保监局印章： 填表日期： 填表人： 联系电话：
注：此表统计范围是各保监局在抽查过程中发现的保险公司未自查、未整改和整改不到位的项目，不包括保险公司已经进行自查自纠的部分。
附件2：
××保监局承保、理赔数据真实性抽查情况统计表
| 被抽查机构名称（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 | 个数 | 金额 |
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| 合计 | | | | | | | | | | | | | | | | | | | |
