ANNUAL RETURN: FORM 1 - FUND BALANCE SHEET I567L LIFE ... · I567L LIFE INSURANCE CORPORATION...

LIFE INSURANCE CORPORATION (SINGAPORE) PTE. LTD.I567L

ANNUAL RETURN: FORM 1 - FUND BALANCE SHEET

Reporting Cycle:

Life: SIF - Participating

122013

Description

ASSETS

Equity securities

Debt securities

Land and buildings

Cash and deposits

Other invested assets

Investment income due or accrued

Outstanding premiums and agents' balances

Deposits withheld by cedants

Reinsurance recoverables (on paid claims)

Income tax recoverables

Fixed assets

Inter-fund balances and intra group balances (due from)

Other assets

Total Assets (1 to 14)

LIABILITIES

Policy liabilities

Other liabilities:

Outstanding claims

Annuities due and unpaid

Reinsurance deposits

Amounts owing to insurers

Bank loans and overdrafts

Inter-fund balances and intra-group balances (due to)

Others

Total Liabilities (16 to 23)

SURPLUS (15 - 24)

RowNo.

Amount

14/04/2015 04:21 PM

Reporting Cycle:

Life: SIF - Participating 2

122013

Description

ASSETS

Equity securities

Debt securities

Land and buildings

Cash and deposits

Fixed assets

Other assets

LIABILITIES

Policy liabilities

Other liabilities:

Outstanding claims

Others

SURPLUS (15 - 24)

RowNo.

Amount

14/04/2015 04:21 PM

Reporting Cycle:

Life: SIF - Non-Participating

122013

Description

ASSETS

Equity securities

Debt securities

Land and buildings

Cash and deposits

Fixed assets

Other assets

LIABILITIES

Policy liabilities

Other liabilities:

Outstanding claims

Others

SURPLUS (15 - 24)

RowNo.

Amount

2,500,000

14/04/2015 04:21 PM

Reporting Cycle:

Life: SIF - Investment-Linked

122013

Description

ASSETS

Equity securities

Debt securities

Land and buildings

Cash and deposits

Fixed assets

Other assets

LIABILITIES

Policy liabilities

Other liabilities:

Outstanding claims

Others

SURPLUS (15 - 24)

RowNo.

Amount

14/04/2015 04:21 PM

Reporting Cycle:

Life: OIF - Participating

122013

Description

ASSETS

Equity securities

Debt securities

Land and buildings

Cash and deposits

Fixed assets

Other assets

LIABILITIES

Policy liabilities

Other liabilities:

Outstanding claims

Others

SURPLUS (15 - 24)

RowNo.

Amount

14/04/2015 04:21 PM

Reporting Cycle:

Life: OIF - Participating 2

122013

Description

ASSETS

Equity securities

Debt securities

Land and buildings

Cash and deposits

Fixed assets

Other assets

LIABILITIES

Policy liabilities

Other liabilities:

Outstanding claims

Others

SURPLUS (15 - 24)

RowNo.

Amount

14/04/2015 04:21 PM

Reporting Cycle:

Life: OIF - Non-Participating

122013

Description

ASSETS

Equity securities

Debt securities

Land and buildings

Cash and deposits

Fixed assets

Other assets

LIABILITIES

Policy liabilities

Other liabilities:

Outstanding claims

Others

SURPLUS (15 - 24)

RowNo.

Amount

14/04/2015 04:21 PM

Reporting Cycle:

Life: OIF - Investment-Linked

122013

Description

ASSETS

Equity securities

Debt securities

Land and buildings

Cash and deposits

Fixed assets

Other assets

LIABILITIES

Policy liabilities

Other liabilities:

Outstanding claims

Others

SURPLUS (15 - 24)

RowNo.

Amount

14/04/2015 04:21 PM

Description

Equity securities other than collective investment schemes

Collective investment schemes

Total (1 to 2) = Row 1 of Form 1

Row No.

Listed

Unlisted

Amount

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1A - INVESTMENT IN EQUITY SECURITIES

14/04/2015 04:22:33 PM

Description

Row No.

Listed

Unlisted

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Listed

Unlisted

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Listed

Unlisted

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Listed

Unlisted

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Listed

Unlisted

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Listed

Unlisted

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Listed

Unlisted

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Government debt securities

Qualifying debt securities

Other debt securities

Row No.

Amount

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1B - INVESTMENT IN DEBT SECURITIES

14/04/2015 04:22:33 PM

Description

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

Description

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1C - INVESTMENT IN LAND AND BUILDINGS

LIFE INSURANCE CORPORATION (SINGAPORE) PTE. LTD.

Location and Descriptionof Land and Buildings Row No. Cost

LastRevaluation

Last ReportedAmount

Changes fromLast Reported

AmountAmount

Total = Row 3 of Form 1 21 0

14/04/2015 04:23:19 PM

122013

Reporting Cycle:

LastRevaluation

Last ReportedAmount

AmountAmount

14/04/2015 04:23:19 PM

122013

Reporting Cycle:

LastRevaluation

Last ReportedAmount

AmountAmount

14/04/2015 04:23:19 PM

122013

Reporting Cycle:

LastRevaluation

Last ReportedAmount

AmountAmount

14/04/2015 04:23:19 PM

122013

Reporting Cycle:

LastRevaluation

Last ReportedAmount

AmountAmount

14/04/2015 04:23:19 PM

122013

Reporting Cycle:

LastRevaluation

Last ReportedAmount

AmountAmount

14/04/2015 04:23:19 PM

122013

Reporting Cycle:

LastRevaluation

Last ReportedAmount

AmountAmount

14/04/2015 04:23:19 PM

122013

Reporting Cycle:

LastRevaluation

Last ReportedAmount

AmountAmount

14/04/2015 04:23:19 PM

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1D - INVESTMENT IN LOANS

Description

Policy loans

Mortgage loans

Other secured loans

Unsecured loans

Row No.

Amount Outstanding

Provision for DoubtfulLoans

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Policy loans

Mortgage loans

Other secured loans

Unsecured loans

Row No.

Amount Outstanding

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Policy loans

Mortgage loans

Other secured loans

Unsecured loans

Row No.

Amount Outstanding

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Policy loans

Mortgage loans

Other secured loans

Unsecured loans

Row No.

Amount Outstanding

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Policy loans

Mortgage loans

Other secured loans

Unsecured loans

Row No.

Amount Outstanding

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Policy loans

Mortgage loans

Other secured loans

Unsecured loans

Row No.

Amount Outstanding

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Policy loans

Mortgage loans

Other secured loans

Unsecured loans

Row No.

Amount Outstanding

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Policy loans

Mortgage loans

Other secured loans

Unsecured loans

Row No.

Amount Outstanding

Amount

14/04/2015 04:22:33 PM

Life: SIF - Participating 2013 12Reporting Cycle:

ANNUAL RETURN: ANNEX 1E - BREAKDOWN OF OTHER INVESTED ASSETS

Description

Derivatives

Options:

(a) Call options

(b) Put options

(c) Swaptions

(d) Other options

Total investments in options (1 to 4)

Futures contracts:

(a) Currency futures contracts

(b) Interest rate futures contracts

(c) Other futures contracts

Total investments in futures contracts (6 to 8)

Forward contracts:

(a) Currency forward contracts

(b) Interest rate forward contracts

(c) Other forward contracts

Total investments in forward contracts (10 to 12)

Swaps:

(a) Interest rate swaps

(b) Currency swaps

(c) Other swaps

Total investments in swaps (14 to 16)

Other derivatives

Total investments in derivatives (5 + 9 + 13 + 17 + 18)

RowNo.

