-06 01/04/2012

CVB-19-3510-002 01/08/2019

CVB-11-0457-040 01/06/2011

CVB-12-0981-005-25 01/04/2012

CVB-10-0293-012 01/06/2011

MBA-MI-20-0000-0011 12/10/2020

MBA-MI-20-0000-0012 12/10/2020

MBA-MI-20-0000-0013 12/10/2020

MBA-MI-20-0000-0014 12/10/2020

CVB-10-0307-027 01/06/2011

CVB-13-1890 11/13/2013

MBA-MI-20-0000-0015 12/10/2020

MBA-MI-20-0000-0016 12/10/2020

MBA-MI-20-0000-0017 12/10/2020

MBA-MI-20-0000-0018 12/10/2020

MBA-MI-20-0000-0019 12/10/2020

MBA-MI-20-0000-0019-013 12/14/2020

CVB-10-0284-004 01/06/2011

MBA-MI-20-0000-0019-014 12/14/2020

MBA-MI-20-0000-0019-015 12/14/2020

MBA-MI-20-0000-0019-016 12/14/2020

MBA-MI-20-0000-0019-017 12/14/2020

MBA-MI-20-0000-0019-018 12/14/2020

MBA-MI-20-0000-0019-019 12/14/2020

MBA-MI-20-0000-0019-020 12/14/2020

MBA-MI-20-0000-0019-021 12/14/2020

MBA-MI-20-0000-0019-022 12/14/2020

MBA-MI-20-0000-0019-023 12/14/2020

MBA-MI-20-0000-0019-024 12/14/2020

MBA-MI-20-0000-0019-025 12/14/2020

MBA-MI-20-0000-0019-026 12/14/2020

MBA-MI-20-0000-0019-027 12/14/2020

MBA-MI-20-0000-0019-028 12/14/2020

MBA-MI-20-0000-0019-029 12/14/2020

MBA-MI-20-0000-0019-030 12/14/2020

MBA-MI-20-0000-0019-031 12/14/2020

MBA-MI-20-0000-0019-032 12/14/2020

MBA-MI-20-0000-0019-033 12/14/2020

MBA-MI-20-0000-0019-034 12/14/2020

MBA-MI-20-0000-0019-035 12/14/2020

MBA-MI-20-0000-0019-036 12/14/2020

MBA-MI-20-0000-0019-037 12/14/2020

MBA-MI-20-0000-0019-038 12/14/2020

MBA-MI-20-0000-0019-039 12/14/2020

MBA-MI-20-0000-0019-040 12/14/2020

MBA-MI-20-0000-0025-001 12/17/2020

SFB-11-04-27 17/12/2020

MBA-MI-20-0000-0025-002 12/17/2020

MBA-MI-20-0000-0025-003 12/17/2020

SFB-15-3712 17/12/2020

SFB-11-0931 17/12/2020

SFB-11-0476-011 17/12/2020

SFB-13-2421 17/12/2020

SFB-11-0355 17/12/2020

SFB-15-3719 17/12/2020

MBA-MI-20-0000-0025-004 12/17/2020

MBA-MI-20-0000-0025-005 12/17/2020

MBA-MI-20-0000-0025-006 12/17/2020

MBA-MI-20-0000-0020 12/17/2020

MBA-MI-20-0000-0021 12/17/2020

MBA-MI-20-0000-0025-007 12/17/2020

MBA-MI-20-0000-0025-008 12/17/2020

MBA-MI-20-0000-0025-009 12/17/2020

MBA-MI-20-0000-0025-010 12/17/2020

MBA-MI-20-0000-0022 12/17/2020

MBA-MI-20-0000-0024 12/17/2020

SFB-14-2832-003 17/12/2020

MBA-MI-20-0000-0025-011 12/17/2020

MBA-MI-20-0000-0025 12/17/2020

MBA-MI-20-0000-0025-012 12/17/2020

MBA-MI-20-0000-0025-013 12/17/2020

MBA-MI-20-0000-0025-014 12/17/2020

SFB-16-4431 17/12/2020

MBA-MI-20-0000-0025-015 12/17/2020

MBA-MI-20-0000-0025-016 12/17/2020

MBA-MI-20-0000-0025-017 12/17/2020

MBA-MI-20-0000-0025-018 12/17/2020

MBA-MI-20-0000-0025-019 12/17/2020

MBA-MI-20-0000-0023 12/17/2020

MBA-MI-20-0000-0025-020 12/17/2020

MBA-MI-20-0000-0025-021 12/17/2020

MBA-MI-20-0000-0025-022 12/17/2020

MBA-MI-20-0000-0025-023 12/17/2020

MBA-MI-20-0000-0025-024 12/17/2020

MBA-MI-20-0000-0025-025 12/17/2020

MBA-MI-20-0000-0038-001 12/18/2020

MBA-MI-20-0000-0038-002 12/18/2020

MBA-MI-20-0000-0031 12/18/2020

MBA-MI-20-0000-0038-003 12/18/2020

MBA-MI-20-0000-0038-004 12/18/2020

MBA-MI-20-0000-0038-005 12/18/2020

MBA-MI-20-0000-0032 12/18/2020

MBA-MI-20-0000-0033 12/18/2020

MBA-MI-20-0000-0034 12/18/2020

MBA-MI-20-0000-0038-006 12/18/2020

MBA-MI-20-0000-0038-007 12/18/2020

MBA-MI-20-0000-0038-008 12/18/2020

MBA-MI-20-0000-0026 12/18/2020

MBA-MI-20-0000-0038-009 12/18/2020

MBA-MI-20-0000-0027 12/18/2020

MBA-MI-20-0000-0038-010 12/18/2020

MBA-MI-20-0000-0038-011 12/18/2020

MBA-MI-20-0000-0038-012 12/18/2020

MBA-MI-20-0000-0038-013 12/18/2020

MBA-MI-20-0000-0038-014 12/18/2020

MBA-MI-20-0000-0038-015 12/18/2020

MBA-MI-20-0000-0038-016 12/18/2020

MBA-MI-20-0000-0028 12/18/2020

MBA-MI-20-0000-0038-017 12/18/2020

MBA-MI-20-0000-0038-018 12/18/2020

MBA-MI-20-0000-0035 12/18/2020

MBA-MI-20-0000-0036 12/18/2020

MBA-MI-20-0000-0038-019 12/18/2020

MBA-MI-20-0000-0037 12/18/2020

MBA-MI-20-0000-0038 12/18/2020

MBA-MI-20-0000-0029 12/18/2020

MBA-MI-20-0000-0038-020 12/18/2020

MBA-MI-20-0000-0030 12/18/2020

MBA-MI-20-0000-0038-021 12/18/2020

MBA-MI-20-0000-0038-022 12/18/2020

MBA-MI-20-0000-0072-009 12/30/2020

SFB-12-1984-001 22/12/2020

MBA-MI-20-0000-0048-001 12/22/2020

SFB-18-4745 22/12/2020

MBA-MI-20-0000-0048-002 12/22/2020

MBA-MI-20-0000-0048-003 12/22/2020

MBA-MI-20-0000-0048-004 12/22/2020

MBA-MI-20-0000-0039 12/22/2020

SFB-12-1923-015 22/12/2020

MBA-MI-20-0000-0040 12/22/2020

SFB-18-4612 22/12/2020

MBA-MI-20-0000-0041 12/22/2020

SFB-18-4621 22/12/2020

SFB-11-0257-001-01 22/12/2020

SFB-14-2961 22/12/2020

SFB-11-1325 22/12/2020

MBA-MI-20-0000-0042 12/22/2020

MBA-MI-20-0000-0043 12/22/2020

MBA-MI-20-0000-0044 12/22/2020

MBA-MI-20-0000-0045 12/22/2020

MBA-MI-20-0000-0046 12/22/2020

MBA-MI-20-0000-0047 12/22/2020

MBA-MI-20-0000-0048 12/22/2020

MBA-MI-20-0000-0038-023 12/21/2020

MBA-MI-20-0000-0038-024 12/21/2020

MBA-MI-20-0000-0049 12/23/2020

MBA-MI-20-0000-0050 12/23/2020

MBA-MI-20-0000-0051 12/23/2020

MBA-MI-20-0000-0052 12/23/2020

MBA-MI-20-0000-0053 12/23/2020

MBA-MI-20-0000-0054 12/23/2020

MBA-MI-20-0000-0055 12/23/2020

MBA-MI-20-0000-0056 12/23/2020

MBA-MI-20-0000-0057 12/23/2020

MBA-MI-20-0000-0058 12/23/2020

MBA-MI-20-0000-0072-001 12/30/2020

MBA-MI-20-0000-0072-002 12/30/2020

MBA-MI-20-0000-0072-003 12/30/2020

MBA-MI-20-0000-0072-004 12/30/2020

MBA-MI-20-0000-0072-005 12/30/2020

MBA-MI-20-0000-0072-006 12/30/2020

MBA-MI-20-0000-0072-007 12/30/2020

MBA-MI-20-0000-0072-008 12/30/2020

MBA-MI-20-0000-0065 12/30/2020

MBA-MI-20-0000-0066 12/30/2020

MBA-MI-20-0000-0067 12/30/2020

MBA-MI-20-0000-0072-010 12/30/2020

MBA-MI-20-0000-0072-011 12/30/2020

MBA-MI-20-0000-0068 12/30/2020

MBA-MI-20-0000-0069 12/30/2020

MBA-MI-20-0000-0070 12/30/2020

MBA-MI-20-0000-0072-012 12/30/2020

MBA-MI-20-0000-0059 12/30/2020

MBA-MI-20-0000-0072-013 12/30/2020

MBA-MI-20-0000-0060 12/30/2020

MBA-MI-20-0000-0061 12/30/2020

MBA-MI-20-0000-0062 12/30/2020

MBA-MI-20-0000-0063 12/30/2020

MBA-MI-20-0000-0071 12/30/2020

MBA-MI-20-0000-0072-014 12/30/2020

MBA-MI-20-0000-0064 12/30/2020

MBA-MI-20-0000-0072-015 12/30/2020

MBA-MI-20-0000-0072 12/30/2020

SFB-13-2613 10/12/2020

MBA-MI-20-0000-0001 12/10/2020

SFB-16-3977 10/12/2020

MBA-MI-20-0000-0002 12/10/2020

SFB-11-0591 03/04/2011

MBA-MI-20-0000-0003 12/10/2020

MBA-MI-20-0000-0004 12/10/2020

SFB-11-0894 10/12/2020

MBA-MI-20-0000-0005 12/10/2020

MBA-MI-20-0000-0006 12/10/2020

MBA-MI-20-0000-0007 12/10/2020

MBA-MI-20-0000-0019-011 12/10/2020

MBA-MI-20-0000-0008 12/10/2020

MBA-MI-20-0000-0019-012 12/10/2020

CVB-13-1890 11/13/2013

MBA-MI-20-0000-0015 12/10/2020

MBA-MI-20-0000-0016 12/10/2020

MBA-MI-20-0000-0017 12/10/2020

MBA-MI-20-0000-0018 12/10/2020

MBA-MI-20-0000-0019 12/10/2020

MBA-MI-20-0000-0019-001 12/10/2020

MBA-MI-20-0000-0019-002 12/10/2020

MBA-MI-20-0000-0019-003 12/10/2020

MBA-MI-20-0000-0019-004 12/10/2020

MBA-MI-20-0000-0019-005 12/10/2020

MBA-MI-20-0000-0019-006 12/10/2020

MBA-MI-20-0000-0019-007 12/10/2020

MBA-MI-20-0000-0019-008 12/10/2020

MBA-MI-20-0000-0019-009 12/10/2020

MBA-MI-20-0000-0019-010 12/10/2020

MBA-MI-20-0000-0011 12/10/2020

MBA-MI-20-0000-0012 12/10/2020

MBA-MI-20-0000-0013 12/10/2020

MBA-MI-20-0000-0014 12/10/2020

CVB-10-0307-027 01/06/2011

MBA-MI-20-0000-0009 12/10/2020

MBA-MI-20-0000-0010 12/10/2020

CVB-10-0293-057 01/13/2011

CVB-10-0293-013 01/06/2011

CVB-12-0981-005-06 01/04/2012

CVB-19-3510-002 01/08/2019

CVB-11-0457-040 01/06/2011

CVB-12-0981-005-25 01/04/2012

CVB-10-0293-012 01/06/2011

CVB-10-0290 01/06/2011

CVB-10-0288 01/06/2011

CVB-10-0293-035 01/13/2011

MBA-MI-20-0000-0019-013 12/14/2020

CVB-10-0284-004 01/06/2011

MBA-MI-20-0000-0019-014 12/14/2020

MBA-MI-20-0000-0019-015 12/14/2020

MBA-MI-20-0000-0019-016 12/14/2020

MBA-MI-20-0000-0019-017 12/14/2020

MBA-MI-20-0000-0019-018 12/14/2020

MBA-MI-20-0000-0019-019 12/14/2020

MBA-MI-20-0000-0019-020 12/14/2020

MBA-MI-20-0000-0019-021 12/14/2020

MBA-MI-20-0000-0019-022 12/14/2020

MBA-MI-20-0000-0019-023 12/14/2020

MBA-MI-20-0000-0019-024 12/14/2020

MBA-MI-20-0000-0019-025 12/14/2020

MBA-MI-20-0000-0019-026 12/14/2020

MBA-MI-20-0000-0019-027 12/14/2020

MBA-MI-20-0000-0019-028 12/14/2020

MBA-MI-20-0000-0019-029 12/14/2020

MBA-MI-20-0000-0019-030 12/14/2020

MBA-MI-20-0000-0019-040 12/14/2020

MBA-MI-20-0000-0019-031 12/14/2020

MBA-MI-20-0000-0019-032 12/14/2020

MBA-MI-20-0000-0019-033 12/14/2020

MBA-MI-20-0000-0019-034 12/14/2020

MBA-MI-20-0000-0019-035 12/14/2020

MBA-MI-20-0000-0019-036 12/14/2020

MBA-MI-20-0000-0019-037 12/14/2020

MBA-MI-20-0000-0019-038 12/14/2020

MBA-MI-20-0000-0019-039 12/14/2020

SFB-13-2613 10/12/2020

MBA-MI-20-0000-0001 12/10/2020

SFB-16-3977 10/12/2020

MBA-MI-20-0000-0002 12/10/2020

