Annex. 1.19. Statement of Premium Information

STATEMENT OF PREMIUM INFORMATION	INS500
Name:
Period Ending:
(All amounts rounded to nearest [USD]’000)

Number of policies sold during the period	Line no.	Current quarter	Current year to date
		A	B
Commercial	1
of which:
New policies	2
Renewals	3
Retail	4
of which:
New policies	5
Renewals	6
Number of policies cancelled or not renewed during the period
		Current quarter	Current year to date
Commercial	7
Retail	8
Premium value of policies cancelled or not renewed during the period
		Current quarter	Current year to date
Commercial	9
Retail	10

Gross Premium receivable	Line no.	Not yet due to 90 days overdue	91-180 days	180+ days
		A	B	C
from direct customers	11
from brokers and other intermediaries	12

Premium Breakdown Amount ('000)

Line of business

Line no.

Risk located in Kazakhstan

Risk located in the rest of the Eurasian Economic Union

Risk located in North America

Risk located in Europe

Risk located in the rest of the world

Retail Business

Commercial Business

Renewed policies

New Business

Unrelated business

Related Business

Direct writing

Facultative Reinsurance: Proportional

Facultative Reinsurance: Non-Proportional

Treaty Reinsurance: Proportional

Treaty Reinsurance: Non-Proportional

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

Gross Premium Written

Net Premium Written

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

S

T

U

V

W

X

Y

Z

AA

BB

CC

DD

EE

FF

Accident

13

Sickness

14

Land veAccidenthicles

15

Railway rolling stock

16

Aircraft

17

Ships

18

Goods in transit

19

Fire and natural forces

20

Damage to property

21

Motor vehicle liability

22

Aircraft liability

23

Liability of ships

24

General liability

25

Credit

26

Suretyship

27

Miscellaneous financial loss

28

Legal expenses

29

Assistance

30

Space

31

Space liabilities

32

Life and annuity

33

Marriage and birth

34

Linked long-term

35

Permanent health

36

TOTAL:

37

Name/ Position	Signature	Date
Name/ Position	Signature	Date

Instructions on Annex 1.19. template on Statement of Premium Information to the Manual is aimed at reporting on premiums.

Statement of Premium Information must be recorded and reported in compliance with the International Financial Reporting Standards and requirements of the AIFC.

Number of policies sold during the period:

Line 1. Number of commercial policies sold during the period – is the number of commercial policies sold during current period (column A) and current year to date (column B) with specifications in line 2. New policies and line 3. Renewals.

Line 4. Number of retail policies sold during the period – is the number of retail policies sold during current period (column A) and current year to date (column B) with specifications in line 5. New policies and line 6. Renewals.

Number of policies cancelled or not renewed during the period must be specified in line 7. Commercial and line 8. Retail for current period (column A) and current year to date (column B).

Premium value of policies cancelled or not renewed during the period must be specified in line 9. Commercial and line 10. Retail for current period (column A) and current year to date (column B).

Gross Premium receivables specified in line 11. From direct customers and line 12. From broker and other intermediaries for current period (column A) and current year to date (column B).

Premium Breakdown – information on Premium must be provided by information on Risk located in Kazakhstan, Risk located in the rest of the Eurasian Economic Union, Risk located in North America, Risk located in Europe, Risk located in the rest of the world, Retail Business, Commercial Business, Renewed policies, New Business, Unrelated business, Related Business, Direct writing, Facultative Reinsurance: Proportional, Facultative Reinsurance: Non-Proportional, Treaty Reinsurance: Proportional, Treaty Reinsurance: Non-Proportional segregated by Gross and Net Premium written by line of business (categories).