STAATSKOERANT, 18 MAART 2011

BOARD NOTICE

BOARD NOTICE 54 OF 2011

FINANCIAL SERVICES BOARD

LONG-TERM INSURANCE ACT NO. 52 OF 1998:

AMENDMENT OF BOARD NOTICE 294 OF 2010: RETURNS TO REGISTRAR

No. 34118 3

I, Dube Phineas Tshidi, Registrar of Long-term Insurance, acting in terms of

section 36(1) of the Long-term Insurance Act, 1998 (Act No. 52 of 1998),

hereby amend Board Notice 294 of 2010, published in G.ovemment Gazette

No. 33113 of 16 April 2010, by substituting the L T201 0 ~tatutory return with

the L T2011 statutory return as set out in schedule.

The L T2011 statutory return consists of a quantitative and qualitative part. The

quantitative part is set out in Annexure A of the schedule and the qualitative

part is set out in Annexure B of the schedule.

This Notice takes effect on the date of publication thereof and applies to every

registered long-term insurer whose financial year ends on or after 1 January

2011 , and applies in respect of the full financial year preceding the end of the

financial year referred to above.

MlSM•ls7 DP TSHIDI

Registrar of Long-Term Insurance

SCHEDULE

4 No. 34118 GOVERNMENT GAZETTE, 18 MARCH 2011

ANNEXURE A

STAATSKO ERANT, 18 MAART 2011

LT2011

LONG~TERM INSURANCE ACT (NO. 52 OF 1998) LONG-TERM QUANTITATIVE RETURN

ABC LIFE INSURANCE LIMITED

REGISTRAR OF LONG-TERM INSURANCE REFERENCE NUMBER END OF PERIOD UNDER REVIEW FINAL PRINTOUT DATE

Statement [ no. Description

..

A A~. A2 A3

B ill 82 83 84 85 86 810

c C1 C2

ill C3

P-6

D D1_ ()3. 9i

Management Information Registration information Addresses & part.iculars of key persons Directors & members ·af audit committee

Data Summary Summary of premiums & benefits Premiums received & outstanding Benefits paid & provided for Summary of long-term business in force Movement in long-term business in force Analysis of movements Information relating to claims, credit life policies and distribut ion channels

Statutory Valuation Method Statutory valuation method of assets Summary of Statutory valuation method of assets and liabilities liabilities Free assets and Capital Adequacy Cover Projected Exce~s ~ssets .~nd Capital Adeguaq Cov~r

Financial Statements Statement of Financial Position Anaiysfs.ot is.sue·d' preTerence-sh~m3s & debentures Statem_e~! of ~-o~pre~e-~~i~e fn~~~ ___ . -·

E Details in respect of Assets E1 Cash & balances & deposits .. --E2-- · securities & loan-s---- -·- ·-- - · .. - ·- .. · --

.. E3 ... 6e'ben'tures,-foan 'stocks & other securities E4 Debtors (Claims against perso-ns and entities) ES Shares, units & depository receipts E6 Immovable property E7 Mortgages over immovable property. including participation bonds E8 Fixed assets E9 Comparison of Statutory & Shareholders assets E1 0 Related party transactions ill Spread of domestic as~e!s (including foreign assets deemed to be domestic)

F Futures & Options F1 Derivatives

No. of pages

1 1 1

1 1 1 1 1 1 1

1 1 1 1 1

1 .. 1 1

1 . --1 1 1 1 1 1 1 1 1 1

1

No. 34118 5

Page 1 of76

10/10/1/000/8 12131 /2011

3/7/2011 8:34

Issue date

2003 2000 2011

2003 2011 2011 2011 2007 2011 201 1

2011 2011 2011 2003 2011

2011 2008 2011

2003 2003 2003 2003 201 1 2003 2003 2000 2000 2003 2011

2011

6 No. 34118 GOVERNMENT GAZETTE, 18 MARCH 2011

LT2011 Page 2 of 76

LONG-TERM INSURANCE ACT (NO. 52 OF 1998} LONG-TERM QUANTITATIVE RETURN

ABC. LIFE INSURANCE LIMITED

REGISTRAR OF LONG-TERM INSURANCE REFERENCE NUMBER 10/10/1/000/8 END OF PERIOD UNDER REVIEW 12/31/2011 FINAL PRINTOUT DATE 3/7/2011 8:34