SFB-11-0591 03/04/2011

MBA-MI-20-0000-0003 12/10/2020

MBA-MI-20-0000-0004 12/10/2020

SFB-11-0894 10/12/2020

MBA-MI-20-0000-0005 12/10/2020

MBA-MI-20-0000-0006 12/10/2020

MBA-MI-20-0000-0007 12/10/2020

MBA-MI-20-0000-0019-011 12/10/2020

MBA-MI-20-0000-0008 12/10/2020

MBA-MI-20-0000-0019-012 12/10/2020

CVB-13-1890 11/13/2013

MBA-MI-20-0000-0015 12/10/2020

MBA-MI-20-0000-0016 12/10/2020

MBA-MI-20-0000-0017 12/10/2020

MBA-MI-20-0000-0018 12/10/2020

MBA-MI-20-0000-0019 12/10/2020

MBA-MI-20-0000-0019-001 12/10/2020

MBA-MI-20-0000-0019-002 12/10/2020

MBA-MI-20-0000-0019-003 12/10/2020

MBA-MI-20-0000-0019-004 12/10/2020

MBA-MI-20-0000-0019-005 12/10/2020

MBA-MI-20-0000-0019-006 12/10/2020

MBA-MI-20-0000-0019-007 12/10/2020

MBA-MI-20-0000-0019-008 12/10/2020

MBA-MI-20-0000-0019-009 12/10/2020

MBA-MI-20-0000-0019-010 12/10/2020

MBA-MI-20-0000-0011 12/10/2020

MBA-MI-20-0000-0012 12/10/2020

MBA-MI-20-0000-0013 12/10/2020

MBA-MI-20-0000-0014 12/10/2020

CVB-10-0307-027 01/06/2011

MBA-MI-20-0000-0009 12/10/2020

MBA-MI-20-0000-0010 12/10/2020

CVB-10-0293-057 01/13/2011

CVB-10-0293-013 01/06/2011

CVB-12-0981-005-06 01/04/2012

CVB-19-3510-002 01/08/2019

CVB-11-0457-040 01/06/2011

CVB-12-0981-005-25 01/04/2012

CVB-10-0293-012 01/06/2011

CVB-10-0290 01/06/2011

CVB-10-0288 01/06/2011

CVB-10-0293-035 01/13/2011

SFB-13-2613 10/12/2020

MBA-MI-20-0000-0001 12/10/2020

SFB-16-3977 10/12/2020

MBA-MI-20-0000-0002 12/10/2020

SFB-11-0591 03/04/2011

MBA-MI-20-0000-0003 12/10/2020

MBA-MI-20-0000-0004 12/10/2020

SFB-11-0894 10/12/2020

MBA-MI-20-0000-0005 12/10/2020

MBA-MI-20-0000-0006 12/10/2020

MBA-MI-20-0000-0007 12/10/2020

MBA-MI-20-0000-0019-011 12/10/2020

MBA-MI-20-0000-0008 12/10/2020

MBA-MI-20-0000-0019-012 12/10/2020

MBA-MI-20-0000-0025-001 12/17/2020

SFB-11-04-27 17/12/2020

MBA-MI-20-0000-0025-002 12/17/2020

MBA-MI-20-0000-0025-003 12/17/2020

SFB-15-3712 17/12/2020

SFB-11-0931 17/12/2020

SFB-11-0476-011 17/12/2020

SFB-13-2421 17/12/2020

SFB-11-0355 17/12/2020

SFB-15-3719 17/12/2020

MBA-MI-20-0000-0025-004 12/17/2020

MBA-MI-20-0000-0042 12/22/2020

MBA-MI-20-0000-0043 12/22/2020

MBA-MI-20-0000-0044 12/22/2020

MBA-MI-20-0000-0045 12/22/2020

MBA-MI-20-0000-0046 12/22/2020

MBA-MI-20-0000-0047 12/22/2020

MBA-MI-20-0000-0048 12/22/2020

MBA-MI-20-0000-0020 12/17/2020

MBA-MI-20-0000-0028 12/18/2020

SFB-16-4431 17/12/2020

MBA-MI-20-0000-0033 12/18/2020

MBA-MI-20-0000-0025-012 12/17/2020

MBA-MI-20-0000-0025-010 12/17/2020

MBA-MI-20-0000-0038-005 12/18/2020

MBA-MI-20-0000-0038-006 12/18/2020

MBA-MI-20-0000-0025-016 12/17/2020

MBA-MI-20-0000-0030 12/18/2020

MBA-MI-20-0000-0038-003 12/18/2020

MBA-MI-20-0000-0038-019 12/18/2020

MBA-MI-20-0000-0038-020 12/18/2020

MBA-MI-20-0000-0025-005 12/17/2020

MBA-MI-20-0000-0038-009 12/18/2020

MBA-MI-20-0000-0038-010 12/18/2020

MBA-MI-20-0000-0038-011 12/18/2020

MBA-MI-20-0000-0025-019 12/17/2020

MBA-MI-20-0000-0032 12/18/2020

MBA-MI-20-0000-0038-013 12/18/2020

MBA-MI-20-0000-0038 12/18/2020

MBA-MI-20-0000-0022 12/17/2020

MBA-MI-20-0000-0024 12/17/2020

MBA-MI-20-0000-0025-006 12/17/2020

MBA-MI-20-0000-0025-008 12/17/2020

MBA-MI-20-0000-0027 12/18/2020

MBA-MI-20-0000-0025-023 12/17/2020

MBA-MI-20-0000-0038-021 12/18/2020

MBA-MI-20-0000-0036 12/18/2020

MBA-MI-20-0000-0038-002 12/18/2020

MBA-MI-20-0000-0025-015 12/17/2020

MBA-MI-20-0000-0025-013 12/17/2020

MBA-MI-20-0000-0021 12/17/2020

MBA-MI-20-0000-0025-007 12/17/2020

MBA-MI-20-0000-0026 12/18/2020

MBA-MI-20-0000-0023 12/17/2020

MBA-MI-20-0000-0025-014 12/17/2020

MBA-MI-20-0000-0025-018 12/17/2020

MBA-MI-20-0000-0025-025 12/17/2020

MBA-MI-20-0000-0025-021 12/17/2020

MBA-MI-20-0000-0038-014 12/18/2020

MBA-MI-20-0000-0025-009 12/17/2020

MBA-MI-20-0000-0034 12/18/2020

MBA-MI-20-0000-0038-015 12/18/2020

MBA-MI-20-0000-0038-018 12/18/2020

MBA-MI-20-0000-0037 12/18/2020

MBA-MI-20-0000-0038-008 12/18/2020

MBA-MI-20-0000-0025-017 12/17/2020

MBA-MI-20-0000-0038-017 12/18/2020

MBA-MI-20-0000-0025-020 12/17/2020

MBA-MI-20-0000-0035 12/18/2020

MBA-MI-20-0000-0025-011 12/17/2020

MBA-MI-20-0000-0029 12/18/2020

MBA-MI-20-0000-0038-022 12/18/2020

MBA-MI-20-0000-0025-022 12/17/2020

MBA-MI-20-0000-0025-024 12/17/2020

MBA-MI-20-0000-0038-012 12/18/2020

MBA-MI-20-0000-0038-004 12/18/2020

SFB-14-2832-003 17/12/2020

MBA-MI-20-0000-0038-001 12/18/2020

MBA-MI-20-0000-0038-016 12/18/2020

MBA-MI-20-0000-0031 12/18/2020

MBA-MI-20-0000-0038-007 12/18/2020

MBA-MI-20-0000-0025 12/17/2020

MBA-MI-20-0000-0019-031 12/14/2020

MBA-MI-20-0000-0019-032 12/14/2020

MBA-MI-20-0000-0019-033 12/14/2020

MBA-MI-20-0000-0019-034 12/14/2020

MBA-MI-20-0000-0019-035 12/14/2020

MBA-MI-20-0000-0019-036 12/14/2020

MBA-MI-20-0000-0019-037 12/14/2020

MBA-MI-20-0000-0019-038 12/14/2020

MBA-MI-20-0000-0019-039 12/14/2020

MBA-MI-20-0000-0038-023 12/21/2020

MBA-MI-20-0000-0038-024 12/21/2020

MBA-MI-20-0000-0019-016 12/14/2020

MBA-MI-20-0000-0019-020 12/14/2020

MBA-MI-20-0000-0019-026 12/14/2020

MBA-MI-20-0000-0019-040 12/14/2020

MBA-MI-20-0000-0019-027 12/14/2020

MBA-MI-20-0000-0019-023 12/14/2020

MBA-MI-20-0000-0019-019 12/14/2020

MBA-MI-20-0000-0019-030 12/14/2020

MBA-MI-20-0000-0019-029 12/14/2020

MBA-MI-20-0000-0019-014 12/14/2020

MBA-MI-20-0000-0019-022 12/14/2020

MBA-MI-20-0000-0019-025 12/14/2020

MBA-MI-20-0000-0019-015 12/14/2020

MBA-MI-20-0000-0019-028 12/14/2020

MBA-MI-20-0000-0019-018 12/14/2020

MBA-MI-20-0000-0019-017 12/14/2020

MBA-MI-20-0000-0019-021 12/14/2020

MBA-MI-20-0000-0019-024 12/14/2020

MBA-MI-20-0000-0019-013 12/14/2020

SFB-11-04-27 17/12/2020

MBA-MI-20-0000-0025-002 12/17/2020

MBA-MI-20-0000-0025-003 12/17/2020

SFB-15-3712 17/12/2020

SFB-11-0931 17/12/2020

SFB-11-0476-011 17/12/2020

SFB-13-2421 17/12/2020

SFB-11-0355 17/12/2020

SFB-15-3719 17/12/2020

MBA-MI-20-0000-0025-004 12/17/2020

SFB-12-1984-001 22/12/2020

MBA-MI-20-0000-0048-001 12/22/2020

SFB-18-4745 22/12/2020

MBA-MI-20-0000-0048-002 12/22/2020

MBA-MI-20-0000-0048-003 12/22/2020

MBA-MI-20-0000-0048-004 12/22/2020

MBA-MI-20-0000-0039 12/22/2020

SFB-12-1923-015 22/12/2020

MBA-MI-20-0000-0040 12/22/2020

SFB-18-4612 22/12/2020

MBA-MI-20-0000-0041 12/22/2020

SFB-18-4621 22/12/2020

SFB-11-0257-001-01 22/12/2020

SFB-14-2961 22/12/2020

SFB-11-1325 22/12/2020

MBA-MI-20-0000-0049 12/23/2020

MBA-MI-20-0000-0050 12/23/2020

MBA-MI-20-0000-0051 12/23/2020

MBA-MI-20-0000-0052 12/23/2020

MBA-MI-20-0000-0053 12/23/2020

MBA-MI-20-0000-0054 12/23/2020

MBA-MI-20-0000-0055 12/23/2020

MBA-MI-20-0000-0056 12/23/2020

MBA-MI-20-0000-0057 12/23/2020

MBA-MI-20-0000-0058 12/23/2020

MBA-MI-20-0000-0019-001 12/10/2020

MBA-MI-20-0000-0019-002 12/10/2020

MBA-MI-20-0000-0019-003 12/10/2020

MBA-MI-20-0000-0019-004 12/10/2020

MBA-MI-20-0000-0019-005 12/10/2020

MBA-MI-20-0000-0019-006 12/10/2020

MBA-MI-20-0000-0019-007 12/10/2020

MBA-MI-20-0000-0019-008 12/10/2020

MBA-MI-20-0000-0019-009 12/10/2020

MBA-MI-20-0000-0019-010 12/10/2020

CVB-13-1890 11/13/2013

MBA-MI-20-0000-0015 12/10/2020

MBA-MI-20-0000-0016 12/10/2020

MBA-MI-20-0000-0017 12/10/2020

MBA-MI-20-0000-0018 12/10/2020

MBA-MI-20-0000-0019 12/10/2020

MBA-MI-20-0000-0009 12/10/2020

MBA-MI-20-0000-0010 12/10/2020

CVB-10-0293-057 01/13/2011

CVB-10-0293-013 01/06/2011

CVB-12-0981-005-06 01/04/2012

CVB-19-3510-002 01/08/2019

CVB-11-0457-040 01/06/2011

CVB-12-0981-005-25 01/04/2012

CVB-10-0293-012 01/06/2011

CVB-10-0290 01/06/2011

CVB-10-0288 01/06/2011

CVB-10-0293-035 01/13/2011

MBA-MI-20-0000-0011 12/10/2020

MBA-MI-20-0000-0012 12/10/2020

MBA-MI-20-0000-0013 12/10/2020

MBA-MI-20-0000-0014 12/10/2020

CVB-10-0307-027 01/06/2011

xxxxxxxxxxxxx xxxxxxxxxxxxx - -

xxxxxxxxxxxxx xxxxxxxxxxxxx 38,600.00 8,504.00



Optional Fund Total Unremitted Members' Allowance for

Contributions/Premiums, dues

& fees Probable Ledger

Premium as of 31 December 2020 Losses Assets

(14) (15) (16) (17)

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

Total Unremitted Balance YEAR END

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

200.00 -2.00 198.00

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

724.00 -7.24 716.76

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

212.00 -2.12 209.88

212.00 -2.12 209.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

212.00 -2.12 209.88

12.00 -0.12 11.88

212.00 -2.12 209.88

12.00 -0.12 11.88

212.00 -2.12 209.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

212.00 -2.12 209.88

12.00 -0.12 11.88

212.00 -2.12 209.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

212.00 -2.12 209.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

