NAME OF INSURANCE BROKER _________________________________
BALANCE-SHEET AS AT ________________________
Co Code
Year
Month
LIABILITIES
ROW NO.
$
ASSETS
ROW NO.
$
Shareholders’ fund —
Paid-up share capital
1
Cash and deposits
1
Unappropriated profits/(losses)
2
Insurance broking premium accounts
2
Reserves
3
Amounts owing from insurers and insureds
3
Total shareholders’ fund (1 to 3)
4
Investments
4
Other liabilities —
Fixed assets
5
Amounts owing to insurers and insureds
5
Other assets
6
Bank loans and overdrafts
6
Others
7
Total liabilities (4 to 7)
8
Total assets (1 to 6)
7
Contingent liabilities
9
Net asset value (4 – 9): $________________
Names and signatures of:
________________
Director
_________________
Director
_________________
Chief Executive Officer
Date: ________
Notes to Form A
The following shall be stated as notes to this Form:
Note 1
Loans to and amounts due from employees of, or persons engaged by, the registered insurance broker to provide technical advice to its clients (please provide details on the date of loan and amount of loan granted to each person).
Note 2
Description in detail of the following items:
(a)
Other assets (Asset Row 6);
(b)
Reserves (Liability Row 3);
(c)
Bank loans and overdrafts (Liability Row 6);
(d)
Others (Liability Row 7); and
(e)
Contingent liabilities (Liability Row 9).
(state also the amounts applicable to each of the above items)
Note 3
Any changes in accounting policies and quantification of their effects.
Instructions for completion of Form A
1.
All amounts shown in this Form are to be rounded up to the nearest dollar. Negative amounts shall be preceded by “—”.
2.
Assets do not include any amount on account of goodwill and other intangible assets.
3.
“Cash and deposits” refers to cash in hand and bank deposits which are not designated or evidenced as “Insurance broking premium accounts”.
4.
“Insurance broking premium accounts” refers to the aggregate of the respective insurance broking premium accounts maintained in accordance with section 35ZD of the Act and any other insurance broking premium account required to be maintained by the insurance broker under any other written law in Singapore.
5.
“Amounts owing from insurers and insureds” refers to premiums, claims moneys, brokerage and fees earned from the provision of consultancy and risk management services due from insurers and insureds.
6.
“Amounts owing to insurers and insureds” refers to premiums and claims moneys owing to insurers and insureds.
7.
“Fixed assets” includes land and buildings, motor vehicles and office equipment.
Regulation 10
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM B
NAME OF INSURANCE BROKER _______________________________________
INSURANCE BROKING PREMIUM ACCOUNT
FOR THE FINANCIAL YEAR _____________ TO ______________
Direct Insurance Broking
□
General Reinsurance Broking
□
Co Code
Year
Month
Life Reinsurance Broking
□
(Tick (√) one only)
ROW NO.
$
PART I
BALANCE OF ACCOUNT AT BEGINNING OF FINANCIAL YEAR
Bank account
1
Deposits
2
TOTAL (1 to 2)
3
PART II
INSURANCE BROKING PREMIUM ACCOUNT TRANSACTIONS
Moneys Received During Financial Year
—————————————————
Premiums
4
Claims moneys
5
Proceeds from deposits
6
Others
7
TOTAL MONEYS RECEIVED (4 to 7)
8
Moneys Withdrawn During Financial Year
—————————————————
Premiums
9
Claims moneys
10
Brokerage
11
Deposits
12
Other approved withdrawals
13
TOTAL MONEYS WITHDRAWN (9 to 13)
14
PART III
BALANCE OF ACCOUNT AT END OF FINANCIAL YEAR
Bank account
15
Deposits
16
TOTAL (15 to 16)
17
Names and signatures of 2 Directors:
____________________________
____________________________
Name and signature of Chief Executive Officer:
_____________________________
Date:
_____________________________
Notes to Form B
The following shall be stated as notes to this Form:
Note 1
Name of bank(s) and account number(s) of the Insurance Broking Premium Account.