NotionalPrincipalAmount

Amount

Other invested assets excluding derivatives

14/04/2015 04:22 PM

Total investments in other invested assets excludingderivatives 40 0

14/04/2015 04:22 PM

Life: SIF - Participating 2 2013 12Reporting Cycle:

Description

Derivatives

Options:

(a) Call options

(b) Put options

(c) Swaptions

(d) Other options

Futures contracts:

Forward contracts:

Swaps:

(b) Currency swaps

(c) Other swaps

Other derivatives

RowNo.

Amount

14/04/2015 04:22 PM

Life: SIF - Non-Participating 2013 12Reporting Cycle:

Description

Derivatives

Options:

(a) Call options

(b) Put options

(c) Swaptions

(d) Other options

Futures contracts:

Forward contracts:

Swaps:

(b) Currency swaps

(c) Other swaps

Other derivatives

RowNo.

Amount

14/04/2015 04:22 PM

Life: SIF - Investment-Linked 2013 12Reporting Cycle:

Description

Derivatives

Options:

(a) Call options

(b) Put options

(c) Swaptions

(d) Other options

Futures contracts:

Forward contracts:

Swaps:

(b) Currency swaps

(c) Other swaps

Other derivatives

RowNo.

Amount

14/04/2015 04:22 PM

Life: OIF - Participating 2013 12Reporting Cycle:

Description

Derivatives

Options:

(a) Call options

(b) Put options

(c) Swaptions

(d) Other options

Futures contracts:

Forward contracts:

Swaps:

(b) Currency swaps

(c) Other swaps

Other derivatives

RowNo.

Amount

14/04/2015 04:22 PM

Life: OIF - Participating 2 2013 12Reporting Cycle:

Description

Derivatives

Options:

(a) Call options

(b) Put options

(c) Swaptions

(d) Other options

Futures contracts:

Forward contracts:

Swaps:

(b) Currency swaps

(c) Other swaps

Other derivatives

RowNo.

Amount

14/04/2015 04:22 PM

Life: OIF - Non-Participating 2013 12Reporting Cycle:

Description

Derivatives

Options:

(a) Call options

(b) Put options

(c) Swaptions

(d) Other options

Futures contracts:

Forward contracts:

Swaps:

(b) Currency swaps

(c) Other swaps

Other derivatives

RowNo.

Amount

14/04/2015 04:22 PM

Life: OIF - Investment-Linked 2013 12Reporting Cycle:

Description

Derivatives

Options:

(a) Call options

(b) Put options

(c) Swaptions

(d) Other options

Futures contracts:

Forward contracts:

Swaps:

(b) Currency swaps

(c) Other swaps

Other derivatives

RowNo.

Amount

14/04/2015 04:22 PM

2013 12Reporting Cycle:Life: SIF - Participating

AGENTS' BALANCES OF DIRECT LIFE INSURER

ANNUAL RETURN: ANNEX 1F(a) - AGEING OF OUTSTANDING PREMIUMS AND

Description

In respect of direct business

Bad debts written off during the year

Ageing of outstanding premiums and agents' balances:

Outstanding period

Up to 3 months

Above 3 months but not exceeding 6 months

Above 12 months

Gross total (2 to 5)

Provision for doubtful debts

Total outstanding premiums and agents' balances in respect of directbusiness (6 - 7)

In respect of reinsurance business

Outstanding period

Up to 6 months

Above 24 months

Total outstanding premiums and agents' balances in respect ofreinsurance business (14 - 15)

Total (8 + 16) = Row 8 of Form 1

RowNo.

Amount

Note: For direct insurance business, outstanding period starts from date of commencement of cover.

In respect of reinsurance business, outstanding period commences from the date premiums areaccrued in the books of the licensed insurer.

14/04/2015 04:21 PM

2013 12Reporting Cycle:Life: SIF - Participating 2

Description

Outstanding period

Up to 3 months

Above 12 months

Outstanding period

Up to 6 months

Above 24 months

RowNo.

Amount

14/04/2015 04:21 PM

2013 12Reporting Cycle:Life: SIF - Non-Participating

Description

Outstanding period

Up to 3 months

Above 12 months

Outstanding period

Up to 6 months

Above 24 months

RowNo.

Amount

14/04/2015 04:21 PM

2013 12Reporting Cycle:Life: SIF - Investment-Linked

Description

Outstanding period

Up to 3 months

Above 12 months

Outstanding period

Up to 6 months

Above 24 months

RowNo.

Amount

14/04/2015 04:21 PM

2013 12Reporting Cycle:Life: OIF - Participating

Description

Outstanding period

Up to 3 months

Above 12 months

Outstanding period

Up to 6 months

Above 24 months

RowNo.

Amount

14/04/2015 04:21 PM

2013 12Reporting Cycle:Life: OIF - Participating 2

Description

Outstanding period

Up to 3 months

Above 12 months

Outstanding period

Up to 6 months

Above 24 months

RowNo.

Amount

14/04/2015 04:21 PM

2013 12Reporting Cycle:Life: OIF - Non-Participating

Description

Outstanding period

Up to 3 months

Above 12 months

Outstanding period

Up to 6 months

Above 24 months

RowNo.

Amount

14/04/2015 04:21 PM

2013 12Reporting Cycle:Life: OIF - Investment-Linked

Description

Outstanding period

Up to 3 months

Above 12 months

Outstanding period

Up to 6 months

Above 24 months

RowNo.

Amount

14/04/2015 04:21 PM

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1G - STATEMENT OF REINSURANCE RECOVERABLES

Description

Reinsurance recoveries on unpaid claims

Reinsurance recoverables written off during the year

Ageing of reinsurance recoverables (on paid claims):

Outstanding period

Up to 1 year

Above 1 year but not exceeding 2 years

Above 2 years

Total (3 to 5)

Provision for doubtful reinsurance recoverables

Total (6 - 7) = Row 10 of Form 1

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Outstanding period

Up to 1 year

Above 2 years

Total (3 to 5)

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Outstanding period

Up to 1 year

Above 2 years

Total (3 to 5)

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Outstanding period

Up to 1 year

Above 2 years

Total (3 to 5)

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Outstanding period

Up to 1 year

Above 2 years

Total (3 to 5)

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Outstanding period

Up to 1 year

Above 2 years

Total (3 to 5)

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Outstanding period

Up to 1 year

Above 2 years

Total (3 to 5)

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Outstanding period

Up to 1 year

Above 2 years

Total (3 to 5)

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1H - FIXED ASSETS

Description

Motor vehicles

Computer equipment

Other fixed assets

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Motor vehicles

Computer equipment

Other fixed assets

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Motor vehicles

Computer equipment

Other fixed assets

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Motor vehicles

Computer equipment

Other fixed assets

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Motor vehicles

Computer equipment

Other fixed assets

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Motor vehicles

Computer equipment

Other fixed assets

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Motor vehicles

Computer equipment

Other fixed assets

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Motor vehicles

Computer equipment

Other fixed assets

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1I - INTER-FUND BALANCES AND

Description

Balances due from head office / shareholders fund

Balances due from overseas branches / related corporations

Balances due from other insurance funds established andmaintained under the Act

Row No.

Amount

INTRA-GROUP BALANCES (DUE FROM)

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

Description Row No. Amount

Total = Row 14 of Form 1 26

ANNUAL RETURN: ANNEX 1J - BREAKDOWN OF OTHER ASSETS

Reporting Cycle:

14/04/2015 04:23 PM

Description

Total assets

Balance in the surplus account

Other liabilities

Policy assets (1 - 2 - 3)

Sum of liability in respect of each policy of the participating fund

Minimum condition liability

Policy Liabilities (highest of 4, 5 or 6) = Row 16 of Form 1

Row No.

