FORM B-RA

FORM B-RA

Name of the Insurer:

Registration No. and Date of Registration with the IRDA

REVENUE ACCOUNT FOR THE YEAR ENDED 31^ST MARCH, 20___.

		Particulars	Schedule	Current Year	Previous Year
				(Rs.’000)	(Rs.’000)
1.		Premiums earned (Net)	1

2.		Profit/ Loss on sale/redemption of Investments

3.		Others (to be specified)

4.		Interest, Dividend & Rent – Gross
		TOTAL (A)

1.		Claims Incurred (Net)	2

2.		Commission	3

3.		Operating Expenses related to Insurance Business	4

		TOTAL (B)
		Operating Profit/(Loss) from Fire/Marine/Miscellaneous Business C= (A - B)
	APPROPRIATIONS

	Transfer to Shareholders’ Account
	Transfer to Catastrophe Reserve
	Transfer to Other Reserves (to be specified)
	TOTAL (C)

Note: See Notes appended at the end of Form B-PL

FORM B-PL

Name of the Insurer:

Registration No. and Date of Registration with the IRDA

PROFIT AND LOSS ACCOUNT FOR THE YEAR ENDED 31^ST MARCH, 20___.

	Particulars	Schedule	Current Year	Previous Year
			(Rs.’000)	(Rs.’000)
1.	OPERATING PROFIT/(LOSS)
	(a) Fire Insurance (b) Marine Insurance (c ) Miscellaneous Insurance

2.	INCOME FROM INVESTMENTS
	(a) Interest, Dividend & Rent – Gross (b) Profit on sale of investments Less: Loss on sale of investments

3.	OTHER INCOME (To be specified)
	TOTAL (A)

4.	PROVISIONS (Other than taxation)
	(a) For diminution in the value of investments (b) For doubtful debts (c) Others (to be specified)

5.	OTHER EXPENSES
	(a) Expenses other than those related to Insurance Business (b) Bad debts written off (c) Others (To be specified)
	TOTAL (B)
	Profit Before Tax
	Provision for Taxation

	APPROPRIATIONS
	(a) Interim dividends paid during the year (b) Proposed final dividend (c) Dividend distribution tax (d) Transfer to any Reserves or Other Accounts (to be specified)

	Balance of profit/ loss brought forward from last year

	Balance carried forward to Balance Sheet

Notes: to Form B-RA and B- PL

(a) Premium income received from business concluded in and outside India shall be separately disclosed.

(b) Reinsurance premiums whether on business ceded or accepted are to be brought into account gross (i.e. before deducting commissions) under the head reinsurance premiums.

(c) Claims incurred shall comprise claims paid, specific claims settlement costs wherever applicable and change in the outstanding provision for claims at the year-end,.

(d) Items of expenses and income in excess of one percent of the total premiums (less reinsurance) or Rs.5,00,000 whichever is higher, shall be shown as a separate line item.

(e) Fees and expenses connected with claims shall be included in claims.

(f) Under the sub-head "Others” shall be included items like foreign exchange gains or losses and other items.

(g) Interest, dividends and rentals receivable in connection with an investment should be stated as gross amount, the amount of income tax deducted at source being included under 'advance taxes paid and taxes deducted at source”..

(h) Income from rent shall include only the realised rent. It shall not include any notional rent.

FORM B-BS

Name of the Insurer:

Registration No. and Date of Registration with the IRDA

BALANCE SHEET AS AT 31^ST MARCH, 20___.

	Schedule	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
SOURCES OF FUNDS

SHARE CAPITAL	5

RESERVES AND SURPLUS	6

FAIR VALUE CHANGE ACCOUNT

BORROWINGS	7

TOTAL

APPLICATION OF FUNDS

INVESTMENTS	8

LOANS	9

FIXED ASSETS	10

CURRENT ASSETS
Cash and Bank Balances	11
Advances and Other Assets	12

Sub-Total (A)

CURRENT LIABILITIES	13

PROVISIONS	14

Sub-Total (B)

NET CURRENT ASSETS (C) = (A - B)