Note 2
Details of deposits with banks (ie. name of bank, account number and amount).
Note 3
Breakdown for the following items:
(a) Others (Row 7); and
(b) Other approved withdrawals (Row 13).
Instructions for completion of Form B
1.
A registered insurance broker shall complete separate forms for each type of registration.
2.
All amounts shown in this Form are to be rounded up to the nearest dollar. Negative amounts shall be preceded by “—”.
3.
“Deposits” refers to deposits placed with any bank licensed under the Banking Act (Cap. 19).
4.
“Proceeds from deposits” refers to the principal sum and interest received from the maturity or withdrawal of deposits.
5.
“Other approved withdrawals” refers to other moneys which have been approved for withdrawal by the Authority.
Regulation 10
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM C
NAME OF INSURANCE BROKER ________________________________
PROFIT AND LOSS ACCOUNT
FOR THE FINANCIAL YEAR ______________TO _____________
Co Code
Year
Month
ROW NO.
$
Brokerage earned from its insurance broking activity:
Direct insurance broking
1
General reinsurance broking
2
Life reinsurance broking
3
Total brokerage (1 to 3)
4
Other revenue
5
Deduct : Staff salaries and related expenses
6
: Other expenses
7
Add : Other income
8
Profit before tax
9
Deduct : Taxation
10
Profit after tax
11
Add : Extraordinary items
12
: Unappropriated profits or accumulated losses brought forward from preceding financial year.
13
Deduct : Dividends
14
: Transfers to reserves
15
: Amounts capitalised
16
Unappropriated profits or accumulated losses at end of financial year
17
Names and signatures of 2 Directors:
____________________
____________________
Name and signature of Chief Executive Officer:
____________________
Date:
____________________
Notes to Form C
The following shall be stated as notes to this Form:
Note 1 Breakdown for the following items:
(a)
Other revenue (Row 5);
(b)
Other expenses (Row 7); and
(c)
Other income (Row 8).
Instructions for completion of Form C
1.
All amounts shown in this Form are to be rounded up to the nearest dollar. Negative amounts shall be preceded by “—”
2.
“Brokerage” refers to income, profit commissions and fees earned in relation to the insurance broking business carried out by the registered insurance broker.
3.
“Other revenue” refers to income from financial advisory activities and fees earned from provision of consultancy and risk management services.
4.
“Staff salaries and related expenses” includes —
(a)
Salaries, bonuses and allowances;
(b)
Director’s fees;
(c)
CPF contributions, pensions and gratuities;
(d)
Medical fees;
(e)
Training; and
(f)
Skills development levy.
Regulation 10
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM D
NAME OF INSURANCE BROKER ________________________________________
PLACEMENT OF BUSINESS HANDLED
FOR THE FINANCIAL YEAR ____________ TO _____________
Direct Insurance Broking
□
General Reinsurance Broking
□
Co Code
Year
Month
Life Reinsurance Broking
□
(Tick (√) one only)
$
Premiums
Domestic Risks
Offshore Risks
Total
(a) Registered insurers
(b) Foreign insurers under the Foreign Insurers Scheme
— under the Insurance (Lloyd’s Asia Scheme) Regulations
— under the Insurance (Lloyd’s Scheme) Regulations
(c) marine mutual insurers
— in Singapore
— outside Singapore
(d) Other insurers
Total
Names and signatures of :
_________
Director
_________
Director
__________________
Chief Executive Officer
Date: _________________
Instructions for completion of Form D
1.
A registered insurance broker shall complete separate forms for each type of registration.
2.
All amounts shown in this Form are to be rounded up to the nearest dollar. Negative amounts shall be preceded by “—”.
3.
“Domestic Risks” is a risk which would have been classified as a “Singapore Policy” as defined in paragraph 2(1) of the First Schedule to the Insurance Act (Cap. 142) had the risk been underwritten by a registered insurer.
4.
“Offshore Risks” refers to any risk other than a Domestic Risk.
5.
