Page 1 OMB No. 1505-0200 (Exp.: 1/31/2027) 

TRIP 02C Schedule C Instructions

TERRORISM RISK INSURANCE PROGRAM

Schedule C 

Bordereau

General Instructions

1 General Instructions

1.1 Form Overview

The purpose of Schedule C (commonly known in the insurance industry as a Bordereau) is to 

provide the necessary underlying claim information that substantiates and supports the initial and 

supplementary Certifications of Loss. The combination of these reports and certifications will 

promote the prompt payment of insurer submissions and provide the information needed for control 

purposes. Descriptions for each data element and field follow. ALL fields are required for each line 

(record), unless otherwise noted. Although reserve information is to be included in this report, all 

requests for payment of the Federal share of compensation must be based on claim amounts 

already paid or to be paid as specified in 31 CFR 50.73(b)(2)(i), and not based on reserves. Only 

claims arising from Program Trigger events are to be reported on the Bordereau. All underlying 

claims must be reported, including those that fall within the insurer deductible.

In the case of workers’ compensation, claim information on the Bordereau is to be reported at the 

policy level, not at the individual claimant level. Up to three lines will be used for reporting claim 

information under a policy (at the policy level regardless of the number of individual claimants); 

information should be reported, where applicable, for medical only, medical portion of indemnity, 

and indemnity portion of indemnity. 

An insurer that is participating in a residual market mechanism (RMA) and is reporting losses that 

have been allocated to the insurer from the RMA will report the information as one claim record on 

the Bordereau. In the case of workers’ compensation, such an insurer will report up to three lines, 

breaking out medical only, medical portion of indemnity, and indemnity portion of indemnity. The 

name of the RMA is to be reported as the “insured name”.

1.2 Header Information

1. INSURER OR INSURER GROUP NAME - Enter the name of the controlling insurer or group under 

which all Direct Earned Premium and Terrorism Risk Insurance Act (TRIA) deductibles are being 

accumulated.

2. NAIC INSURER (OR GROUP) NUMBER - Enter the corresponding National Association of 

Insurance Commissioners (NAIC) number for the referenced insurer or group.

3. TIN (IF NO NAIC #) - If the insurer referenced above does not have a NAIC number, enter the 

insurer’s Federal taxpayer ID number (TIN).

4. CALENDAR YEAR - Enter the four-digit Calendar Year for the certified act(s) of terrorism from 

which the losses arise.

5. DATA AS OF - Enter the “as of” date for the information compiled below.

1.3 Claim Level Information 

Sort information by catastrophe code (CAT), and then line of business (LOB).

1. CAT CODE - Enter the numeric code assigned to the event by the Property Catastrophe Service of 

the Insurance Services Office (ISO).
Page 2 OMB No. 1505-0200 (Exp.: 1/31/2027) 

TRIP 02C Schedule C Instructions

2. LOB CODE - Line of Business - Provide the code for the line of business under which the claim is 

being paid, using the following table. Codes 50.0, 51.0, 52.0, and 80.0 are to be used only if the 

claim cannot be identified under one of the other codes. These four codes will be used to 

accommodate reporting of losses from alien surplus lines insurers and losses allocated to 

participating insurers from residual market mechanisms where there is not a one-to-one 

correspondence with another code.

Description Code

Fire 1.0

Allied Lines 2.1

Commercial Multi-Peril (non-liability) 5.1

Commercial Multi-Peril (liability) 5.2

Ocean Marine 8.0

Inland Marine 9.0

Workers’ Compensation 16.0

Other Liability 17.0

Products Liability 18.0

Aircraft (all perils) 22.0

Boiler and Machinery 27.0

Energy 50.0

All Other Property Risks 51.0

All Other Casualty Risks 52.0

Residual Market (Multiple Coverages) 80.0

3. LOC OF LOSS/STATE CD - Enter location of loss by state or territory, using the two-character 

alpha code for the state or U.S. territory where the loss occurred. (American Samoa = AS; Guam = 