Amount

ANNUAL RETURN: ANNEX 1K - POLICY LIABILITIES OF PARTICIPATING FUND

Reporting Cycle:

122013

14/04/2015 04:23 PM

Description

Total assets

Other liabilities

Row No.

Amount

Reporting Cycle:

122013

14/04/2015 04:23 PM

Description

Total assets

Other liabilities

Row No.

Amount

Reporting Cycle:

122013

14/04/2015 04:23 PM

Description

Total assets

Other liabilities

Row No.

Amount

Reporting Cycle:

122013

14/04/2015 04:23 PM

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1L - INTER-FUND BALANCES AND

Description

Balances due to head office / shareholders fund

Balances due to overseas branches / related corporations

Balances due to other insurance funds established andmaintained under the Act

Row No.

Amount

INTRA-GROUP BALANCES (DUE TO)

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Row No.

Amount

14/04/2015 04:22 PM

Reporting Cycle: 122013

I567L LIFE INSURANCE CORPORATION (SINGAPORE) PTE. LTD.

ANNUAL RETURN: ANNEX 1M - BREAKDOWN OF OTHERS

14/04/2015 04:23 PM

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1N - SURPLUS

Description

Surplus at beginning of period

Net income

Transfer (to) from head office / shareholders fund

Surplus at End of Period (1 to 3) = Row 25 of Form 1

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Net income

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Net income

Row No.

Amount

2,500,000

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Net income

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Net income

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Net income

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Net income

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

Description

Net income

Row No.

Amount

14/04/2015 04:22 PM

122013

Reporting Cycle:

ANNUAL RETURN: ANNEX 1(i) - INFORMATION IN RESPECT OF REDUCTION IN VALUE OF LIABILITIES

DUE TO REINSURANCE CEDED TO REINSURERS IN RESPECT OF LIFE BUSINESS

Description

Licensed insurer

Authorised reinsurer / related corporation / head office/ branch of head office of the licensed insurer

Unlicensed reinsurer

Total (1 to 3)

Row No.

Participatingpolicies

Non-participatingpolicies

Investment-linkedpolicies

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Licensed insurer

Total (1 to 3)

Row No.

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Licensed insurer

Total (1 to 3)

Row No.

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Licensed insurer

Total (1 to 3)

Row No.

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Licensed insurer

Total (1 to 3)

Row No.

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Licensed insurer

Total (1 to 3)

Row No.

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Licensed insurer

Total (1 to 3)

Row No.

Amount

14/04/2015 04:22:33 PM

122013

Reporting Cycle:

Description

Licensed insurer

Total (1 to 3)

Row No.

Amount

14/04/2015 04:22:33 PM

Description of Assets and Name of Investee Company

Name of company: -

Equity securities

Debt securities

Secured loans

Unsecured loans

Row No.

No. of Units

Amount

A RELATED CORPORATION OF LICENSED INSURER

ANNUAL RETURN: ANNEX 1(iii) - INFORMATION IN RESPECT OF INVESTMENTS IN

Reporting Cycle:

2013 12

14/04/2015 04:23:24 PM

Name of company: -

Equity securities

Debt securities

Secured loans

Unsecured loans

Row No.

No. of Units

Amount

Reporting Cycle:

2013 12

14/04/2015 04:23:24 PM

Name of company: -

Equity securities

Debt securities

Secured loans

Unsecured loans

Row No.

No. of Units

Amount

Reporting Cycle:

2013 12

14/04/2015 04:23:24 PM

Name of company: -

Equity securities

Debt securities

Secured loans

Unsecured loans

Row No.

No. of Units

Amount

Reporting Cycle:

2013 12

14/04/2015 04:23:24 PM

Name of company: -

Equity securities

Debt securities

Secured loans

Unsecured loans

Row No.

No. of Units

Amount

Reporting Cycle:

2013 12

14/04/2015 04:23:24 PM

Name of company: -

Equity securities

Debt securities

Secured loans

Unsecured loans

Row No.

No. of Units

Amount

Reporting Cycle:

2013 12

14/04/2015 04:23:24 PM

Name of company: -

Equity securities

Debt securities

Secured loans

Unsecured loans

Row No.

No. of Units

Amount

Reporting Cycle:

2013 12

14/04/2015 04:23:24 PM

Name of company: -

Equity securities

Debt securities

Secured loans

Unsecured loans

Row No.

No. of Units

Amount

Reporting Cycle:

2013 12

14/04/2015 04:23:24 PM

ANNUAL RETURN: NOTES TO FORM 1

Note 1 The aggregate amounts of loans to and amounts due from - Amount

(a) Directors 0

(b) Employees of the licensed insurer 0

Note 3 - Description of any change in accounting policies and methodologies in the valuation ofassets and liabilities and the quantification of their effects.

Note 4 - Description of any prior adjustment and correction for errors and reasons for theadjustments and corrections.

Note 5 In respect of financial guarantee business - Amount

(a) where premiums are payable in instalments, the present value of futureinstalment premiums payable by the insured in a future accounting period 0

and discount rate used 0

(b) where the premiums are payable in full at the commencement of the policy ofinsurance, the full amount of the premiums payable by the insured in the accountingperiod in which the policy commences.

14/04/2015 04:23 PM

(a) Directors 0

14/04/2015 04:23 PM

(a) Directors 0

14/04/2015 04:23 PM

(a) Directors 0

14/04/2015 04:23 PM

(a) Directors 0

14/04/2015 04:23 PM

(a) Directors 0

14/04/2015 04:23 PM

(a) Directors 0

14/04/2015 04:23 PM

(a) Directors 0

14/04/2015 04:23 PM

ANNUAL RETURN: FORM 1 - ADDITIONAL INFORMATION

Annex 1 N Row 3(SIF nonpar): The funds were transferred on 23rd December 2013 and 30thDecember 2013

14/04/2015 04:21 PM

ANNUAL RETURN: FORM 2 - FUND PROFIT AND LOSS ACCOUNT

Reporting Cycle: 12

Description

Gross premiums

Less: Outward reinsurance premiums

Investment revenue

Less: Investment expenses

Other income

Total Income (1 to 5)

Gross claims settled

Less: Reinsurance recoveries

Management expenses

Distribution expenses

Increase (decrease) in net policy liabilities

Provision for doubtful debts/ bad debts written off on receivables

Taxation expenses

Other expenses

Total Outgo (7 to 14)

Net Income (6 - 15)

RowNo.

Amount

14/04/2015 04:22 PM

Reporting Cycle: 12

Description

Gross premiums

Investment revenue

Other income

Management expenses

Taxation expenses

Other expenses

Net Income (6 - 15)

RowNo.

Amount

14/04/2015 04:22 PM

Reporting Cycle: 12

Description

Gross premiums

Investment revenue

Other income

Management expenses

Taxation expenses

Other expenses

Net Income (6 - 15)

RowNo.

Amount

14/04/2015 04:22 PM

Reporting Cycle: 12

Description

Gross premiums

Investment revenue

Other income

Management expenses

Taxation expenses

Other expenses

Net Income (6 - 15)

RowNo.

Amount

14/04/2015 04:22 PM

Reporting Cycle: 12

Description

Gross premiums

Investment revenue

Other income

Management expenses

Taxation expenses

Other expenses

Net Income (6 - 15)

RowNo.

Amount

14/04/2015 04:22 PM

Reporting Cycle: 12

Description

Gross premiums

Investment revenue

Other income

Management expenses

Taxation expenses

Other expenses

Net Income (6 - 15)

RowNo.