INOEX OF STATEMENTS NOT AVAILA : :. '.;; .::'': :;·C •: .<

Statement I no. Description I ::~:: Issue date

B Data Summary 87 Expense analysis 1 2011 88 Investment ex-perience analysis 1 2011 89 Experience analysis 1 2011

c Statutory Valuation Method C4 Statutory valuation method of net policy liabHities 1 2011 C5 Capital a_dequacy r~qui~em~nt before management action 1 2011 C6 . Capitalade!_9llac:y_ reguireJl1ent<mdmana~:JE'lment action 1 2011

. C7. C>-nal;<sis of _surplus _ ! 1 2011 ~

C~8 Dividend test 1 2008 -··~

_ C9 _ Reinsurance 1 2011 C10.1. Statutory valuation method of the liabilities of individua-l business 4 2011 C102 Statutory va-Juaticm meth:0d()f the liabilities of ~roup business 4 2011

E Details in respect of Assets E12 Banking ln~titution £:)(posure 1 I 2011 E13 Other Institution Exposure 1 2011

H Questionnaires & Reports l:i1 Summary of SVM assets and liabilities 1 2006 H2 Free assets and capital adequacy cover 1 2006

H2.1 Free assets and capital adequacy cover of underfunded cells 1 2006

ill Certificate given by directors 1 2006

I Stress & Scenario Tests l1 Single factor stress tests on statutory surplus 1 2011

J1 EconomicScemario stress on statutory surplus 1 2011 Jd Single factor strl'lss tests on statutory surplus 1 2011

'

LT2011

1. DESCRIPTION

Registrar of Long-term Insurance reference number End of financial period (yyyyhnmldd) Name of long-term insurer

Number of months in financial period under review

Regulators Ref: IIREF!

1 10/10/1100018

12

2. TYPES OF POUCIES

0 Assistance

CERTIFICATE OF REGISTRATION AS AN INSURER ISSUED BY THE REGISTRAR

"C:IDiSabilitY ______ _ 0 Fund ·· -- - -.. ·- - --- --- --0--~---

0 Life

·o Sin~.L!!'!L-··------------------

3. NAMES OF CONTACT PERSONS

3.1 PUBLIC OFFICER Initials and surname of Public Officer Initials and sumamo of conlael person regarding the return

3.2AUDITOR Name of first firm

Initials and surname of ReSjlOnslble Partner I Name of second firm

Initials and surname of Responsible Partner

3.3ACTUARY Name of Statutory Actuary

Name of employer/company cA Statutcxy Actuary

Name of Alternate Statutory Actuary

Name of emplOyer/company of Alternate Slatutory Actuary

Notes: Conditions imposed on en insurer ere available from the Registrar on lfKIU&SI.

Conditions imposed' (YIN)

Did person change since previous year (YIN)

Did peBOn change since previous year (YIN)

Did person change since previous year (YIN) Did person change since previous year (YIN)

Did person c:llange since previous year (YIN) Did person change since previous year (YIN)

Did person change since previous year (YIN)

Did person c:llange since previous year (YIN)

Did person change since previous year (YIN) Did person change since previous year (YIN) I''

AUDrTORS (initilll) -===--=~

Page 3 of 76

(/)

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.lT2011

H1:0151"RAA 0' lONGolVat ~e REF~~et'CE NUM!IER

filiAl. ~NTOU1 DATE

1. HEAD OFFICE AND PUBliC OFFICER

1.1 HEAD OFFICE OF LONG-TERM INSURER IN RSA

Telophono (including oroa. COd<>) Fax (including area code) wobaite e-mail

2-AUOITORS

2-1 FIRST AUDITOR (Reaponolbte Pittner)