MISCELLANEOUS EXPENDITURE (to the extent not written off or adjusted)	15

DEBIT BALANCE IN PROFIT AND LOSS ACCOUNT

TOTAL

CONTINGENT LIABILITIES

	Particulars	Current Year	Previous Year
		(Rs.’000).	(Rs.’000).
1.	Partly paid-up investments
2.	Claims, other than against policies, not acknowledged as debts by the company
3.	Underwriting commitments outstanding (in respect of shares and securities)
4.	Guarantees given by or on behalf of the Company
5.	Statutory demands/ liabilities in dispute, not provided for
6.	Reinsurance obligations to the extent not provided for in accounts
7.	Others (to be specified)
	TOTAL

SCHEDULES FORMING PART OF FINANCIAL STATEMENTS

SCHEDULE – 1

PREMIUM EARNED [NET]

Particulars	Current Year	Previous Year
	(Rs.’000)	(Rs.’000)
Premium from direct business written Add: Premium on reinsurance accepted Less : Premium on reinsurance ceded Net Premium Adjustment for change in reserve for unexpired risks

Total Premium Earned (Net)

Note: Reinsurance premiums whether on business ceded or accepted are to be brought into account, before deducting commission, under the head of reinsurance premiums.

SCHEDULE – 2

CLAIMS INCURRED [NET]

Particulars	Current Year	Previous Year
	(Rs.’000)	(Rs.’000)
Claims paid
Direct Add :Re-insurance accepted Less :Re-insurance Ceded Net Claims paid
Add Claims Outstanding at the end of the year
Less Claims Outstanding at the beginning
Total Claims Incurred

Notes:

a) Incurred But Not Reported (IBNR), Incurred but not enough reported [IBNER] claims should be included in the amount for outstanding claims.

b) Claims includes specific claims settlement cost but not expenses of management

c) The surveyor fees, legal and other expenses shall also form part of claims cost.

d) Claims cost should be adjusted for estimated salvage value if there is a sufficient certainty of its realisation.

SCHEDULE- 3

COMMISSION

Particulars	Current Year	Previous Year
	(Rs.’000)	(Rs.’000)
Commission paid
Direct Add: Re-insurance Accepted Less: Commission on Re-insurance Ceded
Net Commission

Note: The profit/ commission, if any, are to be combined with the Re-insurance accepted or Re-insurance ceded figures.

SCHEDULE – 4

OPERATING EXPENSES RELATED TO INSURANCE BUSINESS

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
1.	Employees’ remuneration & welfare benefits
2.	Travel, conveyance and vehicle running expenses
3.	Training expenses
4.	Rents, rates & taxes
5.	Repairs
6.	Printing & stationery
7.	Communication
8.	Legal & professional charges
9.	Auditors' fees, expenses etc
	(a) as auditor (b) as adviser or in any other capacity, in respect of (i) Taxation matters (ii) Insurance matters (iii) Management services; and (c) in any other capacity
10.	Advertisement and publicity
11.	Interest & Bank Charges
12.	Others (to be specified)
13.	Depreciation
	TOTAL

Note: Items of expenses and income in excess of one percent of the total premiums (less reinsurance) or Rs.5,00,000 whichever is higher, shall be shown as a separate line item.

SCHEDULE – 5

SHARE CAPITAL

	Particulars	Current Year	Previous Year
		(Rs.’000).	(Rs.’000).
1.	Authorised Capital
	Equity Shares of Rs..... each
2.	Issued Capital
	Equity Shares of Rs. .....each
3.	Subscribed Capital
	Equity Shares of Rs.......each
4.	Called-up Capital
	Equity Shares of Rs. .....each
	Less : Calls unpaid
	Add : Equity Shares forfeited (Amount originally paid up) Less : Par Value of Equity Shares bought back
	Less : Preliminary Expenses Expenses including commission or brokerage on Underwriting or subscription of shares
	TOTAL

Notes:

(a) Particulars of the different classes of capital should be separately stated.

(b) The amount capitalised on account of issue of bonus shares should be disclosed.

(c) In case any part of the capital is held by a holding company, the same should be separately disclosed.

SCHEDULE – 5A

SHARE CAPITAL

PATTERN OF SHAREHOLDING

[As certified by the Management]

Shareholder	Current Year		Previous Year
	Number of Shares	% of Holding	Number of Shares	% of Holding
Promoters · Indian · Foreign
Others
TOTAL

SCHEDULE – 6

RESERVES AND SURPLUS

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
1.	Capital Reserve
2.	Capital Redemption Reserve
3	Share Premium
4	General Reserves Less: Debit balance in Profit and Loss Account Less: Amount utilized for Buy-back
5	Catastrophe Reserve
6	Other Reserves (to be specified)
7	Balance of Profit in Profit & Loss Account
	TOTAL

Note:

Additions to and deductions from the reserves should be disclosed under each of the specified heads.