“Premiums” refers to premiums received or receivable during the financial year. Brokerage shall not be deducted from premiums.
6.
“Registered insurers” excludes marine mutual insurers in Singapore.
ANNEX 1 TO FORM D
NAME OF INSURANCE BROKER ________________________________________
TOP 5 INSURERS WITH WHOM BUSINESS WAS PLACED FOR FINANCIAL YEAR ____________ TO _____________
Direct Insurance Broking
Co Code
Year
Month
Name of Insurer
% of Total Domestic Gross Premiums Handled
1.
2.
3.
4.
5.
Name of Insurer
% of Total Offshore Gross Premiums Handled
1.
2.
3.
4.
5.
Note: “Top 5 insurers” means the 5 insurers with whom the largest volume of the registered insurance broker’s business was placed.
ANNEX 2 TO FORM D
NAME OF INSURANCE BROKER _____________________________________
SOURCE AND PLACEMENT OF
REINSURANCE PREMIUMS HANDLED
FOR FINANCIAL YEAR ____________ TO _____________
General Reinsurance Broking
□
Co Code
Year
Month
Life Reinsurance Broking
□
(Tick (√) one only)
PART A: SOURCE OF BUSINESS
$
Territory
Row
Offshore Risks
Australia/New Zealand
1
Hong Kong
2
Indonesia
3
Japan
4
Korea
5
Malaysia
6
Philippines
7
Taiwan
8
Thailand
9
________________
10
________________
11
________________
12
________________
13
________________
14
________________
15
________________
16
Others
17
Total
18
PART B: PLACEMENT OF BUSINESS WITH INSURERS
OUTSIDE SINGAPORE (EXCLUDING FOREIGN INSURERS
UNDER THE FOREIGN INSURERS SCHEME AND
PROTECTION AND INDEMNITY CLUBS)
$
Territory
Row
Domestic Risks
Offshore Risks
Australia/New Zealand
1
Denmark
2
France
3
Hong Kong
4
Indonesia
5
Italy
6
Japan
7
Korea
8
Malaysia
9
Philippines
10
Switzerland
11
Taiwan
12
Thailand
13
United Kingdom
14
United States
15
________________
16
________________
17
________________
18
________________
19
________________
20
________________
21
________________
22
________________
23
Others
24
Total
25
Instructions for completion of Annex 2 to Form D
A registered insurance broker shall complete separate forms for each type of registration.
PART A : SOURCE OF BUSINESS
1.
The classification of territory shall be by country of domicile of reinsureds.
2.
For those countries which are not listed under Rows 1 to 9 and the reinsurance premiums sourced from each country amounts to —
(a)
5% or more of total premiums for Offshore Risks, please list down the countries under Rows 10 to 16 and specify the amount of premiums sourced from each country; or
(b)
less than 5% of total premiums for Offshore Risks, please provide the aggregate premiums sourced from all these countries under Row 17.
PART B : PLACEMENT OF BUSINESS WITH INSURERS OUTSIDE SINGAPORE (EXCLUDING FOREIGN INSURERS UNDER THE FOREIGN INSURERS SCHEME AND PROTECTION AND INDEMNITY CLUBS)
1.
For those countries which are not listed under Rows 1 to 15 and the reinsurance premiums placed with each country amounts to —
(a)
5% or more of total premiums for Domestic Risks or Offshore Risks, as the case may be, please list down the countries under Rows 16 to 23 and specify the amount of premiums for Domestic Risks or Offshore Risks, as the case may be, placed with each country; or
(b)
less than 5% of total premiums for Domestic Risks or Offshore Risks, as the case may be, please provide the aggregate premiums for Domestic Risks or Offshore Risks, as the case may be, placed with all these countries under Row 24.
Regulation 11
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM E
NOTICE OF COMMENCEMENT OF
INSURANCE BROKING BUSINESS
1.
Name of corporation:
____________________________
2.
Business address:
____________________________
3.
Telephone number:
____________________________
4.
Fax number:
____________________________
5.
E-mail address:
____________________________
6.