GU; Puerto Rico = PR; U.S. Virgin Islands = VI; Northern Mariana Islands = MP). If more than one 

state or territory is involved, use the state or territory where the majority of the losses occurred. For 

losses occurring in other U.S. territories or possessions not listed herein, use OT. For losses 

occurring on the premises of any United States mission, use UM. Use AC for an air carrier or FV 

for a U.S. flag vessel if not located in a state, territory, or U.S. mission at the time of loss. If 

reporting losses from a residual market entity, enter state of coverage.

4. DOL – Date of Loss (MM/DD/YYYY) - Date of Loss - Enter the date of loss in numeric formatmonth/day/year.

5. INSURER NUMBER - Enter the insurer’s NAIC number (or TIN if no NAIC #) for the insurer that 

issued the policy under which a claim was made or is reporting an allocation of residual market 

losses. Maximum field length is 9 characters.

6. INSURER NAME - Enter the name of the insurer that issued the policy under which a claim was 

made or is reporting an allocation of residual market losses. Maximum field length is 100 

characters.

7. CLAIM # - Enter the insured’s claim number (alpha and/or numeric). If reporting losses allocated 

from a residual market mechanism, enter “RMA” or use RMA as a prefix to any insurer-assigned 

tracking identifier. In the case of workers’ compensation, because claim information on this 

Bordereau is reported at the policy level, a primary or overall claim number is to be reported or, 

alternatively, the policy number may be reported. Maximum field length is 25 characters.

8. INSURED NAME - Enter the name of the insured as this information appears on the policy, the 

first-named insured, or a similar reference as reflected in the insurer’s system. In reporting losses 

allocated from a residual market mechanism, identify the mechanism here and include the date of 

allocation by the residual market mechanism. Maximum field length is 50 characters.

9. INSURED TIN - Enter the Federal taxpayer ID number of the insured, if available. If not available, 

leave blank. Maximum field length is 9 characters.
Page 3 OMB No. 1505-0200 (Exp.: 1/31/2027) 

TRIP 02C Schedule C Instructions

10. EFF DT - Effective date. Enter the effective date of the policy term in which the loss occurred in 

numeric format - month/day/year. If reporting an allocation of residual market losses, leave blank. 

11. EXP DT - Expiration date. Enter the expiration date of the policy term in which the loss occurred in 

numeric format - month/day/year. If reporting an allocation of residual market losses, leave blank. 

12. WC INDICATOR - Workers’ compensation information must be reported separately by medical only 

(MO), medical portion of indemnity, (MI) and indemnity portion of indemnity (II). If all three 

categories are applicable to a claim, three separate records should be reported for the same claim 

number (one line for each indicator). If any of the indicators are not applicable, do not report a 

record for that indicator. If not a workers’ compensation claim, leave this field blank.

13. NUMBER OF WC CLAIMANTS - For each of the records with a unique WC Indicator

(MO, MI, II) named above, enter the corresponding number of claimants by category. If not a 

workers compensation claim, enter a zero. 

14. PRIOR CUMULATIVE LOSS PAYMENTS - Enter the amount from Field 16, “Total Cumulative 

Loss Payments”, from the immediately prior Bordereau for this claim. If claim is being reported for 

the first time, enter a zero.

15. CURRENT LOSS PAYMENT INFORMATION -

a. LOSS PAID AMOUNT - Gross dollar amount paid since the previous Bordereau submission (do 

not include amounts from the previous Bordereau that were included as “Loss to be Paid 

Amount”). Enter the amounts paid electronically or via check/draft as of the date of the report. 