SCHEDULE - 7

BORROWINGS

	Particulars	Current Year	Previous Year
		(Rs.’000).	(Rs.’000).
1.	Debentures/ Bonds
2.	Banks
3.	Financial Institutions
4.	Others (to be specified)
	TOTAL

Notes:

a) The extent to which the borrowings are secured shall be separately disclosed stating the nature of the security under each sub-head.

b) Amounts due within 12 months from the date of Balance Sheet should be shown separately

Schedule –8

Investments

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
	LONG TERM INVESTMENTS
1.	Government securities and Government guaranteed bonds including Treasury Bills
2.	Other Approved Securities
3.	Other Investments
	( a) Shares (aa) Equity (bb) Preference ( b) Mutual Funds (c) Derivative Instruments (d) Debentures/ Bonds (e) Other Securities (to be specified) (f) Subsidiaries (g) Investment Properties-Real Estate
4.	Investments in Infrastructure and Social Sector
5.	Other than Approved Investments
	SHORT TERM INVESTMENTS
1.	Government securities and Government guaranteed bonds including Treasury Bills
2.	Other Approved Securities
3.	Other Investments
	(a) Shares (aa) Equity (bb) Preference (b) Mutual Funds (a) Derivative Instruments (b) Debentures/ Bonds (c) Other Securities (to be specified) (d) Subsidiaries (e) Investment Properties-Real Estate
4.	Investments in Infrastructure and Social Sector
5.	Other than Approved Investments
	TOTAL

Notes:

(a) Investments in subsidiary/holding companies, joint ventures and associates shall be separately disclosed, at cost.

(i) Holding company and subsidiary shall be construed as defined in the Companies Act, 1956:

(ii) Joint Venture is a contractual arrangement whereby two or more parties undertake an economic activity, which is subject to joint control.

(i) Joint control - is the contractually agreed sharing of power to govern the financial and operating policies of an economic activity to obtain benefits from it.

(ii) Associate - is an enterprise in which the company has significant influence and which is neither a subsidiary nor a joint venture of the company.

(iii) Significant influence (for the purpose of this schedule) - means participation in the financial and operating policy decisions of a company, but not control of those policies. Significant influence may be exercised in several ways, for example, by representation on the board of directors, participation in the policymaking process, material inter-company transactions, interchange of managerial personnel or dependence on technical information. Significant influence may be gained by share ownership, statute or agreement. As regards share ownership, if an investor holds, directly or indirectly through subsidiaries, 20 percent or more of the voting power of the investee, it is presumed that the investor does have significant influence, unless it can be clearly demonstrated that this is not the case. Conversely, if the investor holds, directly or indirectly through subsidiaries, less than 20 percent of the voting power of the investee, it is presumed that the investor does not have significant influence, unless such influence is clearly demonstrated. A substantial or majority ownership by another investor does not necessarily preclude an investor from having significant influence.

(b) Aggregate amount of company's investments other than listed equity securities and derivative instruments and also the market value thereof shall be disclosed.

(d) Debt securities will be considered as “held to maturity” securities and will be measured at historical cost subject to amortisation.

(e) Investment Property means a property [land or building or part of a building or both] held to earn rental income or for capital appreciation or for both, rather than for use in services or for administrative purposes.

(f) Investments maturing within twelve months from balance sheet date and investments made with the specific intention to dispose of within twelve months from balance sheet date shall be classified as short-term investments

SCHEDULE - 9

LOANS

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
1.	SECURITY-WISE CLASSIFICATION
	Secured
	(a) On mortgage of property (aa) In India (bb) Outside India
	(b) On Shares, Bonds, Govt. Securities
	(c) Others (to be specified)
	Unsecured
	TOTAL
2.	BORROWER-WISE CLASSIFICATION
	(a) Central and State Governments
	(b) Banks and Financial Institutions
	(c) Subsidiaries
	(d) Industrial Undertakings
	(e) Others (to be specified)
	TOTAL
3.	PERFORMANCE-WISE CLASSIFICATION
	(a) Loans classified as standard (aa) In India (bb) Outside India (b) Non-performing loans less provisions (aa) In India (bb) Outside India
	TOTAL
4.	MATURITY-WISE CLASSIFICATION
	(a) Short Term
	(b) Long Term
	TOTAL

Notes:

(a) Short-term loans shall include those, which are repayable within 12 months from the date of balance sheet. Long term loans shall be the loans other than short-term loans.

