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p.s60a11b5a-5397-4a1f-817a-90e735f1819eBodyText-000020 { text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 11pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } p.s60a11b5a-5397-4a1f-817a-90e735f1819eBodyText-000021 { font-family: 'Times New Roman', 'serif'; font-size: 11pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } p.s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000022 { font-family: 'Times New Roman', 'serif'; font-size: 10pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s60a11b5a-5397-4a1f-817a-90e735f1819e000023 { font-size: 10pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">DEPARTMENT OF LABOR AND REGULATION</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">DIVISION OF INSURANCE</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">REPLACEMENT AND LAPSE REPORTING FORM</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">Chapter 20:</span><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">06:21</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">APPENDIX J</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">SEE: §</span><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000002"> </span><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">20:06:21:52</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">    </span><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000004">Source:</span><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont"> 28 SDR 157, effective </span><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">May 19, 2002.</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000005"><br />&#x200e;</span><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000004">Long-Term Care Insurance</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000001"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000004">Replacement and Lapse Reporting Form</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000006">For the State of</span><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont"> _____________________ </span><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000006">For the Reporting Year of</span><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont"> __________</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">Company Name: __________________________ Due: June 30 annually</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">Company Address: __________________________ Company NAIC Number: _________</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">Contact Person: __________________________ Phone Number: (____)___________</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont">Instructions</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eBodyText"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">The purpose of this form is to report on a statewide basis information regarding long-term care insurance policy replacements and lapses. Specifically, every insurer shall maintain records for each agent on that agent's amount of long-term care insurance replacement sales as a percent of the agent's total annual sales and the amount of lapses of long-term care insurance policies sold by the agent as a percent of the agent's total annual sales. The tables below should be used to report the ten percent (10%) of the insurer's agents with the greatest percentage of replacements and lapses.</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000009"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000010">Listing of the 10% of Agents with the Greatest Percentage of Replacements</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000009"> </span></p><div align="left"><table dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000011"><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Agent's Name</span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Number of Policies Sold</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">By This Agent</span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Number of Policies</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Replaced by This Agent</span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Number of Replacements As % of Number Sold By This Agent</span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr></table></div><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000009"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000015"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000010">Listing of the 10% of Agents with the Greatest Percentage of Lapses</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000009"> </span></p><div align="left"><table dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000011"><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Agent's Name</span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Number of Policies Sold</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">By This Agent</span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Number of Policies</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Lapsed By This Agent</span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000008"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000007">Number of Lapses As % of Number Sold By This Agent</span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr><tr><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000012"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000013"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td><td class="s60a11b5a-5397-4a1f-817a-90e735f1819e000014"><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000003"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000000"> </span></p></td></tr></table></div><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000016"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000017"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000018"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000019">Company Totals</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000016"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000017"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000018"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000019">Percentage of Replacement Policies Sold to Total Annual Sales _____%</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eBodyText-000020"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000019">Percentage of Replacement Policies Sold to Policies in Force (as of the end of the preceding calendar year) _____%</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eBodyText-000020"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000017"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eBodyText-000020"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000019">Percentage of Lapsed Policies to Total Annual Sales _____%</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eBodyText-000020"><span class="s60a11b5a-5397-4a1f-817a-90e735f1819eDefaultParagraphFont-000019">Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year) _____%</span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eBodyText-000021"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000017"> </span></p><p dir="ltr" class="s60a11b5a-5397-4a1f-817a-90e735f1819eNormal-000022"><span xml:space="preserve" class="s60a11b5a-5397-4a1f-817a-90e735f1819e000023"> </span></p></div></body></html>