Company/business registration number:
____________________________
7.
Paid-up capital (based on latest audited accounts ended __________________):
____________________________
8.
Net asset value (based on latest audited accounts ended __________________):
____________________________
9.
Status of exempt insurance broker:
(a)
For persons licensed, approved or registered by the Monetary Authority of Singapore (“MAS”), please indicate status:
□ Bank
□ Merchant Bank
□ Licensed Financial Adviser
□ Holder of a Capital Markets Services Licence
□ Finance Company
□ Direct Life Insurer
(b)
For others, please elaborate __________________________
10. Please indicate type of insurance broking activity carried out:
□ Direct Insurance Broking
□ General Reinsurance Broking
□ Life Reinsurance Broking
11. Please provide a copy of your corporation’s organisation chart detailing key staff and reporting lines and specify the senior management staff member(s) with supervisory responsibility over the corporation’s direct insurance/general reinsurance/life reinsurance* broking operations.
12. If the exempt insurance broker is not licensed, approved or registered by the MAS, please provide the following:
(a)
Particulars of its substantial shareholders holding 5% or more of the share capital of the corporation:
(b) In relation to each substantial shareholder, please furnish details of the nature of business, directorship and substantial shareholdings in other corporations in Singapore or elsewhere, and in the case of any individual, the curriculum vitae.
(c) Particulars of key officers who are not substantial shareholders:
(d) In relation to each key officer, please furnish a copy of his/her curriculum vitae. If the key officer(s) hold(s) any directorship or substantial shareholdings in any other corporation in Singapore or elsewhere, please give details of the corporation, nature of business, date and nature of appointment as director.
13.
Date of commencement of insurance broking business:
______________________________ (dd/mm/yy)
Signature
:
______________________________
Name of Director/Secretary/ Principal Officer/Chief Executive Officer*
:
______________________________
Date
:
______________________________ (dd/mm/yy)
Note:
Please tick (√) in the relevant boxes where appropriate.
*Delete whichever is inapplicable.
Regulation 11
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM F
NOTICE OF CHANGE OF PARTICULARS
Name of corporation:
(If its name has been changed, state its name as previously furnished):
__________________________
Company/business registration number:
__________________________
Notice is hereby given that on _____________________________(dd/mm/yy), the following particulars of the abovementioned corporation have been changed (Note: only those particulars which have changed need to be completed):
1.
Indicate which of the following insurance broking activity is carried out:
Old Activity
Current Activity
Direct Insurance Broking
□
□
General Reinsurance Broking
□
□
Life Reinsurance Broking
□
□
2.
If a new type of insurance broking activity is carried out, please provide a copy of your corporation’s organisation chart detailing key staff and reporting lines and specify the senior management staff member(s) with supervisory responsibility over the corporation’s direct insurance/general reinsurance/life reinsurance* broking operations.
3.
If the exempt insurance broker is licensed, approved or registered by the Monetary Authority of Singapore (“MAS”), please indicate any change in status:
□ Bank
□ Merchant Bank
□ Licensed Financial Adviser
□ Holder of a Capital Markets Services Licence
□ Finance Company
□ Direct Life Insurer
4.
If the exempt insurance broker is not licensed, approved or registered by the MAS, please update the following information, where applicable:
(a)
Name of corporation
:
___________________
(b)
Business address
:
___________________
(c)
Telephone number
:
___________________
(d)
Fax number
:
___________________
(e)
E-mail address
:
___________________
(f)
Company/business registration number
:
___________________
(g)
Paid-up capital
(as at ________________)
:
___________________
(h)
Particulars of its substantial shareholders holding 5% or more of the share capital of the corporation:
In relation to each substantial shareholder, please furnish details of the nature of business, directorship and substantial shareholdings in other corporations in Singapore or elsewhere, and in the case of any individual, the curriculum vitae.
(j)
Particulars of key officers who are not substantial shareholders:
In relation to each key officer, please furnish a copy of his/her curriculum vitae. If the key officer(s) hold(s) any directorship or substantial shareholdings in any other corporation in Singapore or elsewhere, please give details of the corporation, nature of business, date and nature of appointment as director.