(b) Provisions against non-performing loans shall be shown separately.

(c ) The nature of the security in case of all long term secured loans shall be specified in each case. Secured loans for

the purposes of this schedule, means loans secured wholly or partly against an asset of the company.

(d) Loans considered doubtful and the amount of provision created against such loans shall be disclosed.

SCHEDULE – 10

FIXED ASSETS

(Rs.’000)

Particulars	Cost/ Gross Block				Depreciation Net Block
	Opening	Additions	Deductions	Closing	Upto Last Year	For The Year	On Sales/ Adjustments	To Date	As at year end	Previous Year
Goodwill
Intangibles (specify)
Land-Freehold
Leasehold Property
Buildings
Furniture & Fittings
Information Technology Equipment
Vehicles
Office Equipment
Others (Specify nature)
TOTAL
Work in progress
Grand Total
PREVIOUS YEAR

Note:

Assets included in land, building and property above exclude Investment Properties as defined in note (e) to Schedule 8.

SCHEDULE- 11

CASH AND BANK BALANCES

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
1.	Cash (including cheques, drafts and stamps)
2.	Bank Balances
	(a) Deposit Accounts (aa) Short-term (due within 12 months) (bb) Others (b) Current Accounts (c) Others (to be specified)
3.	Money at Call and Short Notice
	(a) With Banks (b) With other Institutions
4.	Others (to be specified)
	TOTAL

	Balances with non-scheduled banks included in 2 and 3 above

Note : Bank balance may include remittances in transit. If so, the nature and amount should be separately stated.

SCHEDULE – 12

ADVANCES AND OTHER ASSETS

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
	ADVANCES
1.	Reserve deposits with ceding companies
2.	Application money for investments
3.	Prepayments
4.	Advances to Directors/Officers
5.	Advance tax paid and taxes deducted at source (Net of provision for taxation)
6.	Others (to be specified)
	TOTAL (A)

	OTHER ASSETS
1.	Income accrued on investments
2.	Outstanding Premiums
3.	Agents’ Balances
4.	Foreign Agencies Balances
5.	Due from other entities carrying on insurance business (including reinsurers)
6.	Due from subsidiaries/ holding
7.	Deposit with Reserve Bank of India [Pursuant to section 7 of Insurance Act, 1938]
8.	Others (to be specified)
	TOTAL (B)
	TOTAL (A+B)

Notes:

(a) The items under the above heads shall not be shown net of provisions for doubtful amounts. The amount of provision against each head should be shown separately.

(b) The term ‘officer’ should conform to the definition of that term as given under the Companies Act, 1956.

(c) Sundry Debtors will be shown under item 9(others)

SCHEDULE – 13

CURRENT LIABILITIES

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
1.	Agents’ Balances
2.	Balances due to other insurance companies
3.	Deposits held on re-insurance ceded
4.	Premiums received in advance
5.	Unallocated Premium
6.	Sundry creditors
7.	Due to subsidiaries/ holding company
8.	Claims Outstanding
9.	Due to Officers/ Directors
10.	Others (to be specified)
	TOTAL

SCHEDULE – 14

PROVISIONS

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
1	Reserve for Unexpired Risk
2	For taxation (less advance tax paid and taxes deducted at source)
3	For proposed dividends
4	For dividend distribution tax
5	Others (to be specified)
	TOTAL

SCHEDULE – 15

MISCELLANEOUS EXPENDITURE

(To the extent not written off or adjusted)

	Particulars	Current Year	Previous Year
		(Rs.’000)	(Rs.’000)
1.	Discount Allowed in issue of shares/ debentures

2.	Others (to be specified)
	TOTAL

Notes:

(a) No item shall be included under the head “Miscellaneous Expenditure” and carried forward unless:

1. some benefit from the expenditure can reasonably be expected to be received in future, and

2. the amount of such benefit is reasonably determinable.

(b) The amount to be carried forward in respect of any item included under the head “Miscellaneous Expenditure” shall not exceed the expected future revenue/other benefits related to the expenditure.