Amount

14/04/2015 04:22 PM

Reporting Cycle: 12

Description

Gross premiums

Investment revenue

Other income

Management expenses

Taxation expenses

Other expenses

Net Income (6 - 15)

RowNo.

Amount

14/04/2015 04:22 PM

Reporting Cycle: 12

Description

Gross premiums

Investment revenue

Other income

Management expenses

Taxation expenses

Other expenses

Net Income (6 - 15)

RowNo.

Amount

14/04/2015 04:22 PM

122013Reporting Cycle:

ANNUAL RETURN: ANNEX 2A - PREMIUM REVENUE IN RESPECT

Description

Individual business:

Single premiums

Regular premiums - new business

Regular premiums - renewal business

Group business:

Premiums

Direct insurance premiums (1 to 4)

Inward reinsurance premiums

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Single premiums

Group business:

Premiums

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Single premiums

Group business:

Premiums

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Single premiums

Group business:

Premiums

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Single premiums

Group business:

Premiums

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Single premiums

Group business:

Premiums

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Single premiums

Group business:

Premiums

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Single premiums

Group business:

Premiums

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

ANNUAL RETURN: ANNEX 2B - OUTWARD REINSURANCE PREMIUMS

Description

Licensed insurer / foreign insurer under the foreign insurerscheme

Authorised reinsurer / related corporation / head office / branch ofhead office of the licensed insurer

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Interest / Dividend /Rental Income

Realised Gains(Losses) From Last

Reported Value /Write-backs(Write-offs)

Unrealised ChangesFrom Last Reported

Amount

122013

Reporting Cycle:

ANNUAL RETURN: Annex 2C - Investment Revenue

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

ANNUAL RETURN: Annex 2C(a) - Investment Revenue Of Assets In Surplus Account Of Participating Fund

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

ANNUAL RETURN: Annex 2C(b) - Investment Revenue Of Assets In Unit Reserves Of Investment-linked Fund

14/04/2015 04:22:48 PM

Description

Equity securities

Debt securities

Land and Buildings

Cash and deposits

Row No.

Amount

122013

Reporting Cycle:

ANNUAL RETURN: Annex 2C(b) - Investment Revenue Of Assets In Unit Reserves Of Investment-linked Fund

14/04/2015 04:22:48 PM

ANNUAL RETURN: ANNEX 2D - BREAKDOWN OF OTHER INCOME

14/04/2015 04:23:41 PM

ANNUAL RETURN: ANNEX 2E - CLAIMS OF DIRECT LIFE INSURER

Description

Death, total permanent disability, critical illness

Accident and health benefits other than total permanent disabilityand critical illness

Maturity / anticipated endowment

Surrenders

Annuities

Cash bonuses

Others

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Surrenders

Annuities

Cash bonuses

Others

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Surrenders

Annuities

Cash bonuses

Others

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Surrenders

Annuities

Cash bonuses

Others

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Surrenders

Annuities

Cash bonuses

Others

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Surrenders

Annuities

Cash bonuses

Others

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Surrenders

Annuities

Cash bonuses

Others

Row No.

Amount

14/04/2015 04:23:28 PM

Description

Surrenders

Annuities

Cash bonuses

Others

Row No.

Amount

14/04/2015 04:23:28 PM

ANNUAL RETURN: ANNEX 2F - MANAGEMENT EXPENSES

Description

Staff salaries & expenses

Office rent

Head office / parent company expenses

Directors' fees

Audit fees

Managing agent's fees

Repairs and maintenance

Public utilities

Printing, stationery and periodicals

Postage, telephone and telex charges

Computer charges

Hire of office equipment

Licence and association fees

Advertising and subscriptions

Entertainment

Travelling expenses

Row No.

Amount

14/04/2015 04:23:45 PM

Description

Office rent

Directors' fees

Audit fees

Public utilities

Computer charges

Entertainment

Travelling expenses

Row No.

Amount

14/04/2015 04:23:45 PM

Description

Office rent

Directors' fees

Audit fees

Public utilities

Computer charges

Entertainment

Travelling expenses

Row No.

Amount

14/04/2015 04:23:45 PM

Description

Office rent

Directors' fees

Audit fees

Public utilities

Computer charges

Entertainment

Travelling expenses

Row No.

Amount

14/04/2015 04:23:45 PM

Description

Office rent

Directors' fees

Audit fees

Public utilities

Computer charges

Entertainment

Travelling expenses

Row No.

Amount

14/04/2015 04:23:45 PM

Description

Office rent

Directors' fees

Audit fees

Public utilities

Computer charges

Entertainment

Travelling expenses

Row No.

Amount

14/04/2015 04:23:45 PM

Description

Office rent

Directors' fees

Audit fees

Public utilities

Computer charges

Entertainment

Travelling expenses

Row No.

Amount

14/04/2015 04:23:45 PM

Description

Office rent

Directors' fees

Audit fees

Public utilities

Computer charges

Entertainment

Travelling expenses

Row No.

Amount

14/04/2015 04:23:45 PM

ANNUAL RETURN: ANNEX 2G - DISTRIBUTION EXPENSES IN RESPECT

Description

First period commissions - single premium

First period commissions - regular premium

Renewal commissions

Group business:

Commissions

Overriding commissions

Production and other bonuses

Trailer fees

Cost of benefits and services

Other cash payments

Total distribution cost excluding reinsurance commissions (1 to 9)

Reinsurance commissions

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Renewal commissions

Group business:

Commissions

Trailer fees

Other cash payments

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Renewal commissions

Group business:

Commissions

Trailer fees

Other cash payments

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Renewal commissions

Group business:

Commissions

Trailer fees

Other cash payments

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Renewal commissions

Group business:

Commissions

Trailer fees

Other cash payments

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Renewal commissions

Group business:

Commissions

Trailer fees

Other cash payments

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Renewal commissions

Group business:

Commissions

Trailer fees

Other cash payments

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Renewal commissions

Group business:

Commissions

Trailer fees

Other cash payments

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

ANNUAL RETURN: ANNEX 2H - NET POLICY LIABILITIES IN RESPECT

Description

Net policy liabilities at end of period

Net policy liabilities at beginning of period

Increase (Decrease) in Net Policy Liabilities (1 - 2) = Row 11 of Form 2

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

Description

Row No.

Amount

OF LIFE BUSINESS

14/04/2015 04:23:28 PM

ANNUAL RETURN: ANNEX 2I - BREAKDOWN OF OTHER EXPENSES

Reporting Cycle:

14/04/2015 04:23:52 PM

Description

Allocation to surplus account

Surplus account investment revenue

Less: Surplus account investment expenses

Surplus account investment income (2 - 3)

Recovery of amount transferred out of the surplus account if ithas not been transferred back into the surplus account previously

Net Income (1 + 4 + 5) = Row 16 of Form 2

Row No.

Amount

ANNUAL RETURN: ANNEX 2J - NET INCOME OF PARTICIPATING FUND

Reporting Cycle:

122013

14/04/2015 04:23:06 PM

Description

Row No.

Amount

Reporting Cycle:

122013

14/04/2015 04:23:06 PM

Description

Row No.

Amount

Reporting Cycle:

122013

14/04/2015 04:23:06 PM

Description

Row No.