Telephone (inclUding ""'B code) Fax (inclueling area code) Cellpt,ono &mail

3.1 STATUTORY ACTUARY

T elephono (InclUding area code) Fax (including area oode) Cellpllone e-maU

~~------_ --id

!_ _ _ _ __.- ] r 1--- addr-ess ----~ 1: -·

1.2 PUBLIC OFFICER

tn~• and surnamo To4ephone (includi1'9 area code) Fax (including aroa codo) Cellphone e-mail

1.3 PERSON COMPLETING TliE RETURN

lnitial6 and .umamo T olephono (indu::ling area code) Fex (inducing area c:od<o) Cellphone e..mall

U CONSUME Ill COMPlAINTS PERSON

lnitNIJt and a\.mame Telephone (including area code) Fu (including oroa oode) Col phone o-maU

2.2 SECOND AUDITOIII (Rnponolble Portner)

'Telephone (incltJdlng area code) Fax (lnekJ<Ing area oode) Celphono &-111811

3.2ALTERNATE STATUTORY ACTUARY

Telephcoe (including area code) Fa. (inclu<i1'9 area code) Cellphone a-mau

• : 1!1

AUDITORS(~~~) =====--=-------=====~~--=====-

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STAATSKOERANT, 18 MAART 2011 No. 34118 9

lT2011 Page 5oH 6

I. DIRECTORS: execvtve

- ···-·--··--- - -----t--- ---+- ----1---- ----;-----, ·---------------------r-------~r-------+-------------,_-------4 - - - -·-----------+----------+--------1--------------+-------~

-··- --···--- -------l---------+--------+-------------+--------1

------·-··-·------·--_,_ __________ +--------1--------------l----------t------------! - ---····----------·---+----------1--------t--------------lr--------+-------------l -----·-··---- ·----·--t------t-------t---------1------+------~ ··--·---- - --... - -- -~---------+-------+------------+------+------------i

--·-- -·--.. --·-·-------+---------lf---------1-------------+---------f------------l - .. ·-- ·-·--·-··-- - - - -- -----+----------+--------+--------------+--------+-------------1 _ _ _ _ __ ,. ____ _ ____ .. _ __j ______ ..,L_ _____ _..J.. ___________ __,_ _____ __ _,_ __________ __,

--·- - ---·-----+----------1--------+-------------t--------+--------------i --- ·----------------------.. ··-+-----+----+------+----+----- -----1 - -------------------+----------+--------l--------------+--------+-------------1 .... ·-----·- - - - - - +--- - --1-- ----1-- - - -----+------t-- ------;

2. MANAGEMENT EXECUTIVES

·---· .. --··----l-----------l--------+-------------+---------1

--- - ----- -------+------t-----1--------+-----;

3. MEMBERS OF AUDIT COMMITTEE:

~-------···--·---·---+----------+--------4--------------1f--------+------------~

----.. ·--------··------+----------1--------+------------~---------t-------------i

-= AUOITORS(inilial) ==------------I ExamDI&slnclude: ChainnM. Vice-chllinnan. NCJHtxeculive. M~Q DWctor etc.

L T2011

SHEET R.EI'ERENCE NUMBER

REGISTIIAA Of lONG-TERMINSURNICE REFEREIOCE NUIOBER

FINAl PRIIfTOIIT llo'.TE

;~~A;?il~~5f:·t~-~~:;.~;:>~ · - · ~-. <'\·;·;·~-.: .··_<·. ·~ -- , ·::·:. : -, .· .· :· -~:~·-.:~::~:~~:~'~;~~{Jlit~r~~~l~~~r~.<-- .· -r:•~::~~i/1·~-~~J!.:f.:;-~1 ·71.(.·'•·,'·':. :;:; . .\' . . .. _,, 'f ·~·:.: ~-..• :. _, .~ .· · ' . ·:' ,._ __ ,,._'f[;;,:•;r:;:~:.::r~x~-}l;:,_.§~(,"J,/- . - . 1!t:: ~·~ :.:~o !:ftJ .. "w~~~l~" ·~ .. $ .. , .... ,> . ·~ ~ >f,~· ' ~ '> - <> .. ..::- • , .. ~ ::. , • 4 , ~-- ~ •• ._y;_ - .. _.A • •• c<('i tl-:t&- >'::il'~~~.o:f~"'>~ -"'~?~~ .. ~,11'- -~ , ,

