Assurance Companies Act, 1909

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FOURTH SCHEDULE.

Sections 5, 30, 32 and 33.

N.B.—Where sinking fund or capital redemption insurance business is carried on, a separate statement signed by the actuary must be furnished, showing the total number of policies valued, the total sums assured, and the total office yearly premiums, and also showing the total net liability in respect of such business and the basis on which such liability is calculated.

(A.)—Form applicable to Life Assurance Business.

Statement respecting the Valuation of the Liabilities under Life Policies and Annuities of the , to be made and signed by the Actuary.

(The answers should be numbered to accord with the numbers of the corresponding questions.)

1. The date up to which the valuation is made.

2. The general principles adopted in the valuation, and the method followed in the valuation of particular classes of assurances, including a statement of the method by which the net premiums have been arrived at, and whether these principles were determined by the instrument constituting the company, or by its regulations or byelaws, or how otherwise; together with a statement of the manner in which policies on under average lives are dealt with.

3. The table or tables of mortality used in the valuation. In cases where the tables employed are not published, specimen policy values are to be given, at the rate of interest employed in the valuation, in respect of whole-life assurance policies effected at the respective ages of 20, 30, 40, and 50, and having been respectively in force for five years, ten years, and upwards at intervals of five years respectively; with similar specimen policy values in respect of endowment assurance policies, according to age at entry, original term of policy, and duration.

4. The rate or rates of interest assumed in the calculations.

5. The actual proportion of the annual premium income, if any, reserved as a provision for future expenses and profits, separately specified in respect of assurances with immediate profits, with deferred profits, and without profits. (If none, state how this provision is made.)

6. The consolidated revenue account since the last valuation, or, in case of a company which has made no valuation, since the commencement of the business. (This return should be made in the form annexed. No return under this heading will be required where a statement under this schedule is deposited annually.)

7. The liabilities of the company under life policies and annuities at the date of the valuation, showing the number of policies, the amount assured, and the amount of premiums payable annually under each class of policies, both with and without participation in profits; and also the net liabilities and assets of the company, with the amount of surplus or deficiency. (These returns to be made in the forms annexed.)

8. The principles upon which the distribution of profits among the shareholders and policy holders is made, and whether these principles were determined by the instrument constituting the company or by its regulations or byelaws or how otherwise, and the number of years’ premiums to be paid before a bonus (a) is allotted, and (b) vests.

9. The results of the valuation, showing—

(1) The total amount of profit made by the company, allocated as follows:—

(a) Among the policy holders with immediate participation, and the number and amount of the policies which participated;

(b) Among policy holders with deferred participation, and the number and amount of the policies which participated;

(c) Among the shareholders;

(d) To reserve funds, or other accounts;

(e) Carried forward unappropriated.

(2) Specimens of bonuses allotted to whole-life assurance policies for 100l. effected at the respective ages of 20, 30, 40, and 50, and having been respectively in force for five years, ten years, and upwards at intervals of five years respectively, together with the amounts apportioned under the various modes in which the bonus might be received; with similar specimen bonuses and particulars in respect of endowment assurance policies, according to age at entry, original term of policy, and duration.

Note.—Separate statements to be furnished throughout in respect of Ordinary and Industrial business respectively, the basis of the division being stated.

(Form referred to under Heading No. 6 in Fourth Schedule (A).)

Consolidated Revenue Account of the_____for_____years commencing_____and ending_____.

Note.—If any sum has been deducted from the expenses of management account and taken credit for in the Balance Sheet as an asset, the sum so deducted to be separately shown in the above Statement.

(Form referred to under Heading No. 7 in Fourth Schedule (A).)

Summary and Valuation of the Policies of the_____as at_____19.

Note 1.—The term “extra premium” in this Act shall be taken to mean the charge for any risk not provided for in the minimum contract premium. If policies are issued in or for any country at rates of premium deduced from tables other than the European mortality tables adopted by the company, separate schedules similar in form to the above must be furnished.

Note 2.—Separate returns and valuation results must be furnished in respect of classes of policies valued by different tables of mortality, or at different rates of interest, also for business at other than European rates.

