公司印章： 填表日期
联系人： 联系电话（座机）： 联系电话（手机）：
注：1、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。
2、产险公司不填写“提取寿险责任准备金”和“提取长期险责任准备金”栏目。
附件5：
××保险公司自纠情况统计表
| 所辖分支机构（简称） | 机构（罚款） | 个人（罚款） | 处罚家/人（次） | 完善规章制度 | 取消的账外账 | 调整账目数量 | 调整账目金额 | 退回不当得利金额 | 收回代缴罚款金额 | 取消账户个数 |
| 家次 | 金额 | 人次 | 金额 | 撤换 | 降职 | 移送 | 通报批评 | 其他 | 财务类 | 业务类 | 内控类 |
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