公司印章： 填表日期
联系人： 联系电话（座机）： 联系电话（手机）：
注：此表统计范围是各保险公司在自查过程中发现和整改的问题，不包括保保险监管部门已处罚和已采取其他监管措施的内容。
附件2：
××保险公司承保、理赔数据真实性自查情况统计表
| 所辖分支机构（简称） | 不严格执行条款费率 | 阴阳保单 | 系统外出单 | 非正常注销保单 | 不按合同约定退保 | 假赔案 | 坐扣保费 | 虚挂应收保费金额 | 跨年度调节保费收入 | 其他 |
| 件数 | 金额 | 件数 | 金额 | 件数 | 金额 | 件数 | 投保金额 | 件数 | 金额 | 件数 | 金额 | 件数 | 金额 | 调入金额 | 调出金额 | 件数 | 金额 |
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