Note 3.—In cases also where separate valuations of any portion of the business are required under local laws in places outside the United Kingdom, a summary statement must be furnished in respect of the business so valued in each such place showing the total number of policies, the total sums assured and bonuses, the total office yearly premiums, and the total net liability on the bases as to mortality and interest adopted in each such place, with a statement as to such bases respectively.

(Form referred to under Heading No. 7 in Fourth Schedule (A).)

Valuation Balance Sheet of_____as at_____19_____.

(C.)—Form applicable to Accident Insurance Business.

Statement of the Estimated Liability in respect of Outstanding Claims arising in the year of Account, and in the preceding year or years; computed as at the end of the year in which the claims arose, and as at the end of the year of Account; with particulars as to the number and amount of the claims actually paid in the intervening period.

I.—Claims arising during the year of account ending 19.

(a) Particulars as to Claims arising, and settled, during the year of Account:—

(b) Particulars as to Claims arising during and outstanding at the end of the year of Account:—

II.—Outstanding Claims which arose during the first year preceding the year of account,         ending 19     .

Note.—If temporary weekly allowances are granted by the Company for periods exceeding 52 weeks, particulars are to be furnished, in a form or forms similar to II. above, showing, in respect of claims involving such extended allowances, the estimated liability as at the end of the year in which such claims arose, and as at the end of the year of account; and the number and amount of such actual claims paid during the intervening period of two (or more) years; distinguishing claims terminated, and not terminated, within such period.

III.—Summary of estimated liability, in respect of claims outstanding as at the end of the year of account—

As per column (4) of Statement I. (b) - - £

    ”         ”         (5)    ”      ”      II. - -

    ”         ”         (5) of further schedules in the form of Statement II. (if required).

In respect of yearly allowances during permanent total disablement, outstanding at the end of the year of account, but not included in the above Statements - - }

Total estimated liability, in respect of outstanding claims as at the end of the year of account, as per First Schedule (C.) - } £

(D.)—Form applicable to Employers’ Liability Insurance Business.

Statement of the Estimated Liability in respect of outstanding Claims arising during each of the Five Years preceding the Year of Account, and in such Year; computed as at the end of the Year in which the Claims arose, and as at the end of the Year of Account; with Particulars as to the Number and Amount of the Claims actually paid in the intervening Period.

I.—Claims arising during the year of account ending       19   .

(a) Particulars as to claims arising and settled during the year of account:—

(b) Particulars as to claims arising during, and outstanding at end of, the year of account:—

II.—Outstanding claims which arose during the first year preceding the year of account, ending         19    .

III.—Outstanding claims which arose during the second year preceding the year of account, ending the           19   .

IV.—Outstanding claims which arose during the third year preceding the year of account, ending the         19   .

V.—Outstanding claims which arose during the fourth year preceding the year of account, ending the           19    .

VI.—Outstanding claims which arose during the fifth year preceding the year of account, ending the            19   .

Note.—In cases where the date at which the estimated liability required under column (2) in Forms IV., V. and VI. above would fall in any year prior to 1908, such estimated liability is to be returned as at the end of the year of account terminated in 1908, and the claims paid, required under column (3) of such forms, are to be in respect of the period between the end of the year of account terminated in 1908 and the end of the year of account rendered.

VII.—Statement respecting claims of five years’ duration and upwards outstanding as at the end of the year of account. (To be made and signed by an actuary.)

(1) The number of claims incumbent and having durations of five years and upwards as at the end of the year of account, including those separately returned under Form VI. above; and the amount of the weekly payment, and of the annual payment, due in respect of such claims; separately stated in respect of each year of life of the workmen, from the youngest to the oldest. (These particulars to be returned under columns (1) to (4) of the tabular statement given below.)

(2) The estimated liability in respect of the claims specified above, computed, as at the end of the year of account, on the basis of the amount which would be required to purchase from the National Debt Commissioners, through the Post Office Savings Bank, an immediate life annuity for the workmen equal to 75 per cent. of the value of the weekly payment, according to the sex and true age of the workers. (These particulars to be returned under column (5) of the tabular statement given below, in respect of each year of life of the workmen, from the youngest to the oldest.)

