FOURTH SCHEDULE
Regulation 3B(a)
Form 12G
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Notes to Form 12J
 
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 12J
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.
UNKNOWN
 
Notes to Form 12K
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 12K
An exempt insurance broker shall complete separate forms for each type of insurance broking business handled.
UNKNOWN
UNKNOWN
UNKNOWN
 
Instructions for completion of Annex 2 to Form 12K
An exempt insurance broker shall complete separate forms for each type of insurance broking business handled.
 
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.