Do not include reserve amounts or deductible amounts that are the responsibility of the insured, 

allocated loss adjustment expenses (ALAE), extra contractual obligations, or amounts paid in 

excess of policy limits. The amount paid must include any punitive damages paid and is prior 

to any netting of salvage or subrogation recovery amounts. If there have been no losses paid 

since the previous Bordereau submission, enter zero.

b. LOSS TO BE PAID AMOUNT - The gross dollar amount that has already been determined and 

that will be paid within five business days after receipt of the Federal share of compensation. 

Do not include reserve amounts or deductible amounts that are the responsibility of the insured, 

ALAE, extra contractual obligations, or amounts paid excess of policy limits. The amount to be 

paid must include any punitive damages to be paid and is prior to any netting of salvage or 

subrogation recovery amounts. If this field is not applicable, enter zero.

16. TOTAL CUMULATIVE LOSS PAYMENTS - This field is the sum of fields 14, 15a, and 15b. Enter

the total amount of payments cumulatively paid or to be paid within five days of receipt of the 

Federal share of compensation. 

17. PUNITIVE DMG PD - Punitive damages paid. Enter the cumulative amount of any punitive 

damages that have been paid or are to be paid as part of the “Loss to be Paid Amount” on this 

claim. Total “Punitive Damages Paid” will be subtracted from loss payments on the Certification of 

Loss. If no punitive damages have been paid, enter zero.

18. ALAE PAID - Allocated Loss Adjustment Expense. Enter allocated loss adjustment expense paid 

to date. Include cumulative amounts paid electronically or via check/draft as of the date of the 

report. Expenses incurred but not yet paid should not be included. For the Terrorism Risk 

Insurance Program (Program), ALAE includes loss adjustment expenses incurred by an insurer in 

connection with the insured loss, and allocated and identified by claim file in insurer records, 

including expenses incurred in the investigation, adjustment, and defense of claims, but excluding 

staff salaries, overhead, and other insurer expenses that would have been incurred notwithstanding 

the insured loss. If no ALAE has been paid, enter zero. In the case of workers’ compensation 

claims, ALAE should be reported for each of the MO, MI, and II categories. If an insurer cannot 

distinguish ALAE for MI and II, then the total amount should be reported in one category or the 

other, but not in both.
Page 4 OMB No. 1505-0200 (Exp.: 1/31/2027)

TRIP 02C Schedule C Instructions

19. SALV RECOVRD - Salvage recovered. Enter the net dollar amount of salvage recoveries booked 

as of the date of this report. Expenses (other than those included in ALAE) that are directly related 

to recovery of any salvage are to be subtracted from gross recoveries. If the insurer does not 

capture salvage and subrogation information separately, then enter zero.

20. SUBRO RECOVRD - Subrogation recovered- Enter the net dollar amount of the subrogation 

recoveries booked as of the date of this report. Expenses (other than those included in ALAE) that 

are directly related to any subrogation recovery are to be subtracted from gross recoveries. If the 

insurer does not capture salvage and subrogation information separately, enter zero.

21. SALV/SUBRO RECOVRD - Enter the net dollar amount of salvage and subrogation recoveries 

booked as of the date of this report. Expenses (other than those included in ALAE) that are directly 

related to recovery of any salvage and subrogation are to be subtracted from gross recoveries. If 

salvage and subrogation have been reported separately under fields 19 and 20, then this field is the 

sum of those two fields. Total “Salvage and Subrogation Recovered” will be subtracted from loss 

payments on the Certification of Loss. If there are no salvage or subrogation recoveries booked as 

of the date of this report, enter zero.

22. REINS RECVRBLE - Reinsurance Recoverable- If reinsurance recoveries have been or are 

expected to be received for this claim, enter Y (Yes). Otherwise, enter N (No).

23. DUPLICATE FEDERAL COMP - Pursuant to 31 CFR 50.71(b)(2), each insurer must inquire of its 

policyholders, insureds, and/or claimants regarding duplicate federal compensation for the insured 

loss. Based on the response to the insurer, this element is an indicator for whether the person 

receiving insurance proceeds for this loss: (1) has received, or expects to receive, based on an 

already approved application, duplicate compensation from another Federal program (enter Y); (2)

will possibly receive future duplicate compensation (e.g., the application is not yet approved) from 

another Federal program (enter P); or (3) has no possibility of duplicate compensation (enter N). 