DESCRIPTION INRSA IN & OUTSIDE RSA TOTAL TOTAL R'OOO R'OOO

1 2 3

1. OROSS'PREMIUMS RECEIVED & OUTSTANDING'

.;A ssistance 0 DisabHity 0 Fund 0 --Heahh

"

0 Life 0 J!!~gFund 0 Q,!i!L_(3~~_PR_EMIUMS 0

2. NET PREMIUMS RECEIVED & OUTSTANOING1

" ' \

1

, _!

I I

0 .··O

o. o· 0 0 0

·Disa~~---·---- 1--------------~:-------------+io Assistance I 0o~~O· I 0 I

~,,-~~~------------------_-_-_-_-_-_-_-_-_-_-_-_-_~-t==============:::::::::====~~=======::::::::::::::=======~lo TOT~.:E§.'!:.EREMIUMS- --·-----~:::~=-=--=-~~-------_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-::_-_-::_-_-_-_-_-.s:..+L----_-_-_-_-_-_-::_-_-_-_-_-_-_-_-_-_-_-::_-_-_-_-_-_..::1j_

3. GROSS BENEFITS PAID & PROVIDED FOR Assistance 0 0 Disability 0 0 Fund ------- 0 a "iieal1h 0 0 Life·- 0 0 - --··-·-Sinkinl! Fund 0 0 TOTAL -~~OSS BENEFITS 0 0

4. NET BENEFITS PAID & PROVIDED FOR Assistance 0 0 Disability 0 0 Fund 0 ·0 Health 0 0 Ufe 0 0 Sinki~ Fund-- 0 0 TOTJI:'::...t;!ET B~NEFITS 0 0

AUDITORS==-===-===--= === Notes:

1 Premium income Includes money I8Ceiv8d in reSIJect of "'nvestment oontnJcts".

Page 6 of76 .. 0

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LT2011

SliEET REFERENCE NUMBER

REGISTRAR Of' LONG-TERM INSURANCE REFERENCE NUMBER

DESCRIPTION

Pension fund 0 0 MedicaTscheme -- 0 q Othei -- ·-- . 0 0 SUBTOTAL 0 0

TOTAL NET PREMIUMS o! o!

ACTUARY======--

Notes: Pramium income Includes money racefved in raspect of "investment contracts",

0 0 0 ' 0 0 0 0 ,_ 0 0 0 ' 0 0 0 0 0 0

o! ol o! o!

AUDITORS,{initial) ---==-

Page 7 of 76

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LT2011

lfl(fil a{ff;ltEJIICE: .., ....

fl:fGIIfiWIOfi.~TlRMIMSI.IIIIAittllltff~I'IW!aR

SurrerA:Mra 01ller

OTHER SUBTOTAL

OfATH OISABiuTY

Income benef'ot

lTS

Lu~_ ........... fil TH RITY ITY ORAWAl.BENEFrrs

HEA~ MAn! ANNU WITH

PeiUCMfand 001«

suer OTAL ----

TOTALGRO SSBEN EFITS

2. NET BENEFfTI PAID & PR.OVIOEO FOA.1

2.1 INDMOUAL DEATH OISAI!ILITY

""""""bene(it lunlP"""booollt

HfALTH M ATURITY ANNUITY WITHDRAWAL BENEFITS

Sll~

Ol!>o• OTHER SUBTOTAL

Z.ZORO UP Ct:ATH DI&AlliUTY

. tncomebeneRt LUmj>iumbo .. lil

HfALTH ¥ ATURITY ANNUiTY WITHDRAWAL BENEFITS

Penaionfl.roel 0111 ..