6.00 -0.06 5.94

12.00 -0.12 11.88

12.00 -0.12 11.88

6.00 -0.06 5.94

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

6.00 -0.06 5.94

12.00 -0.12 11.88

12.00 -0.12 11.88

6.00 -0.06 5.94

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

6.00 -0.06 5.94

12.00 -0.12 11.88

12.00 -0.12 11.88

6.00 -0.06 5.94

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

12.00 -0.12 11.88

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

24.00 24.00 -0.24 23.76

24.00 24.00 -0.24 23.76

24.00 24.00 -0.24 23.76

24.00 24.00 -0.24 23.76

24.00 24.00 -0.24 23.76

14.50 14.50 -0.15 14.36

24.00 24.00 -0.24 23.76

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

24.00 24.00 -0.24 23.76

464.00 464.00 -4.64 459.36

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

24.00 24.00 -0.24 23.76

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

34.00 34.00 -0.34 33.66

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

5.00 5.00 -0.05 4.95

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

5.00 5.00 -0.05 4.95

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

5.00 5.00 -0.05 4.95

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

5.00 5.00 -0.05 4.95

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

5.00 5.00 -0.05 4.95

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

5.00 5.00 -0.05 4.95

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

10.00 10.00 -0.10 9.90

-

- -

- -

- -

- -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

10,644.50 10,644.50 -106.45 10,538.05

10,644.50 57,748.50 106.44- 57,171.01

Non-Ledger NOT NET RBC Fund

Assets Admitted Admitted Code Code

(20)=(17)+(18)-(19)

(18) (19) (20) (20) (21)

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

198.00 FDR GenF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

716.76 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

209.88 FDR MBF

209.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

209.88 FDR MBF

11.88 FDR MBF

209.88 FDR MBF

11.88 FDR MBF

209.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

209.88 FDR MBF

11.88 FDR MBF

209.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

209.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

5.94 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

5.94 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

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11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

5.94 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

5.94 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

5.94 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

5.94 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

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11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

11.88 FDR MBF

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

23.76 FDR Obmi

23.76 FDR Obmi

23.76 FDR Obmi

23.76 FDR Obmi

23.76 FDR Obmi

14.36 FDR Obmi

23.76 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

23.76 FDR Obmi

459.36 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

23.76 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

33.66 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

4.95 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

4.95 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

4.95 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

4.95 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

4.95 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

4.95 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

9.90 FDR Obmi

-

-

-

-

-

-

-

-

-

-

-

-

- - 10,538.05 xxxxxxxxxxxxxxxxxxxxxxxxxx

- - 57,171.01 xxxxxxxxxxxxxxxxxxxxxxxxxx

Microinsurance

True/False

(22)

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mix

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

mi

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

528.00

xxxxxxxxxxxxx

Index

MBA NAME:

YEAR ENDED:


(1) (2)

Member 1

Member 2

Member 3

Member 9

Member 10

Member 11

Member 12

Member 13

TOTAL MICROINSURANCE xxxxxxxxxxxxx

GRAND TOTAL MEMBERS' ASSESSMENT RECEIVABLESxxxxxxxxxxxxx






SCHEDULE OF MEMBERS' ASSESSMENT RECEIVABLES


December 31,2020

NAME OF MEMBER

N/A

Based on IC Approved Date Approved Board

Membership Assess Contributions by IC Resolution

Date No.

(3) (4) (5) (6)

xxxxxxxxxxxxx - xxxxxxxxxxxxx xxxxxxxxxxxxx

xxxxxxxxxxxxx - xxxxxxxxxxxxx xxxxxxxxxxxxx

5) RBC codes:

1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances. FDR - Fees / Dues Receivable

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested. DU-Life - Due & Uncollected: Life insurance premiums and annuity contributions

DU-AccHealth - Due & Uncollected: Accident and Health premiums


SCHEDULE OF MEMBERS' ASSESSMENT RECEIVABLES


December 31,2020

N/A

Balance Balance Allowance for

PRIOR YEAR as of 31 December 2020Probable Ledger

Losses Assets

(7) (8) (9) (10)

-

-

-

-

-

-

-

-

- - - -

- - - -

6) FUND codes:

FDR - Fees / Dues Receivable GenF - General Fund

DU-Life - Due & Uncollected: Life insurance premiums and annuity contributions MBF - Mutual Benefit Fund

DU-AccHealth - Due & Uncollected: Accident and Health premiums OBreg - Mutual Benefit Fund (regular)


NET Members' Equity

Non-Ledger NOT Admittedas of 31 December 2020

Assets Admitted 13=10+11-12

(11) (12) (13) (14)

-

-

-

-

-

-

-

-

- - - -

- - - -

RBC Fund

Code Code Microinsurance

(Note 5) (Note 6) True/False

(15) (16) (17)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR



index

SCHEDULE OF OTHER CURRENT RECEIVABLES

Q.1 114900 Other Current Receivables

Q.1.1 114910 Advances to Officers and Employees

Q.1.2 114920 Due From Officers and Employees

Q.1.3 114930 Lease Receivables

Q.1.4 114940 Receivables - Others

114940 Receivables - Others

114940 Receivables - Others

114940 Receivables - RCMC

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

Grand Totals - Microinsurance

GRAND TOTALS






MBA NAME:

YEAR ENDED

Particulars


December 31,2020

(1)

Outstanding

Balance as of Dec.

31

Outstanding

Balance as of Dec.

31

(Previous year) (Current year)

(2) (3) (4) (5)

1,300.00 3,000.00 4,300.00

-

-

2,207 982 3,188.72

450 7 457.00

3,638 3,638.38

9,348,794 9,348,793.54

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

- - - -

9,352,750 7,627 - 9,360,378

5) RBC codes:

1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances. OAssets1 -AAA

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested. OAssets2 - BBB


Amount Granted

during the year

Amount Collected

During the Year


December 31,2020

(6) (7) (8) (9)

(2,320.00) 1,980.00

-

-

(2,380) 809.16

(452) 4.62

(1,197) 2,440.93

(107,730) 9,241,063.79

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

- - - -

(114,079) 9,246,299 - -

6) FUND codes:

GenF - General Fund



Net Realizeable Value Not AdmittedNon-Ledger

Assets

Allowance for

Probable Lossess

RBC code FUND code Microinsurance?

(note 4) (note 5) TRUE/FALSE

(10) (11) (12) (13)

1,980.00 OAssets1 GenF mix

- ERROR

- ERROR

809.16 OAssets1 MBF mi

4.62 OAssets1 Obmi mi

2,440.93 OAssets1 GenF mix

9,241,063.79 OAssets1 MBF mi

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

- x x x x x x x x x x x x x x -

9,246,299 x x x x x x x x x x x x x x -

index

Net Admitted

Company Name

Schedule G.1.1 - Aeging - Advances to Officers and Employees

Balance Sheet Date 31/12/2020

Particulars

(Borrowers Name)

Date

GrantedDue Date

Period

Covered

1. LINDA GRACE B. AREVALO 11-Nov-19 11-Nov-19

2. JESSIE P. GOMEZ 12-Feb-20 12-Feb-20

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Beginning BalanceAmount Granted

during the year

Amount Collected

During the YearOutstanding Balance

1,300.00 1,300.00

3,000.00 3,000.00

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1,300.00 3,000.00 - 4,300.00

Overdue?

Outstanding

days as of year

end

30 days

but less than 60 days

past due

60 days

but less than 90

days past due

Yes 416.00 - -

Yes 323.00 - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- -

Ageing

90 days

but less than 180

days past due

Equal to/More

than 180 days

past due

Total Matured

Receivables

- 1,300.00 1,300.00

- 3,000.00 3,000.00

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- 4,300.00 4,300.00

Ageing

Company Name

Schedule Q.1.2 - Aeging - Due From Officers and Employees


Particulars

(Borrowers Name)

Date

Granted

Maturity

DateBeginning Balance

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

-

N/A

Amount Granted

during the year

Amount Collected

During the YearOutstanding Balance Matured?