24. AMT ONE OF DUPLI FED COMP - If Duplicate Federal Compensation is “Y”, enter the dollar 

amount of compensation that the insured or claimant has identified as duplicative of the insured 

loss amount. Otherwise, enter zero. If there is more than one source of duplicate payments, enter 

the largest amount in this field.

25. SOURCE ONE OF FED COMP - If Duplicate Federal Compensation is “Y” or “P’, enter the 3-letter 

code for the Federal source of the duplicate compensation. Possible values are: FEM (FEMA/Dept. 

of Homeland Security); HUD (Dept. of Housing and Urban Development); SBA (Small Business 

Administration); DOT (Dept. of Transportation); HHS (Dept. of Health and Human Services); DOL 

(Dept. of Labor); AGR (Dept. of Agriculture); or OTH (other). If there is more than one source of 

duplicate compensation, enter the source of the amount identified in field 24. If Duplicate Federal 

Compensation is “N”, then leave blank. 

26. AMT TWO OF DUPLI FED COMP - If Duplicate Federal Compensation is “Y”, and there is more 

than one source, then enter the remaining dollar amount of compensation that the insured or 

claimant has identified as duplicative of the insured loss amount that has not already been included 

in field 24. Otherwise, enter zero.

27. SOURCE TWO OF FED COMP - If Duplicate Federal Compensation is “Y” or “P”, and if there are 

multiple sources, enter the 3-letter code (see field 25) for the source of the next largest amount

received or expected to be received. If Duplicate Federal Compensation is “N” (or “Y” or “P”, but 

from only one source), leave blank.

28. THIRD PARTY INDICATOR - Indicate if this claim involves a third-party claimant, i.e., an 

underlying claim of liability against the policyholder. Enter Y (Yes) or N (No). If reporting workers’ 

compensation, leave blank.

29. CLAIM STATUS - Indicator for claim status as of the date of the report. Possible values are: O

(open), C (closed), or R (reopened). For workers’ compensation, report claim status at the policy 

level by WC Indicator (field 12). If reporting an allocation of residual market losses, leave blank.
Page 5 OMB No. 1505-0200 (Exp.: 1/31/2027)

TRIP 02C Schedule C Instructions

30. RESERVES - For open or reopened claims, report the total outstanding case reserve as of the date 

of this report, including both loss and ALAE. For closed claims, enter zero. Amounts reported for 

total case reserve should reflect reductions for any amounts paid or to be paid for loss or ALAE 

reported on this Bordereau.

1.4 Pro Rata Loss Percentage

The following data fields must be populated if the Secretary of the Treasury has determined a Pro 

Rata Loss Percentage. If a Pro Rata Loss Percentage has not been determined, leave all fields 

blank.

1. DATE OF LATEST PAYMENT - Enter the date on which the latest claim payment was made to 

the insured either electronically or via check/draft. Enter the date in numeric format -

month/day/year.

2. SETTLEMENT DOCUMENTATION DATE - Date used by an insurer in documenting a complete 

and final settlement for an insured loss, as evidenced by a signed settlement agreement or other 

means reviewable by a third party. Enter the date in numeric format - month/day/year. If a 

settlement documentation date has not been determined, leave blank.

3. TOTAL UNPRORATED LOSS AMOUNT - The gross dollar amount of loss that would be paid if 

there were no Pro Rata Loss Percentage to be applied. Do not include deductible amounts that are 

the responsibility of the insured, ALAE, extra contractual obligations, amounts paid excess of policy 

limits, or any punitive damages. This amount is prior to any netting of salvage or subrogation 

recovery amounts. If the loss is still open, this amount should be the anticipated total final loss 

amount.