Amount

Reporting Cycle:

122013

14/04/2015 04:23:06 PM

Reporting Cycle: 2013 12

14/04/2015 04:22 PM

ANNUAL RETURN: FORM 3 - STATEMENT IN RESPECT OF LIFE BUSINESS OF DIRECT LIFE INSURER RELATING TO POLICIESISSUED TO INDIVIDUALS

Description

A. New Business Policies other than annuities - Whole life Endowment Term Accident Health Others Total (1 to 6) Annuities only

B. Terminations and transfers Policies other than annuities -

Maturity Expiry Surrender Forfeiture Net transfers Others Total (9 to 15) Annuities onlyC. Business in Force Policies other than annuities - Whole life Endowment Term Accident Health Others Total (18 to 23) Annuities only (last period's 25 + 8 -17)

RowNo.

12345678

1011121314151617

1819202122232425

Single PremiumBusiness - Single

Premium

00000000

Single PremiumBusiness -Number of

Policies

00000000

Single PremiumBusiness - Sum

Insured

00000000

Regular PremiumBusiness -

Regular Premium

00000000

Regular PremiumBusiness -Number of

Policies

00000000

Regular PremiumBusiness - Sum

Insured

00000000

14/04/2015 04:22 PM

Description

RowNo.

12345678

1011121314151617

1819202122232425

Premium

00000000

Policies

00000000

Insured

00000000

Regular Premium

00000000

Policies

00000000

Insured

00000000

14/04/2015 04:22 PM

Description

RowNo.

12345678

1011121314151617

1819202122232425

Premium

00000000

Policies

00000000

Insured

00000000

Regular Premium

00000000

Policies

00000000

Insured

00000000

14/04/2015 04:22 PM

Description

RowNo.

12345678

1011121314151617

1819202122232425

Premium

00000000

Policies

00000000

Insured

00000000

Regular Premium

00000000

Policies

00000000

Insured

00000000

14/04/2015 04:22 PM

Description

RowNo.

12345678

1011121314151617

1819202122232425

Premium

00000000

Policies

00000000

Insured

00000000

Regular Premium

00000000

Policies

00000000

Insured

00000000

14/04/2015 04:22 PM

Description

RowNo.

12345678

1011121314151617

1819202122232425

Premium

00000000

Policies

00000000

Insured

00000000

Regular Premium

00000000

Policies

00000000

Insured

00000000

14/04/2015 04:22 PM

Description

RowNo.

12345678

1011121314151617

1819202122232425

Premium

00000000

Policies

00000000

Insured

00000000

Regular Premium

00000000

Policies

00000000

Insured

00000000

14/04/2015 04:22 PM

Description

RowNo.

12345678

1011121314151617

1819202122232425

Premium

00000000

Policies

00000000

Insured

00000000

Regular Premium

00000000

Policies

00000000

Insured

00000000

14/04/2015 04:22 PM

Reporting Cycle:

Single Premium Regular Premium

14/04/2015 04:25 PM

FORM 2 - ADDITIONAL INFORMATION

14/04/2015 04:22 PM

ANNUAL RETURN: FORM 4 - STATEMENT IN RESPECT OF LIFE BUSINESS OF DIRECT LIFE INSURER RELATING TOGROUP POLICIES

Description

A. New Business

Policies other than annuities - Term Accident Health Others Total (1 to 4) Annuities onlyB. Increases under existing policies Policies other than annuities Annuities onlyC. Terminations Policies other than annuities - Expiry Death, total permanent disability, critical illness Others

Total (9 to 11) Annuities onlyD. Business in Force Policies other than annuities - Term Accident Health Others

Total (14 to 17)

Annuities only (last period's 19 + 6 + 8 - 13)

RowNo.

123456

14151617

Number ofPolicies

000000

Number ofLives Covered

000000

Sum Insured

000000

Premiums -Single

000000

Premiums -Regular

000000

14/04/2015 04:22 PM

Description

A. New Business

Total (14 to 17)

RowNo.

123456

14151617

Number ofPolicies

000000

Sum Insured

000000

Premiums -Single

000000

Premiums -Regular

000000

14/04/2015 04:22 PM

Description

A. New Business

Total (14 to 17)

RowNo.

123456

14151617

Number ofPolicies

000000

Sum Insured

000000

Premiums -Single

000000

Premiums -Regular

000000

14/04/2015 04:22 PM

Description

A. New Business

Total (14 to 17)

RowNo.

123456

14151617

Number ofPolicies

000000

Sum Insured

000000

Premiums -Single

000000

Premiums -Regular

000000

14/04/2015 04:22 PM

Description

A. New Business

Total (14 to 17)

RowNo.

123456

14151617

Number ofPolicies

000000

Sum Insured

000000

Premiums -Single

000000

Premiums -Regular

000000

14/04/2015 04:22 PM

Description

A. New Business

Total (14 to 17)

RowNo.

123456

14151617

Number ofPolicies

000000

Sum Insured

000000

Premiums -Single

000000

Premiums -Regular

000000

14/04/2015 04:22 PM

Description

A. New Business

Total (14 to 17)

RowNo.

123456

14151617

Number ofPolicies

000000

Sum Insured

000000

Premiums -Single

000000

Premiums -Regular

000000

14/04/2015 04:22 PM

Description

A. New Business

Total (14 to 17)

RowNo.

123456

14151617

Number ofPolicies

000000

Sum Insured

000000

Premiums -Single

000000

Premiums -Regular

000000

14/04/2015 04:22 PM

Reporting Cycle: 12

Note 2 - Number of dependants covered under group policies (Column 2, Row 18).

Number of dependants covered under group policies Single Premium Regular Premium

Total 0

14/04/2015 04:25 PM

Reporting Cycle: 12

Total 0

14/04/2015 04:25 PM

Reporting Cycle: 12

Total 0

14/04/2015 04:25 PM

Reporting Cycle: 12

Total 0

14/04/2015 04:25 PM

Reporting Cycle: 12

Total 0

14/04/2015 04:25 PM

Reporting Cycle: 12

Total 0

14/04/2015 04:25 PM

Reporting Cycle: 12

Total 0

14/04/2015 04:25 PM

Reporting Cycle: 12

Total 0

14/04/2015 04:25 PM

FORM 2 - ADDITIONAL INFORMATION

14/04/2015 04:22 PM

Form 7(a) - Accident and Health Insurance (Long-term)

ANNUAL RETURN: FORM 7 - STATEMENT IN RESPECT OF ACCIDENT AND HEALTH INSURANCE

12Reporting Cycle: 2013

Description

A. PREMIUMS

Gross premiums

Reinsurance ceded

Net premiums written (1 - 2)

Premium liabilities at beginning of period

Premium liabilities at end of period

Premiums earned during the period (3 + 4 - 5)

B. CLAIMS

Reinsurance recoveries

Net claims settled (7 - 8)

Claims liabilities at end of period

Claims liabilities at beginning of period

Net claims incurred (9 + 10 - 11)

C. MANAGEMENT EXPENSES

Management expenses

D. DISTRIBUTION EXPENSES

Commissions

Net commissions incurred (14 - 15)

Other distribution expenses

E. UNDERWRITING RESULTS (6 - 12 - 13 - 16 - 17)

F. NET INVESTMENT INCOME

G. OPERATING RESULTS (18 + 19)

H. OTHERS

Number of policies in force

Number of lives covered under policies in force

Number of claims registered

RowNo.