Signature
:
___________________________
Name of Director/
Secretary/Principal Officer/
Chief Executive Officer*
:
___________________________
Date
:
___________________________
(dd/mm/yy)
Note:
Please tick (√) in the relevant boxes where appropriate.
*Delete whichever is inapplicable.
Regulation 11
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM G
NOTICE OF INTENTION TO CEASE
INSURANCE BROKING BUSINESS
1.
Name of corporation
:
__________________
2.
Business address
:
__________________
3.
Telephone number
:
__________________
4.
Fax number
:
__________________
5.
E-mail address
:
__________________
6.
Company/business registration number
:
__________________
7.
Please provide information on the arrangement(s) made to provide for orderly run-off of the corporation’s insurance broking business.
8.
Proposed date of cessation of corporation’s insurance broking business:
___________________
(dd/mm/yy)
Signature :________________
Name of Director/
Secretary/Principal Officer/
Chief Executive Officer* :_________________
Date :_________________
(dd/mm/yy)
*Delete whichever is inapplicable.
Regulation 11
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM H
NAME OF EXEMPT INSURANCE BROKER __________________________
INSURANCE BROKING PREMIUM ACCOUNT
FOR THE FINANCIAL YEAR _____________ TO _____________
Direct Insurance Broking
□
General Reinsurance Broking
□
Co Code
Year
Month
Life Reinsurance Broking
□
(Tick (√) one only)
ROW NO.
$
PART I
BALANCE OF ACCOUNT AT BEGINNING OF FINANCIAL YEAR
Bank account
1
Deposits
2
TOTAL (1 to 2)
3
PART II
INSURANCE BROKING PREMIUM ACCOUNT TRANSACTIONS
Moneys Received During Financial Year
_______________________
Premiums
4
Claims moneys
5
Proceeds from deposits
6
Others
7
TOTAL MONEYS RECEIVED (4 to 7)
8
Moneys Withdrawn During Financial Year
_______________________
Premiums
9
Claims moneys
10
Brokerage
11
Deposits
12
Other approved withdrawals
13
TOTAL MONEYS WITHDRAWN (9 to 13)
14
PART III
BALANCE OF ACCOUNT AT END OF FINANCIAL YEAR
Bank account
15
Deposits
16
TOTAL (15 to 16)
17
Signature :_________________
Name of Director/
Secretary/Principal Officer/
Chief Executive Officer* :_________________
Date :_________________ (dd/mm/yy)
AUDITORS’ CERTIFICATION OF FORM H
FOR FINANCIAL YEAR ______________ TO _______________
1.
We have examined the insurance broking premium account for the financial year.
2.
In our opinion and to the best of the information and according to the explanations given to us, the insurance broking premium account has been prepared in accordance with the provisions of the Insurance Act (Cap. 142) and any regulations made thereunder.
3.
As far as can be ascertained from our examination, in our opinion, the insurance broking premium account has been established and maintained in accordance with section 35ZD of the Insurance Act; except
_________________________ (Firm)
Public Accountants and Chartered Accountants
Singapore
Date: ____________________
*Delete whichever is inapplicable.
Notes to Form H
The following shall be stated as notes to this Form:
Note
1 Name of bank(s) and account number(s) of the Insurance Broking Premium Account.
Note
2 Details of deposits with banks (ie. name of bank, account number and amount).
Note
3 Breakdown for the following items:
(a)
Others (Row 7); and
(b)
Other approved withdrawals (Row 13).
Instructions for completion of Form H
1. An exempt insurance broker shall complete separate forms for each type of insurance broking business handled.
2. All amounts shown in this Form are to be rounded up to the nearest dollar. Negative amounts shall be preceded by “—”.
3. “Deposits” refers to deposits placed with any bank licensed under the Banking Act (Cap. 19).
4. “Proceeds from deposits” refers to the principal sum and interest received from the maturity or withdrawal of deposits.
