Report of Premiums Digital

Click the PDF icon to the right to complete the Report of Premiums form.

When your Report of Premiums form is filled out, submit it to WSRB by simply emailing it.

Important:

Remember to attach a copy of your Statutory Page 14 with the email.

For additional assistance, contact Subscriber Services at 206-273-7145 or by clicking here.

Instructions for Report of Premium Completion

Companies under common management may submit a combined premium report. However, if any company within the group differs from the others as to WSRB services received, separate reports must be submitted for the each company.

Annual Statement Premium

Report Annual Statement Premiums from column 1 of your Statutory Page 14 in the space provided. The total direct premiums written at the bottom of this form must equal the total annual statement premiums at the top.

Direct Premiums Written

• Enter full premiums - to the nearest dollar

Lines of Business

Line 1 - Fire includes premiums for Commercial Property, Dwelling Property and Farm Property. Please designate individually in the spaces provided:

• Premiums written under the Dwelling program using WSRB materials
• Premiums written under the Farm program using WSRB materials
• Premiums written under Division 5, Commercial Property, using WSRB materials
• Fire premiums using other than WSRB materials

Line 2.1 - Allied Lines includes premiums for Commercial Property, Dwelling Property and Farm Property. Please designate individually in the spaces provided:

• Premiums written under the Dwelling program using WSRB materials
• Premiums written under the Farm program using WSRB materials
• Premiums written under Division 5, Commercial Property, using WSRB materials
• Allied Lines premiums using other than WSRB materials

Line 3 - Farmowners includes premiums written under the Farmowners program only. Please designate individually in the spaces provided:

• Premiums using WSRB materials
• Premiums using other than WSRB materials

Line 4 - Homeowners includes premiums written under the Homeowners program only. Please designate individually in the spaces provided:

• Premiums using WSRB materials
• Premiums using other than WSRB materials

Line 5.1 - Commercial Multi-Peril - Non Liability includes the property portion only of Commercial Multi-Peril policies. Please include 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:

• Premiums using WSRB materials
• Premiums using other than WSRB materials

Note: Enter Premiums for Capital Assets & Agricultural Assets programs in the space provided.

Line 12 - Earthquake includes Earthquake premiums written under commercial lines and Earthquake premiums written under personal lines. Please designate individually:

• Premiums written under Personal Lines Property using WSRB materials
• Premiums written under Commercial Lines Property, using WSRB materials
• Earthquake premiums using other than WSRB materials