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- - -

N/A

Outstanding

days as of year

end

30 days


past due

60 days

but less than 90

days past due

90 days

but less than 180

days past due

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - -

Ageing

Equal to/More

than 180 days

past due

Total Matured

Receivables

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

Ageing

Company Name

Schedule Q.1.3 - Aeging - Lease Receivables


Particulars

(Borrowers Name)

Date

Granted

Maturity


1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

-

N/A

Amount Granted

during the year

Amount Collected


- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- - -

N/A

Outstanding

days as of year

end

30 days


past due

60 days

but less than 90

days past due

90 days

but less than 180

days past due

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - -

Ageing

Equal to/More

than 180 days

past due

Total Matured

Receivables

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

Ageing

Company Name

Schedule Q.1.4 - Aeging - 114940 Receivables - Others


Particulars

(Borrowers Name)

Date

Granted

Maturity


1. PBCI_double processed EV 31-Jan-19 31-Jan-19 1,260.00

2. ESL OR#123035-it should be CA cash return but di pumasok29-Mar-19 29-Mar-19 946.72

3 ECHO Sec. Agency 29-May-20 29-May-20

4. PBCI 31-Dec-20 31-Dec-20

5. JPG 29-May-20 29-May-20

6. PBCI_MGB 14-Jan-20 14-Jan-20

7. LGBA 26-Feb-20 26-Feb-20

8. PBCI_MGB 27-Feb-20 27-Feb-20

9. JTC 18-Mar-20 18-Mar-20

10. LGBA 31-Mar-20 31-Mar-20

11. GGS 20-Jul-20 20-Jul-20

12. JPG 14-Dec-20 14-Dec-20

13. PBCI_San Francisco 20-Feb-19 31/12/2019 450.00

14. RCMC 15-Mar-18 15-Mar-18 9,348,793.54

15

16

17

18

19

20

21

22

23

24

25

26

9,351,450.26

Amount Granted

during the year

Amount Collected


1,260.00 Yes

946.72 Yes

494.00 494.00 Yes

488.00 488.00 No

7.00 7.00 Yes

750.00 750.00 Yes

839.36 839.36 Yes

750.00 750.00 Yes

879.00 879.00 Yes

300.00 300.00 Yes

0.02 0.02 Yes

120.00 120.00 Yes

450.00 Yes

9,348,793.54 Yes

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

4,627.38 - 9,356,077.64

Outstanding

days as of year

end

30 days


past due

60 days

but less than 90

days past due

90 days

but less than 180

days past due

700.00 - - -

643.00 - - -

216.00 - - -

- - - -

216.00 - - -

352.00 - - -

309.00 - - -

308.00 - - -

288.00 - - -

275.00 - - -

164.00 - - 0.02

17.00 - - -

366.00 - - -

1,022.00 - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

4,876.00 - - 0.02

Ageing

Equal to/More

than 180 days

past due

Total Matured

Receivables

1,260.00 1,260.00

946.72 946.72

494.00 494.00

- -

7.00 7.00

750.00 750.00

839.36 839.36

750.00 750.00

879.00 879.00

300.00 300.00

- 0.02

- -

450.00 450.00

9,348,793.54 9,348,793.54

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

9,355,469.62 9,355,469.64

Ageing

SCHEDULE OF PREPAYMENTS AND OTHER CURRENT ASSETS

MICROINSURANCE

TRUE/FALSE

1 116100 Prepaid Expenses

Detailed Schedule (breakdown):

1 Ex. Prepaid Insurance FALSE 001

2

3

4

5

Total

2 116200 Unused Stationery and Supplies


1 Extra Long BondPaper _pink

2 Extra Long BondPaper (purchase kuya peks) green

3 Declaration of Good Health

4 CLIP Forms ****charge of printing

5 HAPI PLAN FORMS

6 PARAGON NEWSPRINT **LONG

7 DEC. OF GOOD HEALTH

8 NOTICE OF DEATH

9 RE-DATING FORM 130 per ream

10 RE- INSTATEMENT FORM

11 RE- INSTATEMENT FORM

12 Notice of Change of Civil Status 140 per ream

13 HAPI CLAIM FORM 125per ream

14 ADVANCE BONDPAPER LONG (orange)

15 BOOK PAPER _LONG_Advance COPY PAPER

16 BOOK PAPER _A4_Advance COPY PAPER

17 BOOK PAPER _SHORT_Advance COPY PAPER

18 BONDPAPER_SHORT_PAPER ONE

19 FOLDER_SHORT

20 BONDPAPER_LONG_PAPER ONE

21 BOND PAPER_SHORT_PILOT

22 BONDPAPER _SHORT_COPY ONE

23 NEWSPRINT_SHORT _PILOT

24 NEWSPRINT_LONG _PILOT

25 Certificate Paper _Woxy

26 Correction Tape

27 BLIP_APPLICATION FORM (short)

28 CLIP_FORM (long)

29 HAPI_FORMS (short)

MBA NAME:

YEAR ENDED

Name/Description

Document/

Reference No.


December 31,2020

30 DECLARATION OF GOOD HEALTH FORM (short)

31 Used MBA Certificate 1400 pcs X1.50***printing

32 Used MBA Certificate 18 1/2 pads x 24.50

33 MBA OR#8551_10000

34 FTR #0501_5000

35 4 boxes HP toner 78A 1,188 per box.(ESL)

36 4 boxes PRINTER TONER #052 (Dang) 4,350 per box

37 toner GRG 052H 4,280.00/box

38 4 Boxes pRINTER TONER #337 (jtc) 1800 per box

3

4

5

Total

3 Other Assets


1

2

3

4

5

Total

Subtotal - Microinsurance

GRAND TOTALS

28/01/2018 5 years - Life Insurance - Company A -

-

-

-

-

-

Feb 2, 2019 1,272.00

Feb 22, 2019 185.00

02/11/2019 1,360.00

03/07/2019 40.00

07/03/2019 1,760.00

09/09/2019 798.00

2018 150.00

2018 140.00

2018 1,430.00

2018 1,960.00

2018 500.00

2018 140.00

2018 1,000.00

01/10/2020 1,600.00

01/10/2020 630.00

01/10/2020 800.00

01/10/2020 190.00

06/09/2020 188.00

06/09/2020 16.00

6/16/2020 470.00

8/14/2020 150.00

11/20/2020 1,140.00

11/25/2020 1,430.00

11/25/2020 2,280.00

11/25/2020 1,250.00

11/25/2020 70.00

11/30/2020 2,600.00

11/30/2020 4,000.00

11/30/2020 3,900.00

AmountDate Acquired Transaction Details


December 31,2020

11/30/2020 1,820.00

12/31/2020 2,100.00

12/31/2020 453.25

12/31/2020 870.00

12/31/2020 2,700.00

12/31/2020 4,752.00

12/31/2020 17,400.00

12/31/2020 12,840.00

12/31/2020 7,200.00

-

-

-

-

81,584.25

-

-

-

-

-

-

81,584.25

81,584.25

-

-

-

-

- - -

1,272.00

185.00

1,360.00

40.00

1,760.00

798.00

150.00

140.00

1,430.00

1,960.00

500.00

140.00

1,000.00

1,600.00

630.00

800.00

190.00

188.00

16.00

470.00

150.00

1,140.00

1,430.00

2,280.00

1,250.00

70.00

2,600.00

4,000.00

3,900.00

Not Admitted Non-Ledger Assets Net Admitted

1,820.00

2,100.00

453.25

870.00

2,700.00

4,752.00

17,400.00

12,840.00

7,200.00

-

-

-

-

-

-

- - 81,584.25

- - -

- - -

- - -

- - -

- - -

- - -

- - 81,584.25

- - 81,584.25

index


YEAR ENDED:

No. of Shares Cost Acquisiton

Purchased per Cost

Share

(5)=(3)*(4)

(3) (4) (5)

14.1 Investment in Subsidiaries

Subsidiary1 -

Subsidiary2 -

Subsidiary3 -

Subsidiary4 -

Subsidiary5 -

Subsidiary6 -

Subsidiary7 -

Subsidiary8 -

Subsidiary9 -

Subsidiary10 -

Sub- Total-Microinsurance -

Total Investment in Subsidiaries -

14.2 Investment in Associates

Associate1 -

Associate2 -

Associate3 -

Associate4 -

Associate5 -

Associate6 -

Associate7 -

Associate8 -

Associate9 -

Associate10 -

Sub- Total-Microinsurance -

Total Investment in Associates -

Total-Microinsurance -

Total -






5) If allocated to Microinsurance, indicate True if not False

(1)

INVESTMENT IN SUBSIDIARIES AND ASSOCIATES

December 31,2020

Name of Subsidiaries & Associates

Initial Acquisition Cost


No. of Shares Cost Acquisiton No. of Shares Cost Selling

Purchased per Cost Sold per Cost

Share Share

(9)=(7)*(8) (12)=(10)*(11)

(6) (7) (8) (9) (10) (11) (12)

5) RBC codes: 6) Fund Code

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested. OInv1 - AAA GenF - General Fund


4) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template OBreg - Mutual Benefit Fund (regular)


Additional

Paid-in Capital

without

Capital Shares

Acquisition

Purchased Sold

Subsequent Transaction after initial acqusition but before the current year audit

N/A

NONE

No. of Shares Cost Acquisiton No. of Shares

Purchased per Cost Sold

Share

(16)=(14)*(15)

(13) (14) (15) (16) (17)

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Transactions during the year

Additional

Paid-in Capital

without

Capital Shares

Acquisition

Purchased Sold

Percentage

Cost Selling No. of shares Total of

per Cost owned in the number of shares ownership

Share subsidiary of the

(19)=(17)*(18) associates subsidiary (6) = (4)/(5)

(18) (19) (20) (21) (22)

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

-

-

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

-

-

-

-

Transactions during the year Dec 31 Ownership

Sold Common Shares

Method

Accounted

(Cost/ Value Total Ledger Non-Ledger

Fair Value/ per Share Value Assets Assets

/Equity Method) at Dec 31 at Dec 31

(18)=(13)*(17)

(23) (24) (25) (26) (27)

-

-

-

-

-

-

-

-

-

-

- - -

- - -

-

-

-

-

-

-

-

-

-

-

- - -

- - -

- - -

- - -

Non-Admitted Admitted RBC Fund Microinsurance

Assets Assets Code Code True/False

(29)=(26)+(27)-(28)

(28) (29) (30) (31) (30)

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- -

- -

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- -

- -

- - - - -

- - - - -

Index

Date of

Approval from ISD

-

-

COMPANY: PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

YEAR ENDED:

Initial Total

Percentage Initial Cost

of of Joint Venture

ownership

(4) (5)

JointVenture1 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

JointVenture2 0.00%

Total-Microinsurance -

Total -






INVESTMENT IN JOINT VENTURES

December 31,2020

Name of Joint Ventures

(1)


Share in Method Total Total Share in

the Initial Cost Accounted Net Assets Percentage Net Assets

of the (Cost/ (Assets-Liabilities) of (Assets-Liabilities)

Joint Venture Fair Value/ of the ownership of the

/Equity Method) Joint Venture Dec-31 Joint Venture

(6)=(4)*(5) at Dec 31 at Dec 31

(6) (7) (8) (9) (10)

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- Fair Value 0.00%

- - -

- - -

1) INSERT or DELETE rows before the SUBTOTAL to avoid errors in the calculation of balances. 5) RBC codes: 6) Fund Code

2) Fill-up completely the template, indicate N/A for the items not applicable or not needed or no corresponding asset was invested. OInv1 - AAA GenF - General Fund


4) Use the drop-list for the RBC Code and Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template OBreg - Mutual Benefit Fund (regular)


INVESTMENT IN JOINT VENTURES

December 31,2020

N/A

Ledger Non-Ledger Non-Admitted Admitted RBC

Assets Assets Assets Assets Code

(14)=(11)+(12)-(13)

(11) (12) (13) (14) (15)

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

- - - -

- - - -

Index

GenF - General Fund




N/A

Fund Microinsurance

Code True/False

(16) (17)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

REINSURANCE CEDED FOR ACCIDENT & HEALTH BENEFITS

COMPANY:

YEAR ENDED:

Name of Company

(1)

I. Authorized:

a. Accident

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

b. Health

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx


Sub-Total (Authorized)

II. Unauthorized:

a. Accident

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

b. Health

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx


Sub-Total (Authorized)

Sub-total (Microinsurance only)

GRAND TOTALS


Type Premiums in Unearned Other than

Force at end Premiums Unearned

of Year Premiums

(note 1) (note 2)

(2) (4) (5) (6)

31 December 2020

Balances as of December 31 in Current Year

Reserve Credit For (note 4) Amounts Recoverable from Reinsurers

Facultative

Paid Losses (7)

NONE

- - - -

- - - -

- - - -

- - - -

N/A

- - - -

- - - -


1) Use the following abbreviations:

* GP = group business coinsured;

* GPO = reins of group business other than coins or catastrophe;

* DWP = Disability Waiver of Premium;

* YRT = individual life reinsured on yearly renewable term plan;

* M = individual life reinsured on modified coinsurance plan;

* CO = individual life reinsured on coinsurance plan;

* OTH =other reinsurance of individual life business;

If more than one type in same reinsuring company show separate line for each.