SU8TOTAL -

TOTA l NET BENEFITS

ACTUARY

I

I

0 0 0. 0, 0 0 0

o I ol o I o I

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0

~I ~I ~I ~I 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

~I ! I gl il 0 0

o I

0 .. 0 0 0 0

~I 0

0

0 0 0 0 0

0 0 0 0

0

0 0 0 0 0

~I 0

-J(fiOliODt

0 0· 0 0

=:]j

o· 0 0 0

·0

~I 0

0

0 0 0 0 0

0 0 01 0

0

0 0 .

•• 0 o·

!I AUDITORS (WN/j ~~~---

Pogo e ol76 ... 1\)

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Ci) .... ... 6 .... -..I g (JI

I Ul

LT2011

SHEET REFERENCE NUMBER

REGISTRAR OF LONG-TERM INSURANCE REFERENCE NUMBER

FINAL PRINTOUT DATE

DESCRIPTION

1.1NOIVIOUAL

1.1 RECURRING PREMIUM BUSINESS

Number of policies Number of m~mbers_:...9.r.~ individual business Net annualised eremiums R'OOO Policy liabilities R'0001

1.2 NON-RECURRING PREMIUM BUSINESS

Number of policies Number of members - grou~d individual business

Policy_liabilities R'0001

2. GROUP

Number of schemes Number of members Net annualised premiums R'OOO

Scheme liabilities R'0001

---

I . I .

Investments R'OOO

2

..

0 0 0 0

0 0 0

b. I o I

INRSA CURRENT YEAR

TYPE OF BUSINESS Risk

R'OOO 3

0 0 0

0

0 0

0

o I Ol

Annuities R'OOO

4

0 0 0 0

0 d 0

Ol o I

Universal Ufe R'OOO

5

0 Q 0 0

Q 0

o. .

0 0

.. . . ~~;

'.

TOTAL

R'OOO 6

. ' .

..

0 0 0

0

0 0 0

0 9 0 0

ACTUARY AUDITORS (initial)

Notu: 1 Policy liabilities or scheme liabilities net of approved reinsurance only and schedule 3 adjustments.

Page 9of76

804-89-A

10110/1100018

317/2011 8:34

IN &OUTSIDE TOTAL

CURRENT YEAR R'OOO

7

0 0 0

0

0 0 0

0 0 0 0

==-=====:a-=

(j)