MedicalExpense

Individual

MedicalExpense

Critical Illness

Individual

Critical Illness

Disability

Individual

Disability

PersonalAccident

Individual

PersonalAccident

Hospital Cash

Individual

Hospital Cash

Individual

14/04/2015 04:22 PM

Form 7(b) - Accident and Health Insurance (Short-term)

ANNUAL RETURN: FORM 7 - STATEMENT IN RESPECT OF ACCIDENT AND HEALTH INSURANCE

Description

A. PREMIUMS

Gross premiums

Reinsurance ceded

Net premiums written (1 - 2)

Premium liabilities at beginning of period

Premium liabilities at end of period

Premiums earned during the period (3 + 4 - 5)

B. CLAIMS

Reinsurance recoveries

Net claims settled (7 - 8)

Claims liabilities at end of period

Claims liabilities at beginning of period

Net claims incurred (9 + 10 - 11)

C. MANAGEMENT EXPENSES

Management expenses

D. DISTRIBUTION EXPENSES

Commissions

Net commissions incurred (14 - 15)

Other distribution expenses

E. UNDERWRITING RESULTS (6 - 12 - 13 - 16 - 17)

F. NET INVESTMENT INCOME

G. OPERATING RESULTS (18 + 19)

H. OTHERS

Number of policies in force

Number of lives covered under policies in force

Number of claims registered

RowNo.

MedicalExpense

Individual

MedicalExpense

Critical Illness

Individual

Critical Illness

Disability

Individual

Disability

PersonalAccident

Individual

PersonalAccident

Hospital Cash

Individual

Hospital Cash

Individual

14/04/2015 04:22 PM

Reporting Cycle:

Note 1 - Items in this Form may be allocated according to a reasonable basis used by thelicensed insurer. The bases used shall be stated as a Note to this Form.

14/04/2015 04:25 PM

14/04/2015 04:22 PM

ANNUAL RETURN: FORM 8 - BALANCE SHEET IN RESPECT OF GLOBAL BUSINESS OPERATIONS

Description

ASSETSEquity securitiesDebt securitiesLand and buildings

Cash and depositsOther invested assets

Deposits withheld by cedantsReinsurance recoverables (on paid claims)Income tax recoverables

Fixed assets

Inter-fund balances and intra-group balances (due from)

Other assetsTotal Assets (1 to 14)LIABILITIESPolicy liabilitiesOther liabilities

Outstanding claims Annuities due and unpaid

Reinsurance deposits Amounts owing to insurers Bank loans and overdrafts

Inter-fund balances and intra-group balances (due to) OthersTotal Liabilities (16 to 23)NET ASSETS (15 - 24)SHAREHOLDERS' EQUITY & SURPLUSPaid-up capital

Reserves: Unappropriated profits (losses)

Other reservesSurplus

Total (26 to 29)

RowNo.

192021

22232425

Business in Singapore- Life Business

2,500,0000

02,500,000

2,500,000

Business in Singapore- General Business

Overseas (Branch)Operations - Life

Business

Overseas (Branch)Operations - General

Business

Shareholders Fund

17,771,1070

33,603

538,988

276,74518,620,443

031,30831,308

18,589,135

23,930,000

-5,340,865

18,589,135

20,271,1070

33,603

538,988

276,74521,120,443

031,30831,308

21,089,135

23,930,000

-5,340,865

02,500,000

21,089,135

14/04/2015 04:22 PM

ANNUAL RETURN: ANNEX 8A - STATEMENT OF CHANGES IN EQUITY OF SHAREHOLDERS FUND

Description

Balance at beginning of period

Changes in accounting policy

Increase (decrease) in reserves

Net profit for the period

Dividends paid for the period

Issue of share capital

Transfer (to) from insurance funds maintained in Singapore

Transfer (to) from overseas (branch) operations

Balance at End of Period

Row No.

Paid-up Capital

23,930,000

Other Reserves

UnappropriatedProfits (Losses)(Please Specify)

-715,559

-2,125,306

-2,500,000

-5,340,865

23,214,441

-2,125,306

-2,500,000

18,589,135

14/04/2015 04:24 PM

ANNUAL RETURN: ANNEX 8B - INTRA-GROUP BALANCES IN RESPECT OF OVERSEAS OPERATIONS(GENERAL BUSINESS)

Description

Due From

Balances due from related corporations

Balances due from insurance funds established and maintained under theAct

Total Balances Due From

Due To

Balances due to related corporations

Balances due to insurance funds established and maintained under the Act

Total Balances Due To

Total Net Balances (4 - 8)

Row No.

Amount

14/04/2015 04:25 PM

ANNUAL RETURN: ANNEX 8C - INTRA-GROUP BALANCES IN RESPECT OF OVERSEAS OPERATIONS (LIFEBUSINESS)

Description

Due From

Balances due from related corporations

Balances due from insurance funds established and maintained under theAct

Total Balances Due From

Due To

Balances due to related corporations

Balances due to insurance funds established and maintained under the Act

Total Balances Due To

Total Net Balances (4 - 8)

Row No.

Amount

14/04/2015 04:24 PM

Reporting Cycle:

Note 1 Breakdown of "Other Reserves" Row No. Amount

14/04/2015 04:24 PM

The Company obtained its insurance license on 22 January 2013. This is the first year that theCompany submitted annual MAS returns. With reference to Annex 8A row 1, the Company raisedshare capital and incurred other operating expenses in year 2012.

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ANNUAL RETURN: FORM 9 - PROFIT AND LOSS ACCOUNT IN RESPECT OF GLOBAL BUSINESS OPERATIONS

Description

Gross premiums

Investment revenue

Other income

Management expenses

Provision for doubtful debts / bad debts writtenoff on receivables

Taxation expenses

Other expenses

NET INCOME (6 - 15)

Row No.

Business inSingapore - Life

Business

Business inSingapore -

GeneralBusiness

Overseas(Branch)

Operations -Life Business

Overseas(Branch)

Operations -General

Business

ShareholdersFund

137,273

2,262,579

-2,125,306

137,273

2,262,579

-2,125,306

14/04/2015 04:24 PM

Form14(a)(i) - Policy Liabilities of Participating Fund

Description

Group 1 - Participating Policies

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Acccident and Health

Annuity

Others

Sub total (1 to 8)

RowNo.

Particulars ofthe PoliciesValuation

Number ofPolicies

Sum Insured

OfficePremuims

Present ValueStatistics

Benefits

Expenses

Premiums

NegativeReserves

ANNUAL RETURN: FORM 14 - ABSTRACT OF VALUATION RESULTS OF LIFE BUSINESS OF DIRECT LIFE INSURER

Life: Singapore Insurance Fund

Group 2 - Non-Participating Policies

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Sub total (10 to 17)

Total (9 +18)

Number of Policies

Sum Insured

Office Premuims

Benefits

Expenses

Premiums

Negatve Reserves

Present Value Statistics Total

14/04/2015 04:25 PM

Form14(a)(ii) - Minimum Condition Liability of Participating Fund

Description

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Sub total (1 to 8)

RowNo.

Number ofPolicies

Sum Insured

OfficePremuims

Benefits

Expenses

Premiums

NegativeReserves

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Total (9 +18)

Number of Policies

Sum Insured

Office Premuims

Benefits

Expenses

Premiums

Negatve Reserves

14/04/2015 04:25 PM

Form14(a)(i) - Policy Liabilities of Participating Fund

Description

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Sub total (1 to 8)

RowNo.

Number ofPolicies

Sum Insured

OfficePremuims

Benefits

Expenses

Premiums

NegativeReserves

Life: Offshore Insurance Fund

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Total (9 +18)

Number of Policies

Sum Insured

Office Premuims

Benefits

Expenses

Premiums

Negatve Reserves

14/04/2015 04:25 PM

Form14(a)(ii) - Minimum Condition Liability of Participating Fund

Description

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Sub total (1 to 8)

RowNo.