5. “Other approved withdrawals” refers to other moneys which have been approved for withdrawal by the Authority.
Regulation 11
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM I
NAME OF EXEMPT INSURANCE BROKER __________________________
PLACEMENT OF BUSINESS HANDLED
FOR THE FINANCIAL YEAR _____________ TO _____________
Direct Insurance Broking
□
General Reinsurance Broking
□
Co Code
Year
Month
Life Reinsurance Broking
□
(Tick (√) one only)
$
Premiums
Domestic Risks
Offshore Risks
Total
(a)
Registered insurers
(b)
Foreign insurers under the Foreign Insurers Scheme
— under the Insurance (Lloyd’s Asia Scheme) Regulations
— under the Insurance (Lloyd’s Scheme) Regulations
(c)
marine mutual insurers
— in Singapore
— outside Singapore
(d)
Other insurers
Total
Signature :_________________
Name of Director/
Secretary/Principal Officer/
Chief Executive Officer* :_________________
Date :_________________ (dd/mm/yy)
* Delete whichever is inapplicable.
Instructions for completion of Form I
1.
An exempt insurance broker shall complete separate forms for each type of registration.
2.
All amounts shown in this Form are to be rounded up to the nearest dollar. Negative amounts shall be preceded by “—”.
3.
“Domestic Risks” is a risk which would have been classified as a “Singapore policy” as defined in paragraph 2(1) of the First Schedule to the Insurance Act (Cap. 142) had the risk been underwritten by a registered insurer.
4.
“Offshore Risks” refers to any risk other than a Domestic Risk.
5.
“Premium” refers to premiums received or receivable during the financial year. Brokerage shall not be deducted from premiums.
6.
“Registered insurers” excludes marine mutual insurers in Singapore.
ANNEX 1 TO FORM I
NAME OF EXEMPT INSURANCE BROKER _________________________
TOP 5 INSURERS WITH WHOM BUSINESS WAS PLACED
FOR FINANCIAL YEAR ____________ TO _____________
Direct Insurance Broking
Co Code
Year
Month
Name of Insurer
% of Total Domestic Gross Premiums Handled
1.
2.
3.
4.
5.
Name of Insurer
% of Total Offshore Gross Premiums Handled
1.
2.
3.
4.
5.
Note: “Top 5 insurers” means the 5 insurers with whom the largest volume of the registered insurance broker’s business was placed.
ANNEX 2 TO FORM I
NAME OF EXEMPT INSURANCE BROKER _________________________
SOURCE AND PLACEMENT OF
REINSURANCE PREMIUMS HANDLED
FOR FINANCIAL YEAR ____________ TO _____________
General Reinsurance Broking
□
Co Code
Year
Month
Life Reinsurance Broking
□
(Tick (√) one only)
PART A: SOURCE OF BUSINESS
$
Territory
Row
Offshore Risks
Australia/New Zealand
1
Hong Kong
2
Indonesia
3
Japan
4
Korea
5
Malaysia
6
Philippines
7
Taiwan
8
Thailand
9
_______________
10
_______________
11
_______________
12
_______________
13
_______________
14
_______________
15
_______________
16
Others
17
Total
18
PART B: PLACEMENT OF BUSINESS WITH INSURERS
OUTSIDE SINGAPORE (EXCLUDING FOREIGN INSURERS
UNDER THE FOREIGN INSURERS SCHEME AND
PROTECTION AND INDEMNITY CLUBS)
$
Territory
Row
Domestic Risks
Offshore Risks
Australia/New Zealand
1
Denmark
2
France
3
Hong Kong
4
Indonesia
5
Italy
6
Japan
7
Korea
8
Malaysia
9
Philippines
10
Switzerland
11
Taiwan
12
Thailand
13
United Kingdom
14
United States
15
_______________
16
_______________
17
_______________
18
_______________
19
_______________
20
_______________
21
_______________
22
_______________
23
Others
24
Total
25
Instructions for completion of Annex 2 to Form I
An exempt insurance broker shall complete separate forms for each type of registration.