2) This refers to the aggregate premiums ( for full term of the policy)

for all policies recorded on or prior to the statement date which have

not expired or been cancelled as of the statement





Allowance

for Impairment

(9)


Amounts Recoverable from Reinsurers Amount Due to Reinsurer

Treaty Facultative Treaty Facultative

Paid Losses (7) Unpaid Losses (8) Premiums (10)

NONE

- - - - -

- - - - -

- - - - -

- - - - -

N/A

- - - - -

- - - - -

7) RBC codes: 8) Fund Code

OAssets1 - AAA GenF - General Fund

OAssets2 - BBB MBF - Mutual Benefit Fund





Reinsurance

Funds Premium on

Held for Reinsurance

Reinsurers Ceded

During

the year

(12)

Balances as of December 31 in Current Year Transactions During the Year

Amount Due to Reinsurer

Premiums (10) Others (11)

Treaty Facultative Treaty

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

Particulars

Reinsurance Recoverable on Paid Losses - Treaty

Reinsurance Recoverable on Paid Losses - Facultative

Reinsurance Recoverable on Unpaid Losses - Treaty

Reinsurance Recoverable on Unpaid Losses - Facultative

Allowance for Impairment Losses

Particulars

Due to Reinsurers- Treaty

Due to Reinsurers- Facultative

Funds Held for Reinsurers

GRAND TOTAL

GRAND TOTAL

Commissions Recoveries Other Remittances Ledger

on Ceded on Recoveries Made During Assets

Business Claims (Payment) the Year

Reinsured

(13) (14) (15) (16) (17)

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Transactions During the Year

-

-

-

-

-

-

-

-

-

- - - - -

- - - - -

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

- - - - -

- - - - -

- - - - -

- - - - -

Ledger Non-Ledger Non Admitted

Assets Assets Admitted Assets

Reinsurance Recoverable on Paid Losses - Treaty - -

Reinsurance Recoverable on Paid Losses - Facultative - -

Reinsurance Recoverable on Unpaid Losses - Treaty - -

Reinsurance Recoverable on Unpaid Losses - Facultative - -

- -

- - - -

Ledger Non-Ledger Non Admitted

Liabilities Liabilities Admitted Assets

- -

- -

- -

- - - -

GRAND TOTAL

GRAND TOTAL

Non-Ledger Non-Admitted

Assets Assets Admitted

Assets

Facultative Treaty Facultative Treaty

(20)=(17)+(18)-(19)

(18) (19) (20)

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

- - - - -

- - - - -

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

- - - - -

- - - - -

- - - - -

- - - - -

Index

RBC Fund Microinsurance

Code Code True/False

(21) (22) (23) (24)

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

Counterparty Rating

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

-

-

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

-

-

REINSURANCE CEDED FOR LIFE AND RELATED BENEFITS


YEAR ENDED:

TYPE Amount

Name of Company In Force Reserve

at End Credits

(note 1) of Year

(1) (2) (4) (5)

I. Authorized:

486,058

PHILAM LIFE _DAPAR, JESUSA T.

PHILAM LIFE _BORGUITE, ROSITA M.

PHILAM LIFE _NUER, ANGELINA S.

PHILAM LIFE _MARMITO, BELMA O.

PHILAM LIFE _GENABE, ROSEMARIE B.

PHILAM LIFE _BUTCON, RONALD S.

PHILAM LIFE _PEREZ, CENDERILA G

PHILAM LIFE _SUMILE, EDDIE C

PHILAM LIFE _RONQUILLO, NILDA M

PHILAM LIFE _PETIELAN, ALIMODIN T

PHILAM LIFE _ESPAÑA, JUVANIE C

PHILAM LIFE _MARSALA, NORA L

PHILAM LIFE _O-ONG, CRESENCIO M

Sub-Total Microinsurance - -

GRAND TOTAL - 486,058

II. Unauthorized:

Sub-Total Microinsurance - -

GRAND TOTAL - -

Sub-total (Microinsurance only) - -

GRAND TOTALS - 486,058


1) Use the following abbreviations:

* GP = group business coinsured;


* DWP = Disability Waiver of Premium;

31 December 2020


N/A

* YRT = individual life reinsured on yearly renewable term plan;

* M = individual life reinsured on modified coinsurance plan;

* CO = individual life reinsured on coinsurance plan;

* OTH =other reinsurance of individual life business;

If more than one type in same reinsuring company show separate line for each.

2) This refers to the aggregate premiums ( for full term of the policy)

for all policies recorded on or prior to the statement date which have

not expired or been cancelled as of the statement






17,300.00 (17,300)

6,000.00 (6,000)

10,000.00 (10,000)

5,000.00 (5,000)

20,000.00 (20,000)

70,000.00 (70,000)

25,000.00 (25,000)

75,000.00 (75,000)

55,000.00 (55,000)

100,000.00 (100,000)

23,000.00 (23,000)

10,000.00 (10,000)

210,000.00 (210,000)

- - - - - - - -

- - 626,300 - 626,300- - - -

- - - - - - - -

- - - - - - - -

- - - - - - - -

- - 626,300 - (626,300) - - -



Amounts Recoverable From ReinsurersAmounts Due to Reinsurers

Paid Losses (6) Unpaid Losses (7)Allowance for

Impairment (8)

Premiums (9) Others (10)

Facultative Treaty Facultative Treaty Facultative Treaty Facultative

N/A

7) RBC codes:

OAssets1 - AAA

OAssets2 - BBB

Premium on Commissions Recoveries

Funds Reinsurance on Ceded on Claims

Held for during Business Reinsured

Reinsurers the Year (note 4)

(11) (12) (13)

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

- - - - -

Reinsurance Recoverable on Paid Losses - Treaty

Reinsurance Recoverable on Paid Losses - Facultative

Reinsurance Recoverable on Unpaid Losses - Treaty

Balances as of December 31 in Current Year Transactions During the Year

Amounts Due to Reinsurers

Others (10)

Treaty

Reinsurance Recoverable on Unpaid Losses - Facultative

Allowance for Impairment Losses

8) Fund Code

GenF - General Fund



OBmi - Mutual Benefit Fund (micro) Due to Reinsurers- Treaty

Due to Reinsurers- Facultative

Funds Held for Reinsurers

GRAND TOTAL

GRAND TOTAL

Non-Ledger Assets

Other Remittances

Recoveries made during Ledger

(Payments) the Year Assets Facultative Treaty

(16)=(6)+(7)

(14) (15) (16) (17)

-

17,300

6,000

10,000

5,000

20,000

70,000

25,000

75,000

55,000

100,000

23,000

10,000

210,000

-

-

- - - - -

- - 626,300 - -

-

-

-

-

-

-

-

-

-

-

-

-

-

-

- - - - -

- - - - -

- - - - -

- - 626,300 - -

Particulars Ledger Non-Ledger Non

Assets Assets Admitted

Reinsurance Recoverable on Paid Losses - Treaty -

Reinsurance Recoverable on Paid Losses - Facultative -

Reinsurance Recoverable on Unpaid Losses - Treaty -

Transactions During the Year

Reinsurance Recoverable on Unpaid Losses - Facultative 626,300 626,300

Allowance for Impairment Losses 626,300- 626,300-

- - -

Particulars Ledger Non-Ledger Non

Liabilities Liabilities Admitted

Due to Reinsurers- Treaty -

Due to Reinsurers- Facultative -

Funds Held for Reinsurers -

- - - GRAND TOTAL

GRAND TOTAL

Non-Admitted Assets

Admitted

Assets RBC

Facultative Treaty Code

(19)=(16)+(17)-(18)

(18) (19) (20) (21)

-

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

- - OAssets1

-

-

- - - - -

- - - - -

-

-

-

-

-

-

-

-

-

-

-

-

-

-

- - - -

- - - -

- - - - -

- - - - -

Admitted

Assets

-

-

-

Counterparty Rating

-

-

-

Admitted

Assets

-

-

-

-

Index

Fund Microinsurance

Code True/False

(22) (23)

ERROR

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

Obmi mi

ERROR

ERROR

- -

- -

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

- -

- -


LEDGER ASSET -

COST

LEDGER ASSET -

ACCUMULATED

DEPRECIATION

Land:

1

2

3

4

5

Building:

1

2

3

4

5

Equipment:

1

2

3

4

5 -

- -

- -

SCHEDULE OF RIGHT-OF-USE ASSET AND LEASE LIABILITY - PFRS 16

COMPANY:

YEAR ENDED:

RIGHT OF USE ASSET

December 31,2020

N/A


LEDGER ASSET - NET

CARRYING AMOUNTNON-LEDGER ASSET

NON-ADMITTED

ASSET

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

- - -

- - -

SCHEDULE OF RIGHT-OF-USE ASSET AND LEASE LIABILITY - PFRS 16

ADMITTED ASSET RBC Code Fund Code Microinsurance

True/False

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- ERROR

- xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx

- xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx

BEGINNING BALANCEMOVEMENT DURING

THE YEAR

Land:

1

2

3

4

5

Building:

1

2

3

4

5

Equipment:

1

2

3

4

5

Total - -

LEASE LIABILITY

ENDING BALANCE /

LEDGER LIABILITY

NON-LEDGER

LIABILITY

BALANCE PER

COMPANY

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- - -

Index

OTHER NON- CURRENT ASSETS

COMPANY:

YEAR ENDED:

Document

Index

No.

(note 1) (note 2)

(1) (2) (3)

Othe Funds and Deposits 0.00%

Rental Deposits 0.00%

Net Pension Asset (Fill out W.1 for the detailed schedule)0.00%

Miscellaneous non-current Asset 0.00%


GRAND TOTAL

Total Prepaid or Deferred Charges

NOTES & INSTRUCTIONS: 1) No Sub-account named as Others/Sundry/Suspense/Miscellaneous should be 10% or more, if not further breakdown is required.


4) Prepaid Charges pertains to expenses paid in advance but will be rendered or be consumed within one year while Deferred Charges

Pertains to expenses paid in advance but will be rendered or be consumed in more than one year.


Description/Particulars/Nature of

AccountPercentage to

Total

December 31,2020

N/A

Micro

insurance Ledger Non-Ledger Non-Admitted Admitted

True/False Assets Assets Assets Assets

(note 3) (note 4) (9)=(6)+(7)-(8)

(4) (5) (6) (7) (8) (9)

-

-

-

-

- - - -

- - - -

- - - -

1) No Sub-account named as Others/Sundry/Suspense/Miscellaneous should be 10% or more, if not further breakdown is required.


Index

4) Prepaid Charges pertains to expenses paid in advance but will be rendered or be consumed within one year while Deferred Charges

Pertains to expenses paid in advance but will be rendered or be consumed in more than one year.