Number ofPolicies

Sum Insured

OfficePremuims

Benefits

Expenses

Premiums

NegativeReserves

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Total (9 +18)

Number of Policies

Sum Insured

Office Premuims

Benefits

Expenses

Premiums

Negatve Reserves

14/04/2015 04:25 PM

Form14(b) - Policy Liabilities of Non-Participating Fund

Description

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Total (1 to 8)

RowNo.

Number ofPolicies

Sum Insured

OfficePremuims

Benefits

Expenses

Premiums

NegativeReserves

14/04/2015 04:25 PM

Form14(c) - Policy Liabilities of Investment-Linked Fund

Description

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Total (1 to 8)

RowNo.

Number ofPolicies

Sum Insured

OfficePremuims

Benefits

Expenses

Premiums

NegativeReserves

Unit Reserves

14/04/2015 04:25 PM

Form14(b) - Policy Liabilities of Non-Participating Fund

Description

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Total (1 to 8)

RowNo.

Number ofPolicies

Sum Insured

OfficePremuims

Benefits

Expenses

Premiums

NegativeReserves

14/04/2015 04:25 PM

Form14(c) - Policy Liabilities of Investment-Linked Fund

Description

Whole Life

- Single Premium

- Regular Premium

Endowment

- Single Premium

- Regular Premium

Annuity

Others

Total (1 to 8)

RowNo.

Number ofPolicies

Sum Insured

OfficePremuims

Benefits

Expenses

Premiums

NegativeReserves

Unit Reserves

14/04/2015 04:25 PM

Description Row No. From 01/01/2013 to 31/12/2013

Sources of net income arising in the year:

New Business

Mortality/Morbidity

Forfeiture/Surrender

Interest

Expense

Change in basis

Miscellaneous

Total (1 to 7)

Actual

Expected

Actual LessExpected

ANNUAL RETURN: FORM 16 - STATEMENT OF ANALYSIS OF EXPERIENCE OF INSURANCE FUND INRESPECT OF LIFE BUSINESS

14/04/2015 04:24 PM

New Business

Mortality/Morbidity

Interest

Expense

Change in basis

Miscellaneous

Total (1 to 7)

Actual

Expected

Actual LessExpected

14/04/2015 04:24 PM

New Business

Mortality/Morbidity

Interest

Expense

Change in basis

Miscellaneous

Total (1 to 7)

Actual

Expected

Actual LessExpected

14/04/2015 04:24 PM

New Business

Mortality/Morbidity

Interest

Expense

Change in basis

Miscellaneous

Total (1 to 7)

Actual

Expected

Actual LessExpected

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New Business

Mortality/Morbidity

Interest

Expense

Change in basis

Miscellaneous

Total (1 to 7)

Actual

Expected

Actual LessExpected

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New Business

Mortality/Morbidity

Interest

Expense

Change in basis

Miscellaneous

Total (1 to 7)

Actual

Expected

Actual LessExpected

14/04/2015 04:24 PM

New Business

Mortality/Morbidity

Interest

Expense

Change in basis

Miscellaneous

Total (1 to 7)

Actual

Expected

Actual LessExpected

14/04/2015 04:24 PM

New Business

Mortality/Morbidity

Interest

Expense

Change in basis

Miscellaneous

Total (1 to 7)

Actual

Expected

Actual LessExpected

14/04/2015 04:24 PM

ANNUAL RETURN: FORM 17 - ACTUARY'S CERTIFICATE ON POLICY LIABILITIES INRESPECT OF LIFE BUSINESS

Reporting Cycle:

Description

Participating Fund

Non-Participating Fund

Investment-Linked Fund

*Qualifications (if non, state "none"):

I have conducted an investigation into the valuation of policy liabilities relating to life business asrequired under section 37 of the Insurance Act and confirm that the valuation is in accordance withall applicable requirements stipulated under the Act and directions issued under the Act, subject tothe qualifications stated below*. I certify these amounts as follows:

ACTUARIAL INVESTIGATION OF POLICY LIABILITIES

14/04/2015 04:24 PM

Reporting Cycle:

14/04/2015 04:24 PM

ANNUAL RETURN: FORM 18 - STATEMENT OF PARTICIPATING FUND ALLOCATIONS

Description

Bonus payments made to policy owners in anticipationof allocation

Allocation to policy owners:

Cash Bonus

Reversionary Bonus

Terminal Bonus

Total amt to policy owners (1 to 4)

Row No.

SingaporeInsurance Fund

OffshoreInsurance Fund

14/04/2015 04:24 PM

ANNUAL RETURN: FORM 19 - ACTUARY'S CERTIFICATE ON PARTICIPATING FUNDALLOCATIONS

Reporting Cycle:

I have conducted an investigation into the bonus allocation of the participating fund to policyowners and the surplus account as required under section 17(6) of the Insurance Act and it is myopinion that the allocation is fair and equitable, having taken into account the prospective financialconditions of the participating fund, and is in accordance with the Insurance (Actuaries) Regulations2004 (G.N. No. S 495/2004) subject to the qualifications stated below*.

The amount of bonus to policy owners and allocation to the surplus account are as shown below:

Description

Bonus payments made to policy owners in anticipationof allocation

Allocation to policy owners:

Cash Bonus

Reversionary Bonus

Terminal Bonus

Total amount to policy owners (1 to 4)

RowNo.

*Qualifications (if non, state "none"):

14/04/2015 04:24 PM

Reporting Cycle:

14/04/2015 04:24 PM

ANNUAL RETURN: FORM 21 - STATEMENT IN RELATION TO FUND SOLVENCY REQUIREMENT OFINSURANCE FUND

Reporting Cycle:

Description

(i) Financial Resources of Insurance Fund

Balance in the surplus account (of participating fund)

Allowance for provision for non-guaranteed benefits

(of participating fund): (lower of 3 or 4)

Policy liabilities - minimum condition liability

50% of aggregate of provisions for non-guaranteed benefits and PAD

Surplus of insurance fund (of any other insurance fund)

Reinsurance adjustment

Financial resource adjustment: (8 to 12)

(a) loans to, guarantees granted for, and other

unsecured amounts owed to the licensed insurer

(b) charged assets

(c) deferred tax assets

(d) intangible assets

(e) other financial resource adjustments

Financial Resources of Insurance Fund

(1 + 2 + 5 - 6 - 7)

(ii) Total Risk Requirement of Insurance Fund

A. Component 1 Requirement - Insurance Risks

Life Insurance Risk Requirement

(for participating fund): (15 + 18)

(a) Policy Liability Risk Requirement:

(zero or 16 - 17, whichever is higher)

Modified minimum condition liability

(b) Surrender Value Condition Risk Requirement:

Aggregate of surrender values of policies of the insurance fund

Higher of 21 or 22:

Sum of total risk requirement and minimum condition

liability of the insurance fund

Policy liabilities of the insurance fund

(other than participating fund) (24 + 27)

Modified policy liabilities

Policy Liabilities

Sum of total risk requirement and policy liabilities of the insurance fund

General Insurance Risk Requirement

(for general business): (31 to 32)

(a) Premium liability risk requirement

(b) Claim liability risk requirement

Total C1 Requirement (14 + 23 + 30)

B. Component 2 Requirement - Investment Risks and Risks arising

from Interest Rate Sensitivity and Foreign Currency Mismatch

between Asset and Liabilities

Equity Investment Risk Requirement (35 to 36)

(a) Specific Risk Requirement

Row No.

