# An Act respecting Insurance Companies/Schedule

SCHEDULE—FORMS.
Form A.
Statement to be made by every Life or Accident Insurance Company, except Companies mentioned in Section fifteen.
* (Name of the Company.)
* Assets of the Company.
* Liabilities of do.
* Amount of Capital Stock.
* Amount paid thereon.
* Of what the assets of the Company consist, viz: (insert particulars).
* Total premiums received during the year.
* Number and amount of Policies issued during the year.
* Amount of claims from death (or accident) do.
* Expenses of management, agency, &c.
* Total premiums received during the year in Canada.
* Number and amount of Policies issued do.
* Amount at risk on total policies issued in Canada.
* Number and amount of policies that have become claims in Canada, during the year by death (or accident)
Form B.
Statement to be made by a Fire or Guarantee Insurance Company, whose deposits are not less than one hundred thousand dollars, (except Companies mentioned in section 15,) referred to in section four.
* Assets of the Company.
* Liabilities of the Company.
* Amount of Capital Stock.
* Amount paid thereon.
* Of what the assets of the Company consist, viz: {insert particulars)
* Amount of losses paid during the year.
* Amount of losses due and unpaid Losses adjusted and not due.
* Losses in suspense and waiting further proof.
* Losses, the payment of which is resisted and for what cause
* All other claims against the Company.
* Amount of premiums earned for the past year.
* Amount of premiums unearned for the past year.
* Number and amount of policies issued during the year.
* Amount at risk on total policies in force in Canada.
* Losses in Canada paid during the year.
* Do.adjusted and not due
* Do.in suspense and waiting for further proof
* Do.the payment of which is resisted and for what cause.
* All other claims against the Company.
* Premiums earned in Canada during the year.
* Do.unearned dodo
Form C.
Statement to be made by a Fire or Guarantee Insurance Company whose deposits are under one hundred thousand dollars, except those referred to in section four.
* Amount of Premiums received during the year on risks effected in Canada less twenty-five per cent, and the net amount of losses actually paid.
* Deposit in conformity with the second section of the said Act.
* Assets of the Company.
* Liabilities of the Company.
* Amount of Capital Stock.
* Amount paid thereon.
* Of what the assets of the Company consist, viz: {insert particulars)
* Amount of losses paid during the year.
* Amount of losses due and unpaid.
* Losses adjusted and not due.
* Losses in suspense and waiting for further proof.
* Losses the payment of which is resisted, and for what cause.
* All other claims against the Company.
* Amount of premiums earned during the past year.
* Amount of premiums unearned.
* Amount at risk on total policies in force in Canada.
* Losses in Canada paid during the year.
* Losses in Canada adjusted and not due. ​
* Losses in suspense and waiting for further proof.
* Losses the payment of which is resisted and for what cause.
* All other claims against the Company.
* Premiums earned in Canada during the year.
* Premiums unearned in Canada during the year.
Form D.
Statement to be made by an Insurance Companies referred to in Section fifteen.
* Total premiums received during the year, in Canada
* Number and amount of policies issued do. do.
* Amount at risk in total policies in force in Canada.
* Number and amount of policies that have become claims in Canada during the year.
* Amount of losses in Canada paid during the year.
* Amount of losses in Canada in suspense and waiting further proof.
* Losses in Canada the payment of which is resisted and for what cause
* Amount of premiums earned for the past year in Canada.
* Amount of premiums unearned in Canada.