| FIFTH SCHEDULE |
| Regulation 4A(3) |
| actuary’s certificate |
| NAME OF INSURER |
| _________________ |
| ACTUARIAL INVESTIGATION AS AT |
| ____________________________________ |
| I have conducted an investigation into the valuation of general insurance policy liabilities as required under section 37 of the Insurance Act (Cap. 142) and confirm that the valuation is in accordance with the requirements stipulated in the Insurance Regulations (Rg 1), subject to the qualifications stated below 1. I certify these amounts, net of reinsurance, as follows: |
| 1 Qualifications (if none, state “none”): |
|
| ____________________________________________ |
| ____________________________________________ |
| ____________________________________________ |
| Name of actuary: ________________ |
| Signature: ________________ |
| Date: ________________ |