(3) If the estimated liability, as reserved under the First Schedule in respect of the claims specified above, is computed on any basis other than that specified under Heading No. (2) above, the whole of the particulars required under Headings (1) and (2) above are to be returned in columns (1) to (5) of the tabular statement given below, together with the following additional particulars:—

(i) If the estimated liability is determined on the basis of the value of an immediate life annuity:—

(a) The table of mortality upon which such life annuity values are based;

(b) The rate of interest at which such life annuity values are computed;

(c) Whether such life annuity values are discriminated according to the sex of the workers;

(d) The proportion of such life annuity values representing the estimated liability;

(e) The modifications (if any) made in the true ages of the workmen, in deducing the estimated liability;

(f) The amount of the estimated liability. (To be returned, in respect of each year of life, in column (6) of the tabular statement given below.)

(ii) If the estimated liability is not determined on the basis of the value of an immediate life annuity, full particulars are to be specified as to the precise method adopted in deducing such estimated liability, and the total amount of estimated liability is to be returned under column (6) of the tabular statement given below.

Note.—Separate particulars to be furnished in respect of male and female workers.

Summary of estimated liability in respect of outstanding claims as at the end of the year of account—

As per column (4) of Statement I (b) - - - £

   ”        ”          (4)         ”       II - - - -

   ”        ”          (4)         ”       III - - - -

   ”        ”          (4)         ”       IV - - - -

   ”        ”          (4)         ”       V - - - -

   ”        ”          (5) or (6)   ”       VII - - - -

Total estimated liability in respect of outstanding claims as at the end of the year of account as per First Schedule (D) - - -} £

(E.)—Form applicable to Bond Investment Business.

Statement respecting the Valuation of the Liability under Bonds and Endowment Certificates of the to be made and signed by the Actuary.

(The answers should be numbered to accord with the numbers of the corresponding questions.)

1. The date up to which the valuation is made.

2. The principles adopted in the valuation of the liabilities under bond investment policies and endowment certificates, and whether these principles were determined by the instrument constituting the company, or by its regulations or byelaws, or how otherwise.

3. The rate or rates of interest assumed in the calculations.

4. The actual proportion of the annual income from contributions, if any, reserved as a provision for future expenses and profits. (If none, state how this provision is made.)

5. The consolidated revenue account since the last valuation, or, in the case of a company which has made no valuation, since the commencement of the business. (This return should be made in the form annexed. No return under this heading will be required where the valuation is made annually.)

6. The liabilities of the company under bond investment policies and endowment certificates at the date of the valuation, showing the number of policies or certificates, the amounts assured, the amount of contribution payable annually, and the provision for future expenses and profits; also the net liabilities and assets of the company, with the amount of surplus or deficiency. (These returns should be made in the forms annexed.)

7. The principles upon which the distribution of profits among the bond and certificate holders and shareholders is made, and whether those principles are determined by the instrument constituting the company, or by its regulations or byelaws, or how otherwise, and the time during which a bond investment policy or endowment certificate must be in force to entitle it to share in the profits.

8. The results of the valuation, showing—

(1) The total amount of profit made by the company, allocated as follows:—

(a) among participating bond or certificate holders, with the number so participating and the total amount of their bonds or certificates;

(b) among the shareholders;

(c) to reserve funds, or other accounts;

(d) carried forward unappropriated.

(2) Specimens of profit allotted to policies or certificates for 100l. effected for different periods, and having been in force for different durations.

(Form referred to under Heading No. 5 in Fourth Schedule (E).)

Consolidated Revenue Account of the_____for_____Years commencing_____19_____and ending_____19_____.

Note.—If any sum has been deducted for the Expenses of management account and taken credit for in the Balance Sheet as an asset, the sum so deducted to be separately shown in the above Statement.

(Forms referred to under Heading No. 6 in Fourth Schedule (E).)

Summary and Valuation of the Bond Investment Policies or Endowment Certificates of the_____as at_____19_____.

(Form referred to under Heading No. 6 in Fourth Schedule (E).)

Valuation Balance Sheet of the          as at 19   .