Prepaid or

Deferred

Charges

(Yes or No)

N/A

RBC Fund Microinsurance

Code Code True/False

(10) (11) (12)

ERROR

ERROR

ERROR

ERROR




COMPANY:

YEAR ENDED:

PARTICULARS

Fair value of plan assets at reporting date

LESS:Present value of defined benefit obligation at reporting date

PENSION ASSET (LIABILITY)

Pension Asset

Pension Liability

Type of Fund:

Employee Contribution:

Percentage of Employee Contribution:

Employer Contribution:

Percentage of Employer Contribution:

A Fair value ofplan assets (FVPA)

B Present value of defined benefit obligation (PVDBO)

Pension benefit asset (Liability)

A FVPA, beginning of year

Interest income

Employer Contribution

Participant Contribution

Benefits Paid

Gain (Loss) on Plan Asset

FVPA, end of year

B PVDBO, beginning of year

Current Service Cost

Interest cost

Past Service Cost

Settlement benefit payments

Benefits paid (other than settlement)

Settlement (gain) loss

Loss (Gain) arising from:

changes in demographic assumptions

changes in financial assumptions

deviations of experience from assumptions

PVDBO, end of year

Method of Valuation:

Total Number of Employees

Average Age

Average Years of Service

Indpendent Actuary:

Indpendent Actuarial Firm:

Pension Asset(Obligation) (Arising from Retirement and Post-Employment Benefits)


December 31,2020

N/A

Compound Entry to record movement in PVDBO and FVPA (indicating in the remarks if asset, liability, profit & loss or other comprehensive income account): (example below)

Dr. Current service cost

Dr. Interest cost

Dr. Remesurement of pension obligation

Dr. Remesurement of pension obligation

AMOUNT (PHP) Dr. Remesurement of pension obligation

- Dr. Present Value of the Defined Benefit Obligation

- Dr. Fair Value of Plan Assets

- Cr.

Cr.

- Cr.

- Cr.

Cr.

(example: funded, non-contributory plan)

Yes/No

(Example: 50%)

Yes/No

(Example: 50%)

0.00

0.00

0.00

0.00

0.00

(example: Projected Unit Credit Method)

_______________

_______________

_______________

_______________

_______________

Index

Pension Asset(Obligation) (Arising from Retirement and Post-Employment Benefits) Account


December 31,2020


Debit Credit

Current service cost 100,000.00₱

Interest cost 15,000.00

Remesurement of pension obligation 3,000.00



Present Value of the Defined Benefit Obligation 4,000.00

Fair Value of Plan Assets 108,000.00

Fair Value of Plan Assets 1,000.00₱

Fair Value of Plan Assets 4,000.00

Present Value of the Defined Benefit Obligation 120,000.00

Interest Income 8,000.00

Cash 100,000.00

233,000.00₱ 233,000.00₱

Account


Remarks

Current service cost (Profit & Loss Account)

Interest cost (Profit & Loss Account)

Loss arising from changes in financial assumptions (Other Comprehensive Income Account)

Loss arising from deviations of experience from assumptions (Other Comprehensive Income Account)

Loss on Plan Asset (Other Comprehensive Income Account)

Benefits paid (Liability)

Interest Income and Contributions paid (Asset)

Loss on Plan Asset (Asset)

Benefits paid (Asset)

Current service cost , Interest cost, Loss arising from changes in financial assumptions and Loss arising from deviations of experience from assumptions (Liability)

Interest Income (Profit & Loss Account)

Contributions paid (Asset)

Current service cost , Interest cost, Loss arising from changes in financial assumptions and Loss arising from deviations of experience from assumptions (Liability)

COMPANY:

YEAR ENDED:

Nature and Description

(2)

1

2 n/a

3 SSS/ECC/Pagibig/Philhealth Contributions Payable n/a

4 n/a

5 n/a

6 Transaction mistagged in PBC MBA accounts for trace

Collection fee to agents

MIMAP_SP2 payable

NOTES & INSTRUCTIONS: 1) If allocated to Microinsurance, indicate True if not False

2) If Other Accounts Payable is equivalent to 10% or more of the total Accounts Payable, please input breakdown in Y.1

Other Accounts Payable_MIMAP

GRAND TOTAL

ACCOUNTS PAYABLE


December 31,2020

COUNTERPARTY

(1)

Accounts Payable - Minor Beneficiary

Withholding Taxes Payable

SSS/ Pagibig Loans Payable

Grants Held in Trust

Other Accounts Payable

Microinsurance

Other Accounts Payable_collection fee

Other Accounts Payable_Accrued Expense

Other Accounts Payable_EV

MICROINSURANCE

(TRUE/FALSE) Unpaid Balance Percentage to Total Ledger Liability

(Note 1) (Note 2)

(3) (4) (5) (6)

TRUE - 0.00% -

FALSE - 0.00% -

TRUE - 0.00% -

TRUE - 0.00% -

TRUE - 0.00% -

TRUE 594,537.05 76.29% 594,537.05

TRUE 121,630.79 15.61% 121,630.79

TRUE 3,891.00 0.50% 3,891.00

TRUE 38,498.00 4.94% 38,498.00

TRUE 20,741.01 2.66% 20,741.01

779,297.85 1.00 779,297.85

779,297.85 1.00 779,297.85

Ledger Liability Non-Ledger Liability Liability per AS

Microinsurance 779,297.85 - 779,297.85

Total 779,297.85 - 779,297.85


2) If Other Accounts Payable is equivalent to 10% or more of the total Accounts Payable, please input breakdown in Y.1

Non-Ledger

Liability Liability per AS Remarks

(8)=(6)+(7)

(7) (8) (9)

- -

- -

- -

- -

- -

- 594,537.05

121,630.79

3,891.00

38,498.00

20,741.01

- 779,297.85

- 779,297.85

Index

COUNTERPARTY Nature and Description

(1) (2)

1 TB collection fee

2 BB collection fee

3 SFB collection fee

4 PB collection fee

5 SJB collection fee

6 SB collection fee

7 LB collection fee

8 OB collection fee

9 CVB collection fee

10 DB collection fee

11 KB collection fee

12 CB collection fee

13 PBC _OPS collection fee

14 seC. Force collection fee

15 FRIEND collection fee

16 RCMC collection fee

17 BA2MODA collection fee

18 MOLD collection fee

19 BB Over of fund transfer from Bayugan Branch dtd 1/3/2019 ***.30.

20 CB Fund transfer from Cabadbaran BRanch

21 To record transaction dtd 7/10/2019 as payable

22 DB Reverse the entry transaction from Digos Branch

23 LB To record ICSD from Lupon dtd 9/30**700 & 10/31**250, from MAti dtd 10/31**450. (balance)

24 Unidentified transaction 10/30/2019

25 RCMC Excess premium from RCMC month of Jan, 2020

26 BLU MATI to record transaction from BLU Mati 450, SFB 550, OPS 301 & 786.50 PBCAR payroll deduction

27 LB TO RECORD OTHER ACCOUNTS PAYABLE FROM PAYROLL OF LB EMPLOYEES DTD 3.31.2020

28 SFB FROM PAYROLL OF PBCI_SFB (FB EMPLOYEES)

29 PB TO RECORD AS OTHER ACCOUNT PAYABLE TO PBC MBA CLIP COLLECTION ACCOUNT BANK RECON IN PROSPERIDAD BRANCH

30 PBCI TO RECORD BANK RECON OF CLOSED ACCOUNTS FROM BRANCHES_KB, CVB, SFB, SJB & OB REFER ATTACHED SUMMARY

31 SFB Fund transfer of HAPI collection Sept. & Oct, 2018 San Francisco Branch ***over 2 victor

32 SFB SFB members payment jan, 2018

33 SFB Double transaction dated 9/23/2019 dtd 10/28/2019 & 100 for trace dtd 9/3/2019

34 LGBA CSH : Gerald Marsala double payment from LGBA dtd 9/2/2020

35 OB To record bank recon of Oroquieta Branch_HAPI account

36 SFB To record as payable transaction dtd 8/14/2020_440, dtd9/15/2020_148 & 10/9/2020_37 in Hapi plan main account

37 SFB Payment of salaries & wages Aug 1-15, 2019 of JPG, LAMA & BBA (balance)

MBA NAME:

YEAR ENDED


December 31,2020

OTHER ACCOUNTS PAYABLE

38 LGBA Fuel expense of LGBA under CV#19-00396MF. AP LGBA 5,157.71

39 SFB Mistag transaction

40 LGBA To liquidate the CA of LGBA for fidelity bond of lGBA/ESL & JTC from 12/31-12/31/2020. AP to LGBA 43.75

41 LGBA To liquidate the CA of LGBA dtd 2/21/2020 12k for SUBARU maintenance 9,922.20 & trans expense 3,407 with payable 1,329.20

42 SFB For trace transaction, cash dtd 3/2/2020

43 LGBA To liquidate the Ca of LGBA dtd 12/3/2019 for Subaru's maintenance with payable to LGBA 4,349.68

44 ECHO Echo transaction

45 (PARTICULARS)

46 (PARTICULARS)

47 (PARTICULARS)

48 (PARTICULARS)

49 (PARTICULARS)

50 (PARTICULARS)

51 (PARTICULARS)

52 (PARTICULARS)

53 (PARTICULARS)

54 (PARTICULARS)

55 (PARTICULARS)

56 (PARTICULARS)

57 (PARTICULARS)

58 (PARTICULARS)

59 (PARTICULARS)

60 (PARTICULARS)

61 (PARTICULARS)

62 (PARTICULARS)

63 (PARTICULARS)

64 (PARTICULARS)

10 Others/Sundry/Suspense/Miscellaneous


Beginning Balance

Additional or

Accrual

during the year

Payments

during the year Unpaid Balance Percentage to Total

(6)=(3)+(4)-(5) (Note 1)

(3) (4) (5) (6) (7)

1,363.76 1,363.76 0.29%

153.42 153.42 0.03%

6,235.66 6,235.66 1.35%

4,086.90 4,086.90 0.88%

1,302.46 1,302.46 0.28%

3,857.86 3,857.86 0.83%

959.36 959.36 0.21%

4,451.54 4,451.54 0.96%

13,657.24 13,657.24 2.95%

6,579.80 6,579.80 1.42%

4,327.42 4,327.42 0.93%

700.42 700.42 0.15%

191.00 191.00 0.04%

474.96 474.96 0.10%

220.08 220.08 0.05%

71,741.29 71,741.29 15.50%

34.84 34.84 0.01%

1,292.78 1,292.78 0.28%

0.30 0.30 0.00%

151.06 151.06 0.03%

11,758.24 11,758.24 2.54%

775.75 775.75 0.17%

700.00 700.00 0.15%

2,145.55 2,145.55 0.46%

96.00 96.00 0.02%

2,087.50 2,087.50 0.45%

250.00 250.00 0.05%

225.00 225.00 0.05%

224,611.15 224,611.15 48.51%

60,684.21 60,684.21 13.11%

1.40 1.40 0.00%

1,034.00 1,034.00 0.22%

100.00 100.00 0.02%

216.00 216.00 0.05%

7,234.99 7,234.99 1.56%

625.00 625.00 0.13%

2,905.63 2,905.63 0.63%


December 31,2020

OTHER ACCOUNTS PAYABLE

5,157.71 5,157.71 1.11%

1,016.00 1,016.00 0.22%

43.75 43.75 0.01%

1,329.20 1,329.20 0.29%

750.00 750.00 0.16%

4,349.68 4,349.68 0.94%

13,100.00 13,100.00 2.83%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

389,214.96 73,763.95 - 462,978.91

1) Others/Sundry/Suspense/Miscellaneous sub account percentage to total should be less than 10%, break futher until no account has 10% or more.

