Click on the PDF icon to the right to open the Report of Premiums PDF form. First save it to your computer, then open it in Adobe Reader in order to accurately fill in the correct data within the predefined fields of the form. Certain fields are required for submission and are indicated with a red outline (only visible in Adobe Reader). Once the form is completed, be sure to save it to your computer for your records before submitting.
Report of Premiums submissions to WSRB can be done through the icon at the end of the PDF form (must be using Adobe Reader for this function to work) or by clicking the button to the right.
Remember to attach your statutory Page 14 to the email no matter what method you use. Ensure the completed Report of Premiums is attached if you are sending it through the icon to the right, as it doesn't attach automatically.
If you have trouble submitting the form using either method above, you can simply email it. For additional assistance, contact Customer Service at 206.217.0101 or by clicking here.
Companies under common management may submit a combined premium report. If, however, any company of the group differs from the others as to Bureau services received, then separate reports are to be submitted for the differing companies.
Report Annual Statement Premiums from column 1 of your Statutory page 14, in the space provided.
THE TOTAL ANNUAL STATEMENT PREMIUMS MUST EQUAL THE TOTAL DIRECT PREMIUMS WRITTEN.
Direct Premiums Written
Annual Statement Line 1 includes premiums for Commercial Property, Dwelling Property and Farm Property. Please designate individually, in the spaces provided:
Annual Statement Line 2.1 includes premiums for Commercial Property, Dwelling Property and Farm Property. Please designate individually in the spaces provided:
Annual Statement Line 3 includes premiums written under the Farmowners program only. Please designate individually in the spaces provided:
Annual Statement Line 4 includes premiums written under the Homeowners program only. Please designate individually in the spaces provided:
Annual Statement Line 5.1 includes the property portion only of Commercial Multi-Peril policies. Please include on this report premiums written under Commercial Package policies (including Market Segments Programs) and premiums written under Businessowners policies. Enter property premiums only. Please designate individually in the spaces provided:
Note: Enter Premiums for Capital Assets & Agricultural Assets programs in the spaced provided.
Annual Statement Line 12 includes earthquake premiums written as commercial lines and earthquake premiums written as personal lines (Dwelling Property and Farm Property). Please designate individually: