THIRD SCHEDULE
Regulation 3A(a)
Form 12A
UNKNOWN
Notes to Form 12A
 
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 its effects.
 
Instructions for completion of Form 12A
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.
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.
UNKNOWN
Notes to Form 12B
 
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 12B
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.
UNKNOWN
Notes to Form 12C
 
The following shall be stated as notes to this Form:
Note 1
Breakdown for the following items:
 
(a) other revenue (Row 2);
 
(b) other expenses (Row 4); and
 
(c) other income (Row 5).
 
Instructions for completion of Form 12C
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 contribution, pensions and gratuities;
(d) Medical fees;
(e) Training; and
(f) Skills development levy.
UNKNOWN
Notes to Form 12D
 
 
Note 1
“Domestic Risks” is a risk which would have been classified as a “Singapore policy” as defined in regulation 2(1) of the First Schedule to the Insurance Act (Cap. 142) had the risk been underwritten by a registered insurer.
Note 2
“Offshore Risks” refers to any risk other than a Domestic Risk.
Note 3
“Premiums” refers to premiums received or receivable during the financial year. Brokerage shall not be deducted from premiums.
Note 4
“Registered insurers in Singapore” excludes Protection and Indemnity Clubs in Singapore.
 
Instruction for completion of Form 12D
A registered insurance broker shall complete separate forms for each type of registration.
UNKNOWN
UNKNOWN
UNKNOWN
Instructions for completion of Annex 2 to Form 12D
 
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 Row 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 Row 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 Row 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 Row 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.
UNKNOWN
UNKNOWN