Ledger Liability Non-Ledger Liability Liability per AS Remarks

(10)=(8)+(9)

(8) (9) (10) (11)

- - -

1) Others/Sundry/Suspense/Miscellaneous sub account percentage to total should be less than 10%, break futher until no account has 10% or more. index

ACCRUED EXPENSES

COMPANY:

YEAR ENDED:

AMOUNT (PHP) Ledger Liability

(3) (4)

54.1 Accrued utilities:

54.1.1 Electricity 12,354.46 12,354.46

54.1.2 Water 879.55 879.55

54.1.3 Communications 7,507.00 7,507.00

54.2 Accrued services

54.2.1 Technical and Professional Fees - -

54.2.2 Service Fees - -

54.2.7 Other Accrued Services - -

54.3 Accrual for unused compensated absences - -

54.4 Accrued Interest Expense - -

54.5 Other Accrued Expenses - -

Microinsurance - -

GRAND TOTAL 20,741.01 20,741.01

Ledger Liability

Accrued Utilities 20,741.01

Accrued Services -

Accrual for Unused Compensated Absences -

Accrued Interest Expense -

Other Accrued Expenses -

Microinsurance -

Total 20,741.01




3) Use the drop-list for the Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template

4) If Other Accrued Expenses is equivalent to 10% or more of the total Accrued Expenses, please input breakdown in Z.1


December 31,2020

PARTICULARS

(1)

Non-Ledger Liability Liability per AS RBC Code

(6)=(4)+(5) Note 5

(5) (6)

- 12,354.46 60% GenF

- 879.55 4% GenF

- 7,507.00 36% GenF

- - 0%

- - 0%

- - 0%

- - 0%

- - 0%

- - 0%

- - xxxxxxxxxxxx

- 20,741.01 100% xxxxxxxxxxxx

Non-Ledger Liability Liability per AS

- 20,741.01

- -

- -

- -

- -

- -

- 20,741.01

5) FUND codes:

GenF - General Fund


3) Use the drop-list for the Fund Code, for inserted rows, copy the cell with droplist for ease in filling up the template OBreg - Mutual Benefit Fund (regular)

4) If Other Accrued Expenses is equivalent to 10% or more of the total Accrued Expenses, please input breakdown in Z.1 OBmi - Mutual Benefit Fund (micro)

Percentage to Total

Microinsurance Remarks

True/False

(8)

mix

mix

mix

ERROR

ERROR

ERROR

ERROR

ERROR

ERROR

xxxxxxxxxxxx xxxxxxxxxxxx

xxxxxxxxxxxx xxxxxxxxxxxx

GenF - General Fund Index




COUNTERPARTY Nature and Description

(1) (2)

1 (PARTICULARS)

2 (PARTICULARS)

3 (PARTICULARS)

4 (PARTICULARS)

5 (PARTICULARS)

6 (PARTICULARS)

7 (PARTICULARS)

8 (PARTICULARS)

9 (PARTICULARS)

10 Others/Sundry/Suspense/Miscellaneous


OTHER ACCRUED EXPENSES


YEAR ENDED December 31,2020

Beginning Balance

Additional or

Accrual

during the year

Payments

during the year Unpaid Balance Percentage to Total

(6)=(3)+(4)-(5) (Note 1)

(3) (4) (5) (6) (7)

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- 0.00%

- - - -


OTHER ACCRUED EXPENSES


December 31,2020

N/A

Ledger Liability Non-Ledger Liability Liability per AS Remarks

(10)=(8)+(9)

(8) (9) (10) (11)

- - -

1) Others/Sundry/Suspense/Miscellaneous sub account percentage to total should be less than 10%, break futher until no account has 10% or more. index

COMPANY:

YEAR ENDED:

NAME OF CREDITOR

NATURE AND

DESCRIPTION OF

ACCOUNT

MICROINSURANCE

(TRUE/FALSE)

(Note 1)

(1) (2) (3)

CREDITOR1 TRUE

CREDITOR2 FALSE

CREDITOR3 TRUE

MicroinsuranceGRAND TOTAL


LONG TERM LOANS PAYABLE


December 31,2020

Interest rate, if

anyPRINCIPAL INTEREST TOTAL Ledger Liability

(7)=(5)+(6)

(4) (5) (6) (7) (8)

- - - -

- - - -

- - - -

- - - -

- - - -

Ledger Liability

Microinsurance -

Total -


N/A

Non-Ledger Liability Liability per AS Remarks

(10)=(8)+(9)

(9) (10) (11)

- -

- -

- -

- -

- -

Non-Ledger Liability Liability per AS

- -

- -

Index

OTHER LONG TERM LIABILITIES

COMPANY:

YEAR ENDED:

(1) (2) (3)

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

(PARTICULARS) 0.00%

Others/Sundry/Suspense/Miscellaneous 0.00%


GRAND TOTAL

Total Prepaid or Deferred Charges

NOTES & INSTRUCTIONS: 1) Others/Sundry/Suspense/Miscellaneous sub account percentage to total should be less than 10%, break futher until no account has 10% or more.


December 31,2020




Total

NATURE AND

DESCRIPTION OF

ACCOUNT

Micro

insurance Ledger Non-Ledger

True/False TOTAL Liability Liability

(4) (5) (6)

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

- -

- -

- -



Principal Interest


Interest rate

if any

N/A

Liability

per AS Remarks

(7) (8)

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -

- -


Index

UNEARNED INCOME


YEAR ENDED:

Micro

insurance

True/False

(1) (2) (3) (4) (5)

PARTICULAR1 0.00%

PARTICULAR2 0.00%

PARTICULAR3 0.00%

PARTICULAR4 0.00%

Others/Sundry/Suspense/Miscellaneous 0.00%


GRAND TOTAL

NOTES & INSTRUCTIONS: 1) No Sub-account named as Others/Sundry/Suspense/Miscellaneous should be 10% or more, if not further breakdown is required.


31 December 2020



Total

Interest rate

if any Beginning

N/A


Ledger Non-Ledger Liability

Liability Liability per AS

(6) (7) (8) (9) (10) (11)

- -

- -

- -

- -

- -

- - -

- - -

- - -

1) No Sub-account named as Others/Sundry/Suspense/Miscellaneous should be 10% or more, if not further breakdown is required.


Additional

Unearned

Income

Payments

during the

year

TOTAL

Unearned

Income

N/A

Remarks

(12)

xxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxxxxx

Index

MBA NAME:

YEAR ENDED:

RBC EXHIBIT IX - C-4 REQUIREMENTS

(1) C-1: Asset Default Risk 2,677,206

(2) C-2: Insurance Pricing Risk 649,880

(3) C-3: Interest Rate Risk -

(4) C-4: General Business Risk 172,537

(5) Sum of C-1 to C-4 requirements 3,499,623

(6) Aggregate RBC requirement 2,927,491

(7) Member's Equity* 30,266,613

(8) RBC Ratio: (7)/(6) 1033.88%

(9) RBC Ratio, previous year

* Members Equity= Total Admitted Assets-Total Liabilities

* Members Equity= Admitted Assets-Total Liabilities

Admitted Assets 67,324,508.78

Total Liabilities 37,057,895.65

Members Equity 30,266,613.13

RISK BASED CAPITAL (RBC) COMPUTATION

December 31,2020


A/S FOR YEAR ENDED ANNUAL STATEMENT FOR THE YEAR ENDED: OF OFA/S FOR YEAR ENDED 12/31/2020 of PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

RBC EXHIBIT V - Asset Default Risk

C-1 REQUIREMENTS

RBC code

1 1 Bonds and Treasury Bills

1.1 1.1 Government, in local currency GLC

1.2 1.2 Government, in foreign currency GFC

1.3 1.3 Investment Grade IG

1.4 1.4 Below Investment Grade BIG

1.5 1.5 Near default ND

3 2 Short-term Investments

3.1 3.1 Government, in local currency GLC2

3.2 3.2 Government, in foreign currency GFC2

3.3 3.3 Investment Grade IG2

3.4 3.4 Below Investment Grade BIG2

3.5 3.5 Near default ND2

4 3 Stocks

4.1 4.1 Common Stocks CS

4.2 4.2 Preferred Stocks PS

4.2.1 4.2.1 Traded and Rated PTR

4.2.2 4.2.2 Non-traded and Non-rated PnTnR

5 4 Real estate (net of encumbrances)

5.1 5.1 Please enter the company's real estate quota here (Admitted Asset value basis)

5.2 5.2 MBA occupied, up to quota OCC

5.3 5.3 MBA-occupied, above quota OCC

5.4 5.4 Acquired in satisfaction of debt/foreclosed REF

5.5 5.5 Investments in real estate REI

6 5 Mortgage Loans and Purchase Money Mortgages

6.1 6.1 In good standing IGS

6.2 6.2 Others Others

8 6 Policy loans

8.1 8.1 All Member Equity or individual policy loans… PL

7 7 Cash on Hand & in Banks

7.1 7.1 Cash on Hand CoH

7.2 7.2 Deposits in banks and trusts DepBT

7.3 7.3 Others (not in good standing) NGS

9 8 Collateral, Guaranteed, and Other loans

9.1 9.1 Of best security OFB

9.2 9.2 Adequately secured AS

9.3 9.3 Others OCGO

11 9 Guaranty Fund GF

12 10 Fees / Dues Receivable FDR

13 11 Due & Uncollected: Life insurance premiums and annuity contributions DU-Life

14 12 Due & Uncollected: Accident and Health premiumsDU-AccHealth

15 13 Electronic Data Processing

15.1 13.1 Hardware HW

15.1 13.2 Software SW

16 14 Investment income due & accrued

15.1 14.1 Overdue investment income AINC1

15.2 14.2 AAA AINC2

16 15 Other Investments

16.1 16.1 AAA OInv1

16.2 16.2 BBB OInv2

17 17 Other Assets

17 17.1 AAA OAssets1

17.2 BBB OAssets2

19 18 Total assets and C-1 requirement



2) Legend:



A/S FOR YEAR ENDED 12/31/2020 of PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

Fair Value Net Admitted Value

RBC

factor RBC requirement

(1) (2) (3) (4) = (2) x (3)

17,266,602 17,266,602 0.0% -

1.6% -

1.6% -

10.0% -

30.0% -

0.0% -

1.6% -

1.6% -

10.0% -

30.0% -

30.0% -

15.0% -

30.0% -

Please enter the company's real estate quota here (Admitted Asset value basis)

4,523,037 4,523,037 8.0% 361,843

15.0% -

30.0% -

1,429,310 1,429,310 15.0% 214,397

10.0% -

30.0% -

0% -

12,000 12,000 20% 2,400

33,705,454 33,705,454 0.3% 101,116

20% -

0.0% -

10.0% -

30.0% -

0.0% -

57,171.01 57,171.01 8.0% 4,574

8.0% -

DU-AccHealth 8.0% -

268,475.02 268,475.02 20.0% 53,695

733,107.99 733,107.99 10.0% 73,311

1,469 1,469 20.0% 294

0.0% -

20.0% -

20.0% -

9,246,298.50 9,246,298.50 20.0% 1,849,260

81,584.25 81,584.25 20.0% 16,317

67,324,508 67,324,508 - x - 2,677,206




RBC EXHIBIT VI - Insurance Pricing Risk

C-2 REQUIREMENTS

PART 1: C-2 Contingency Exposure measure

Exposure, gross of

reinsurance

Exposure, net of

reinsurance C2 code

(1) (2) (3) (4) (5)

1 1 Individual Life, non-par NAR* C2inp

2 2 Individual Life, par or adjustable premium NAR* C2ip

3 3 Group Life

3.1 3.1 Basic Life NAR* 616,566,421 616,566,421 C2gbl

3.2 3.2 Credit Life NAR* 111,408,111 111,408,111 C2gcl

3.2 3.2 HAPI Plan NAR* 58,536,000 58,536,000

4 4 Life Annuity Reserve C2la

5 5 Disability - active, all types including TPD Premium C2da

6 6 Disability - disabled Reserve C2dd

7 7 Accident Premium C2acc

8 8 Health Premium C2h

9 9 Accident & Health Premium C2ah

10 10 Critical Illness Premium C2ci

11 11 Claim Reserves Reserve 413,441 413,441 n/a

12 12 Other risks Premium C2o

13 13 Total C-2 Requirement xxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