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LT2011

SHEET REFERENCE NUMBER

REGISTRAR OF LONG-TERM INSURANCE REFERENCE NUMBER

FINAL PRINTOUT OA TE

~~

1 011 011100018

31712011 &:34 ll'!!¥'"'"""--' n ' ' ."'"'""''"" .,.. "'~·~=···•·· ''""'"~~~~illlf''""''• "P> •·• ''''>:'""\'1m ~of.., \~ \. ,..;~"''~' y>:t-•1'' '1~ ' .. ,.~~~.,.,-: ,..,. .,_'i '"~'"t , ( , '-'·~ · ~~:·J' 1:~~~~ ,.. p?.( t .. ~''" -"'•;,..;~ ••"'•- '- ' {'Vo- Jl• I ~~·~ ~)"~~lflt' 1'JP ~i~}1~:r;•Jt>~·. ::,,.," >\ , tJ":,:_!-1{\~f;~ ·~tty~, f)JJt•~~:N~~~¥~':, .. •:.W¥:"t~71!":!¥-'"" }1~;e~ t~-~~~~ ~~ ~ >h,.._\,;.;:, :p,. ; n. ~ :. " ~< ~ ~~.:~:r~1~ (?-; h\;~J;~-.!~,.t .. h·15i~ t;"' -~~~~~~<;-o-... ,' . ·" ~-): ' ·O:·i·t.··. ~ ' \ "');: · :.:.~~~:t<~ii/ ~!.;,\ :..x~~· .. /.,..;:~ •. i~ •;;r:- ~71 ~ 1-f'- ~?t: ~~~~~~i"~;~··.·, ·~~ ·~. " ·~·'-:~t;.:~"~,i;~i:"..c~~;l-&~;r.""':.:><'~"'•¥f ~~~ ;r}i,c,,n" .• : . ~ 6::'f-"?f;'fr·r;;;, .. ·-~~· .:nt'''·· ;~1·· "'~"'!':< ·Jj'l.tr<··rm"'!'~·: ·tF~~~-i,.mv.~>\'(:·~"' 1:.' . • . , " -~-1~;r~";-;·~~ri\ ,(J "!ll~~ .. ·r~nr·~~ i$~ -+ .. ~~: .. :~ ... j •• :':""::~t~' ... - .... ;.- ,.~ ... :~, -~:;;· ··;yt.~.: .. r .J..,t,Jo,r~.:~: .~t~ ~,::;~~·"'~~ ~' {.tt~.:-t~~z~~ .. ~ .. . ··,\,,~.:!·t{:~¥::~~~ ~to:~+'·{tu·~~~,qt~~ ~~~~t~:~~· :p.:. ,.t}~'~1f:w.·.{·;.9'~J~~~~t ~'4·"~~~"~;a?~+{~f\ <;;~ . r~~:~';~ .,t ~ ~-;:.·t~t ~d~ ~fil' ;~ ,,.. ~ \_ : ;~:~~.~Jl': .*-!~iJ~~:if~ h~~~~·~~0>~~~ . ..:.').~ l? ... ...u:~_ou;-~~.::.~-.:~~~J>".<t~.: . .) .... ~\ ·,i,;;;.,clt,cl:_~+'~~.u ·;...,_b-: .>.4:wik~~ ~J'~a::~:....:.~.;;... ~~ ~.Jt u~~ ;0~ ~.::,."'v-.;/. .. If ~· .-<y.:£!,.-.r-i?:~i~ .. ..:"{{~·tn)jj

DESCRIPTION ..

1

1. INDIVIDUAL

T START OF FINANCIAL YEAR NUMBER OF POLICIES A plus: New policies - - - ·-less: Death cla·iJ!l~ __ -:-

•

ns Disability terminatio Health terminations

Matii!~_!:l~i~---Surrenders

Laeses ·-==-­Transfers i.t.o. the A ct Policies e,(i>irea-­AdJustmeni$: specify ··----- --- ----

------ -----

..•

----

NUMBER OF POLICIES AT END OF FINANCIAL YEAR

2.GROUP

___ ,_

·--·

INRSA IN & OUTSIDE RSA CURRENT YEAR TOTAL CURRENT

TYPE OF BUSINESS TOTAL YEAR Non-recurring Recurring No. of pol/des No. of policies No. of policies No. of pokie$

