Form LTC-G "Long-Term Care Insurance Replacement and Lapse Reporting Form" - Missouri

What Is Form LTC-G?

This is a legal form that was released by the Missouri Department of Commerce and Insurance - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 15, 2007;
  • The latest edition provided by the Missouri Department of Commerce and Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form LTC-G by clicking the link below or browse more documents and templates provided by the Missouri Department of Commerce and Insurance.

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Download Form LTC-G "Long-Term Care Insurance Replacement and Lapse Reporting Form" - Missouri

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Long-Term Care Insurance
Replacement and Lapse Reporting Form
For the State of Missouri
For the Reporting Year of ________________
Company Name:
_______________________________
Due: June 30 annually
Company Address: _______________________________
Company
NAIC
Number:
__________
Contact Person:
_______________________________
Phone
Number:
(____)___________
Instructions
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 producer
on that producer’s amount of long-term care insurance replacement sales as a percent of the producer’s total
annual sales and the amount of lapses of long-term care insurance policies sold by the producer as a percent of
the producer’s total annual sales. The tables below should be used to report the ten percent (10%) of the
insurer’s producers with the greatest percentages of replacements and lapses.
Listing of the 10% of Producers with the Greatest Percentage of Replacements
Producer’s
Number of Policies Sold
Number of Policies
Number of Replacements As % of
Name
By This Producer
Replaced By This
Number Sold By This Producer
Producer
Listing of the 10% of Producers with the Greatest Percentage of Lapses
Producer’s
Number of Policies Sold
Number of Policies
Number of Lapses As % of
Name
By This Producer
Lapsed By This
Number Sold By This Producer
Producer
Company Totals
Percentage of Replacement Policies Sold to Total Annual Sales ____%
Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year)
____%
Percentage of Lapsed Policies to Total Annual Sales _____%
Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year) _____%
Form LTC-G
(Rev 11/15/2007)
Long-Term Care Insurance
Replacement and Lapse Reporting Form
For the State of Missouri
For the Reporting Year of ________________
Company Name:
_______________________________
Due: June 30 annually
Company Address: _______________________________
Company
NAIC
Number:
__________
Contact Person:
_______________________________
Phone
Number:
(____)___________
Instructions
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 producer
on that producer’s amount of long-term care insurance replacement sales as a percent of the producer’s total
annual sales and the amount of lapses of long-term care insurance policies sold by the producer as a percent of
the producer’s total annual sales. The tables below should be used to report the ten percent (10%) of the
insurer’s producers with the greatest percentages of replacements and lapses.
Listing of the 10% of Producers with the Greatest Percentage of Replacements
Producer’s
Number of Policies Sold
Number of Policies
Number of Replacements As % of
Name
By This Producer
Replaced By This
Number Sold By This Producer
Producer
Listing of the 10% of Producers with the Greatest Percentage of Lapses
Producer’s
Number of Policies Sold
Number of Policies
Number of Lapses As % of
Name
By This Producer
Lapsed By This
Number Sold By This Producer
Producer
Company Totals
Percentage of Replacement Policies Sold to Total Annual Sales ____%
Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year)
____%
Percentage of Lapsed Policies to Total Annual Sales _____%
Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year) _____%
Form LTC-G
(Rev 11/15/2007)