* NAR: Net Amount at Risk, or Death Benefit minus Policy Reserves



2) Legend:

Enter data in light green black font shaded areas, as applicable 9,999.00

Cells in tan color and blue font are linked to other schedules and exhibits 9,999.00

Basic Life Insurance

Count Death Benefit

Members

less than 6 months 431 5,000.00 2,155,000.00

6 months but less than 12 months 42 7,000.00 294,000.00

12 months but less than 24 months 17,487 15,000.00 262,305,000.00 264,754,000.00

24 months and above -

Legal Dependents -

less than 6 months 801 3,000.00 2,403,000.00

6 months but less than 12 months 86 6,000.00 516,000.00

12 months but less than 24 months 34,890 10,000.00 348,900,000.00 351,819,000.00

24 months and above

616,573,000.00 616,573,000.00

Reserves for Basic Life Insurance 6,579.30 * See Actuary's Certification for Reserves

Net Amount at Risk 616,566,420.70

Credit Life Insurance

Total Amount of Active Loans 111,408,111.45 RE.INSURED 40,534,000.00

Reserves for Credit Life Insurance 779,200.91 NOT REINSURED 70,874,111.45

Net Amount at Risk 110,628,910.54 111,408,111.45

HAPI PLAN

Total Insured Amount 58,536,000.00

Reserves for HAPI 75,686.47

Net Amount at Risk 58,460,313.53

Total insurance Inforce 745,983,111.45

Reserves 200,186.67

Comment

RBC

Factor RBC Requirement

(6) (7) = (6)x(4)

0.10% - Linked to x4p11


0.08% 493,253 Linked to x4p11

0.08% 89,126 Linked to x4p11

0.08% 46,829








5.00% 20,672 NET PORTION: items 4 & 5 on x6p13? What about gross?


xxxxxxxxx 649,880


RBC EXHIBIT VII - Interest Rate Risk

C-3 REQUIREMENTS

Liability / Valuation Standard (note 1)

Valuation

Interest

Currency - ISO

Code

(1) (2) (3)

C3. C3. C3 LIABILITIES

C3.1 C3.1 Unearned Premium: Basic Life 0.00% PHP

C3.2 C3.2 Unearned Premium: Credit Life 0.00% PHP

C3.2 C3.2 Unearned Premium: HAPI 0.00% PHP

C3.3 C3.3 Claims reserves 0.00% PHP

C3.4 C3.4 RSF (Accumulated Value) 2.00% PHP

C3.5 C3.5 Equity Value (Accumulated Value) 0.00% PHP

C3.6 C3.6

C3.7 C3.7

C3.8 C3.8

C3.9 C3.9

C3.10 C3.10

C3.11 C3.11

C3.12 C3.12

Total - x - - x -



2) Indicate by Valuation Standard (mortality and interest basis) in the same format and sequence as in Exhibit 8, but broken down further by Currency and C-3 Category.

3) Legend:

Enter data in light green black font shaded areas, as applicable

Cells in tan color and blue font are linked to other schedules and exhibits

Reference Table for RBC Factors and Current Interest Rates

RBC Factors by Valuation Spread and C-3 Category (Zero for "S" liabilities)

Valuation Spread, rounded down 0.5% E1

1 2

-3% or below -999.0% 6.0%

-2.5% -2.5% 6.0%

-2% -2.0% 6.0%

-1.5% -1.5% 6.0%

-1% -1.0% 6.0%

-0.50% -0.50% 6.0%

0.00% 0.00% 4.5%

0.50% 0.50% 2.2%

1.00% 1.00% 0.0%

1.50% 1.50% 0.0%

2% or above 99.0% 0.0%

Current Interest Rates for the year, as declared by the Commission:

L1, E1 rates are based on 5-year Treasuries while L2, E2 are based on 10-year Treasuries.

Currency - ISO Code E1 E2

PHP 2.329% 2.605%

USD 2.329% 2.605%


C-3 Category

(note 4)

Reserves, gross of

reinsurance

Reserves, net of

reinsurance

Current

Interest

Actual valuation

spread

(4) (5) (6) (7) (8)

S 6,579 6,579

S 486,058 486,058

S 75,686 75,686

S -

e2 - 2.605% 0.60%

L3 35,250,166 35,250,166 2.880% 2.88%

0.000% 0.00%

0.000% 0.00%

0.000% 0.00%

0.000% 0.00%

0.000% 0.00%

0.000% 0.00%

0.000% 0.00%

- x - 35,818,490 35,818,490 - x -

4) C-3 classification rules

2) Indicate by Valuation Standard (mortality and interest basis) in the same format and sequence as in Exhibit 8, but broken down further by Currency and C-3 Category. i. S: Short term deposits and unearned premium reserves with GD ≤ 1 year

ii. L1: Whole Life, Term and Insurance plans with 1 year < GD ≤ 5 years.

999,999.00 iii. L2: Whole Life, Term and Insurance plans with 5 < GD < 10 years.

999,999.00 iv. L3: Whole Life, Term and Insurance plans with GD > 10 years.

iv. E1: Endowment Plans, Annuities, Deposits with 1 year < GD ≤ 5 years.

v. E2: Endowment Plans, Annuities, Deposits with 5 < GD < 10 years.

vi. E3: Endowment Plans, Annuities, Deposits with GD > 10 years.

E2 E3 L1 L2 L3

3 4 5 6 7

6.0% 6.0% 6.0% 6.0% 6.0%

6.0% 6.0% 6.0% 6.0% 6.0%

6.0% 6.0% 6.0% 6.0% 6.0%

6.0% 6.0% 6.0% 6.0% 6.0%

6.0% 6.0% 6.0% 6.0% 6.0%

6.0% 6.0% 5.1% 6.0% 6.0%

6.0% 6.0% 3.4% 6.0% 6.0%

6.0% 6.0% 1.7% 5.3% 5.3%

5.9% 5.9% 0.0% 2.2% 2.2%

2.2% 2.2% 0.0% 0.0% 0.0%

0.0% 0.0% 0.0% 0.0% 0.0%

L1, E1 rates are based on 5-year Treasuries while L2, E2 are based on 10-year Treasuries.

E3 L1 L2 L3 S

2.880% 2.329% 2.605% 2.880% 0.00%

2.880% 2.329% 2.605% 2.880% 0.00%

Rounded

valuation

spread RBC factor

RBC Requirement

(6) X (10)

(9) (10) (11)

0.00% -

0.00% -

0.00% -

0.50% 6.00% -

1.50% 0.00% -

0.00% 999.00% -

0.00% 999.00% -

0.00% 999.00% -

0.00% 999.00% -

0.00% 999.00% -

0.00% 999.00% -

0.00% 999.00% -

- x - - x - -

4) C-3 classification rules

i. S: Short term deposits and unearned premium reserves with GD ≤ 1 year

ii. L1: Whole Life, Term and Insurance plans with 1 year < GD ≤ 5 years.

iii. L2: Whole Life, Term and Insurance plans with 5 < GD < 10 years.

iv. L3: Whole Life, Term and Insurance plans with GD > 10 years.

iv. E1: Endowment Plans, Annuities, Deposits with 1 year < GD ≤ 5 years.

v. E2: Endowment Plans, Annuities, Deposits with 5 < GD < 10 years.

vi. E3: Endowment Plans, Annuities, Deposits with GD > 10 years.

S

8

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

A/S FOR YEAR ENDED 12/31/2020 of PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC0 RBC EXHIBIT VIII - General Business Risk

C-4 REQUIREMENTS

C4. (1)

C4.1 C4.1 Total Premiums and contributions collected (x4p11)

C4.2 C4.2 Total Admitted Assets (p2)

C4.3 C4.3 TOTAL Base C-4 Requirement

C-4 Exposure Measure


Exposure, gross of

reinsurance

Exposure, net of

reinsuranceRBC Factor

RBC Requirement

(2) (3) (4) (5) = (3)x(4)

845,090 845,090 0.50% 4,225

- x - 67,324,508 0.25% 168,311

xxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxx xxxxxxxxxxxx 172,537

Annual Statement for the Year Ended December 31, 2020

of PEOPLES BANK OF CARAGA - MUTUAL BENEFIT ASSOCIATION,INC

SWORN STATEMENT

)

) s.s

)

, President, , Secretary,

, Treasurer, , Actuary,

, Chied Executive Office and , Accountant

of the

being duly sworn, each for himself deposes and says that he/she is one of the herein described officers of said

association, and that on the 31st day of December 2020 , all the herein described assets were the

absolute properties of the said association, free and clear from any liens or claims thereon, except as herein

stated, and that the foregoing statement, with the schedules and explanations therein contained, annexed or

referred to are a full and correct statement of all Assets, Liabilities, and Members' Equity on the said 31st day of

December, 2020 , Receipts and Disbursements, Income and Expenses, and of the conditions and affairs

of said association for the year ended on that date, according to the best of his/her information, knowledge and

belief, respectively.

President- 708-278-416

Secretary- 205-927-797

Treasurer- 708-445-993

Actuary- 152-556-210

Chief Executive Officer 912-284-161

Accountant- 213-066-731

Corporate Resident Certificate

No. xxxxxxxxxxxxxxxxxxxxxx issued at xxxxxxxxxxxxxxxxx

on xxxxxxxxxxxxxxxxxxxxxx

Subscribed and sworn to before me this day of ,

Doc No. ___________________

Page No.____________________

Book No. ___________________

Series of 2021

Notary Public


(Name of the Association)

DocumentaryStamp

worth P20.00Documentary

Stampworth P30.00

Life/MBA's/Trust Division

Summary of Changes

MBA Annual Statement for CY 2020

No. UPDATED TABS/SHEETS

1 Tab C

2 Tab E

3 Tab G

4 Tab J

5 Tab K

6 Tab N

7 Tab O

8 Tab P

9 Tab Q

10 Exhibit 6

11 Tab T

12 Tab U

13 Tab V

14 Tab V.1

15 Tab W

16 Tab W.1

17 Tab X

18 Tab Y

19 Tab Y.1

18 Tab Z

19 Tab Z.1

20 Tab AA

21 Tab AB

22 Tab AC

19 Page 6

20 Exhibit 4

PARTICULARS

Mutual Funds,Unit Investment Trust Fund, Real Estate Investment Trust

and Other Funds Schedule

Short Term Financial Asset Schedule

Added Leasehold Improvement

Added columns for Membership Certificate Number, Membership Equity

value as of 31 December 2020

Added columns for Membership Certificate, Policy Number, Cash

Surrender Value, Member's Equity Value and policy reserves as of 31

December 2020

Added column for Members' Equity Value as of 31 December 2020

Added Membership Certificate Number, Members' Fees and Dues based

on IC approved rate as indicated in the IRR and Membership Equity value

as of 31 December 2020

Added columns for Membership Certificate, Policy Number, date of

Membership and total Unremitted Members' Contribution/ Premiums, dues

and fees as of 31 December 2020

Members' Assessment Receivable

Free and Unassigned Fund Balance Schedule

Investment in Subsidiaries and Associate Schedule

Investment in Joint Venture Schedule

Reinsurance Ceded for Accident and Health Benefits

Reinsurance Ceded for Life and Related Benefits

Other Non-Current Asset

Net Pension Asset (liability)

Right of Use Asset

Accounts Payable

Other Accounts Payable

Accrued Expenses

Other Accrued Expenses

Long Term Loans Payable

Other Long Term Liabilities

Unearned Income

Added Changes in Short Term Investment, Mutual Funds,Unit Investment

Trust Fund, Real Estate Investment Trust and Other Funds Schedule

under Cash Flow from Investing Activities

Receivables, Property, Plant and Equipment and Investment Property are

already presented net of allowances and Accumulated Depreciation

members of the board, officers and employees

Documents