Amount

2013 12

14/04/2015 04:22:18 PM

(b) General Risk Requirement

Debt Investment and Duration Mismatch Risk Requirement:

(38 or 43, whichever is higher)

(a) Sum of: (39 + 42)

Debt investment risk requirement in an increasing interest rate

environment (40 to 41)

Debt specific risk requirement

Debt general risk requirement

Liability adjustment requirement in an increasing interest rate environment

(b) Sum of: (44 + 47)

Debt investment risk requirement in a decreasing interest rate

Negative of debt general risk requirement

Liability adjustment requirement in a decreasing interest rate environment

Loan Investment Risk Requirement

Property Risk Requirement

Foreign Currency Mismatch Risk Requirement (for Singapore Insurance Fund)

Derivative Counterparty Risk Requirement

Miscellaneous Risk Requirement

Total C2 Requirement (34 + 37 + 48 + 49 + 50 + 51 + 52)

C. Component 3 Requirement - Concentration Risks Counterparty Exposure Equity Securities Exposure Unsecured Loans Exposure Property Exposure Foreign Currency Risk Exposure Exposure to assets in miscellaneous risk requirements

Exposure to non-liquid assets with Singapore Insurance Fund

(for general business)

Total C3 Requirement (54 to 60)

Total Risk Requirement of Insurance Fund (33 + 53 +61)

545556575859

000000

14/04/2015 04:22:18 PM

Reporting Cycle:

Description

(b) charged assets

(1 + 2 + 5 - 6 - 7)

Higher of 21 or 22:

Policy Liabilities

Row No.

Amount

2013 12

14/04/2015 04:22:18 PM

(a) Sum of: (39 + 42)

(b) Sum of: (44 + 47)

545556575859

000000

14/04/2015 04:22:18 PM

Reporting Cycle:

Description

(b) charged assets

(1 + 2 + 5 - 6 - 7)

Higher of 21 or 22:

Policy Liabilities

Row No.

Amount

2,500,000

2013 12

14/04/2015 04:22:18 PM

(a) Sum of: (39 + 42)

(b) Sum of: (44 + 47)

545556575859

000000

14/04/2015 04:22:18 PM

Reporting Cycle:

Description

(b) charged assets

(1 + 2 + 5 - 6 - 7)

Higher of 21 or 22:

Policy Liabilities

Row No.

Amount

2013 12

14/04/2015 04:22:18 PM

(a) Sum of: (39 + 42)

(b) Sum of: (44 + 47)

545556575859

000000

14/04/2015 04:22:18 PM

Reporting Cycle:

Description

(b) charged assets

(1 + 2 + 5 - 6 - 7)

Higher of 21 or 22:

Policy Liabilities

Row No.

Amount

2013 12

14/04/2015 04:22:18 PM

(a) Sum of: (39 + 42)

(b) Sum of: (44 + 47)

545556575859

000000

14/04/2015 04:22:18 PM

Reporting Cycle:

Description

(b) charged assets

(1 + 2 + 5 - 6 - 7)

Higher of 21 or 22:

Policy Liabilities

Row No.

Amount

2013 12

14/04/2015 04:22:18 PM

(a) Sum of: (39 + 42)

(b) Sum of: (44 + 47)

545556575859

000000

14/04/2015 04:22:18 PM

Reporting Cycle:

Description

(b) charged assets

(1 + 2 + 5 - 6 - 7)

Higher of 21 or 22:

Policy Liabilities

Row No.

Amount

2013 12

14/04/2015 04:22:18 PM

(a) Sum of: (39 + 42)

(b) Sum of: (44 + 47)

545556575859

000000

14/04/2015 04:22:18 PM

Reporting Cycle:

Description

(b) charged assets

(1 + 2 + 5 - 6 - 7)

Higher of 21 or 22:

Policy Liabilities

Row No.

Amount

2013 12

14/04/2015 04:22:18 PM

(a) Sum of: (39 + 42)

(b) Sum of: (44 + 47)

545556575859

000000

14/04/2015 04:22:18 PM

ANNUAL RETURN: FORM 22 - STATEMENT IN RELATION TO TOTAL RISK REQUIREMENT OF ASSETS ANDLIABILITIES OF LICENSED INSURER THAT DO NOT BELONG TO ANY INSURANCE FUND ESTABLISHED AND

MAINTAINED UNDER THE ACT

Description

(i) Total Risk Requirement

Life Insurance Risk Requirement:

(for participating business only) (2 + 5)

(a) Policy Liability Risk Requirement: (zero or 3 - 4, whichever is higher)

(b) Surrender Value Condition Risk Requirement: (zero or 6 - 7, whichever is higher)

Aggregate of surrender values of policies

Higher of 8 or 9:

Sum of total risk requirement and minimum condition liability

Policy liabilities

Life Insurance Risk Requirement: (other than participating business) (11 + 14)

(a) Policy Liability Risk Requirement: (zero or 12 - 13, whichever is higher)

Policy liabilities

(b) Surrender Value Condition Risk Requirement: (zero or 15 - 16, whichever is higher)

Aggregate of surrender values of policies

Sum of total risk requirement and policy liabilities

General Insurance Risk Requirement (for general business) (18 to 19)

B. Component 2 Requirement - Investment Risks and Risks arising from Interest

Rate Sensitivity and Foreign Currency Mismatch between Asset and Liabilities

Equity Investment Risk Requirement: (22 to 23)

(a) Sum of: (26 + 29)

Debt investment risk requirement in an increasing interest rate environment

(27 to 28)

(b) Sum of: (31 + 34)

Debt investment risk requirement in a decreasing interest rate environment

(32 to 33)

Row No.

Amount

14/04/2015 04:24:26 PM

Total C2 Requirement (21 + 24 + 35 + 36 + 37 + 38)

Total Risk Requirement of Assets and Liabilities of Licensed Insurer that do not

belong to any insurance fund established and maintained under the Act (20 + 39)

239,972

14/04/2015 04:24:26 PM

FORM 23 - STATEMENT IN RELATION TO CAPITAL ADEQUACY REQUIREMENT OF LICENSED INSURER

ANNUAL RETURN

Description

(i) Financial Resources of Licensed Insurer

A. Tier 1 Resource

Aggregate of surpluses of all insurance funds other than a participating fund

Balances in the surplus account of each participating fund

Paid-up ordinary share capital

Unappropriated profits (losses)

Surpluses of Overseas Branch Operations

Irredeemable and non-cumulative preference shares

Any other capital instrument approved by the Authority as a Tier 1 resource

(a) loans to, guarantees granted for and other unsecured amounts owed to

the licensed insurer

(b) charged assets

Total Tier 1 Resource (1 to 7 less 8 to 9)

B. Tier 2 Resource

Irredeemable and non-cumulative preference shares not recognised

as Tier 1 resource

Irredeemable and non-cumulative preference shares

Other Tier 2 resource

Total Tier 2 Resource (16 to 18)

C. Aggregate of allowance for provisions for non-guaranteed benefits

of participating funds

Financial Resources of Licensed Insurer (higher of $5m or 15 + 19 +20)

(ii) Total Risk Requirement of Licensed Insurer

(a) Total risk requirements of insurance funds established or maintained

under the Act

(b) Total risk requirements of assets and liabilities that do not belong to any

insurance fund established and maintained under the Act

Total Risk Requirement of Licensed Insurer (22 to 23)

CAPITAL ADEQUACY RATIO (21/24)

Row No.

Amount

239,972

2,500,000

23,930,000

-5,340,865

21,089,135

246,222

8565.09 %

14/04/2015 04:22:26 PM

2013 12Reporting Cycle:

14/04/2015 04:22:26 PM

ANNUAL RETURN: FORM 1 - FUND BALANCE SHEET I567L LIFE ... · I567L LIFE INSURANCE CORPORATION...

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