PART A : SOURCE OF BUSINESS
1.
The classification of territory shall be by country of domicile of reinsureds.
2.
For those countries which are not listed under Rows 1 to 9 and the reinsurance premiums sourced from each country amounts to —
(a)
5% or more of total premiums for Offshore Risks, please list down the countries under Rows 10 to 16 and specify the amount of premiums sourced from each country; or
(b)
less than 5% of total premiums for Offshore Risks, please provide the aggregate premiums sourced from all these countries under Row 17.
PART B: PLACEMENT OF BUSINESS WITH INSURERS OUTSIDE SINGAPORE (EXCLUDING FOREIGN INSURERS UNDER THE FOREIGN INSURERS SCHEME AND PROTECTION AND INDEMNITY CLUBS)
1.
For those countries which are not listed under Rows 1 to 15 and the reinsurance premiums placed with each country amounts to —
(a)
5% or more of total premiums for Domestic Risks or Offshore Risks, as the case may be, please list down the countries under Rows 16 to 23 and specify the amount of premiums for Domestic Risks or Offshore Risks, as the case may be, placed with each country; or
(b)
less than 5% of total premiums for Domestic Risks or Offshore Risks, as the case may be, please provide the aggregate premiums for Domestic Risks or Offshore Risks, as the case may be, placed with all these countries under Row 24.
Regulation 12
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM J
CERTIFICATE ON THE ACCOUNTS OF
THE INSURANCE BROKING BUSINESS OF ______________
FOR THE FINANCIAL YEAR ENDED ____________________
We, the undersigned, hereby certify that in our belief the assets set forth in the balance-sheet in Form A are fully of the value stated in the balance-sheet, and that in the relevant financial year, regulations 3 (3) and 4 (3) of the Insurance (Intermediaries) Regulations 2003 have been complied with; and that no part of the assets has been dealt with in contravention of section 35ZC or 35ZD of the Insurance Act (Cap. 142); except
Names and signatures of:
__________
Director
__________
Director
________________
Chief Executive Officer
Date: ________________
Regulation 13
INSURANCE ACT
(CHAPTER 142)
INSURANCE
(INTERMEDIARIES)
REGULATIONS
FORM K
REPORT OF THE AUDITORS APPOINTED UNDER
SECTION 36 OF THE INSURANCE ACT TO
AUDIT THE ACCOUNTS OF THE INSURANCE BROKING BUSINESS
OF _______________________________
FOR THE FINANCIAL YEAR __________ TO ___________
1.
We have examined the attached balance-sheet as at _________________, insurance broking premium accounts, profit and loss account and other statutory returns for the financial year.
2.
Our audit was carried out in accordance with the requirements of section 36 of the Insurance Act (Cap. 142), for the purpose of expressing our opinion on the accounts drawn up in accordance with the provisions of the Insurance Act. Our examination was necessarily conducted on a test basis and included such samples as we deemed appropriate. In this connection, we have reviewed the accounting system and system of internal controls in operation and reliance has been placed on internal controls where appropriate.
3.
In our opinion and to the best of the information and according to the explanations given to us —
(a)
the balance-sheet, insurance broking premium accounts, profit and loss account and other statutory returns have been prepared in accordance with the provisions of the Insurance Act and any regulations made thereunder;
(b)
the balance-sheet represents a true and fair view of the financial position of the business of the registered insurance broker; and
(c)
the books of the registered insurance broker have been properly kept and recorded fairly the affairs and transactions of the insurance broker in respect of that business.
4.
As far as can be ascertained from our examination, in our opinion —
(a)
the appropriate professional indemnity insurance required under section 35Y (1) (c) of the Insurance Act is in force;
(b)
the prescribed net asset value required under section 35ZC of the Insurance Act has been complied with; and
(c)
the insurance broking premium accounts have been established and maintained in accordance with section 35ZD of the Insurance Act; except
_____________________________(Firm)
Public Accountants and Chartered Accountants Singapore