2 3 4 5

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

~~~~~~~=~=;~ES ~T START OF FINANCIAL YEA~-----===~- . ~--__ ... _. -_··_---~ ~-- -_-_J+ _ __ -----~~00-4.1------~00g-fl 'rransfer&Tto. the Act _ _ J . . Ad]Us'.meritS: Specify

: ==~~~--------_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-__ -_-_-~_--_-_-_-_-_-_-_-_-_-_-_-_-_-_~~=========~jo· !l.:::::::::~:o~~~ NUMBER OF SCHEMES AT END OF FINANCIAL YEAR . ~ .

ACTUARY-.--==--==--~ AUDITORS (initial) -======-====

Page 10 of76

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LT2011

SHE£TREFEREHCE-

RIEGIS1RAR OF LONG-TERM INSURANCE REFERENCE NIIMilER

fWW. PRINTOUT OO.lE

DESCRIPTION

'

1 1. NEW BUSINESS

INDIVIDUAL · NEW ISSUES ~URRING BUSINESS

Number of policies Net aMuariSed premium R'OOO

NON~CURRING BUSINESS Number of policies Net p~ium ~ived R'OOO

2. SURRENDERS IIDMDUAL

RECURRING BUSINESS Number_~!Jlolicies Net annualised premium R'OOO

~CURRING BUSINESS

Num~r of po!_~---

3.LAPSES INDMDUAL RECURRING BUSINESS

NUMBER OF POLICIES Fntyear Second year _Third year and oider Total

NET ANNUAUSED PREMIUM ROOD Fnt year Second year Third ~ar and older Total

ACTUARY ===--=-•

. '

INRSA CURRENT YEAR

TYPE OF BUSINESS TYPE OF BUSINESS

lnvestmenls I Risk I Annuities I R'OOO R'OOO R'OOO 2 _j_ 3 I 4 j_

g I ~I ~I ~I ~I g I

~I ~I ~I o I ol ol

~I ~I ~I .. 0 0 0 ..

0 0 0 .. . p -. 0 0

0 0 0

Page 11 of76

IN&OUTSIDE RSA

TOTAL CURRENT

TOTAL Universal Life YEAR

R'OOO R'OOO R'OOO 5 6 7

~I ~I ~I ~I ~I ~ I

~I g I ~I ol o l o I

! I ~I ~I p 0 0 0 0 - 0 0 0 ··) 0 0 0 0

AUDITORS (initisl} =-=--

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SHEET RfA!RENCE NUiollEA

AI!GIST1WI OF lONG-l<Mo! INIURAHCE RUEAENCE IIUio8I!R

FIIW. PRINTOIJT Oil TE

DESCRIPTION

1. ACTUAL EXPENSES INCURRED

1.1 ACQUISmON EXPENSES lncllvidual business selling expenses

· -~~rri!!ll --- .! J'I.Cl!!:.•~----_§!_~siness sellins expenses lssui!:!Q & unele~nA el<llenses

• R~rring • Non-reooning

Other ]_p~!§tP:~--=---·

1.2 OPERAnNG EXPENSES'

Investments I R'OOO

2 I

0 0 0 0 0 0 0 0 0

Risk R'OOO

3

INRSA

CONFIDENTIAL STATEMENT NOT AVAILABL.e TO PUBUC -­W1~-

snnou a:><

IN&OUTSIOE CURRENT YfAR

TYPE OF BUSINESS TOTAL

R"'OO

TOTAL CURRENT

YEAR R'OOO I

L 4 5

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Other R'OOO

6 7 8

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

_lndW __ . __ i~~~~~~=~===========-----1--------~0000~. t--------~~~~~--------~~~~t--------~~~~~----------+-------~~~~~-------~~~1 · ~la~~~~~~--------+--------~-r--------*f---------~-r--------*f·----------r--------*gf-· ------~~-.Q!2!!.e.... -

~er. Specify --- - ---• Asset ms.nagement fees . --. ·...-- -. . .

reiiotd_!'rs' ~-----·----slia su BT_9TAI,. __ .. _ __

1.3 OTHER EXPENSES

-~.!!!9.1~~- =~ TOTAL

ACTUARY

Notu:

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

o I o I 0 0

!I !I ll ll o I o I o I o!

OperatinQ expenses for the CB/culalion of MCAR and include• •H expenS& in f91Specl of "investment conlrBcts".

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0

! I !I o! o I o!

AUDITORS (initial)

Page 12 of76

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SHtnltl~.,..,.

M!.C.naAAOI-l.~n:...........altUEJt(NO£~

ACTUAl. EXPERIENCe

1.1NDMOUAL

A...C vllul at .uwt1

~ce-Not-..-11' A.teot Y8lla lit end1

ln-ylold

TOTAL

Molllodof-

J.OAOUP

Aaeet velue et ster~' Net-Net--· --·--yiold

TOTAL

--Nil-ijtOWil?

~·-·-· I'CTUAR'I' _ ___ _

-

0 0 0 0 0 0 0 0

0% 01(,

0 0 0 0 0 0 Q ' 0

0% 0%

CONFWlENTIAL STATEMENT NOT AVAit.AIII.E TO~ -

12!

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

cor. 0~ 0% 0%

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

cor. 0% 0% 0%

0 0 0 0 0 o; 0 il

0% 0%

AUDITORS (lnllll-----1 --··--300111H>~-At;laf119f·lhiJSbMrllyV,__, 2 Net.,_,~/tlcludN-altd-~aplte/a~.

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6 m ll l> z : -t

z !:> (.,) ~ .... .... Q)