Document ID: chunk:federal_register_of_legislation:F2017L00435:body:0:p11
Version: federal_register_of_legislation:F2017L00435
Segment Type: other
Provision Reference: 
Character Range: 43498–52088

TOTAL

GROSS KNOWN                                                                                                                                           Current yr
OUTSTANDING                                                                                                                                           Previous yr
CLAIMS (at quarter                                                                                                                                    2 yrs previous
end)                                                                                                                                                  (etc)
                                                                                                                                                      1998*
                                                                                                                                                      1997*
                                                                                                                                                      1996*
                                                                                                                                                      1995*
                                                                                                                                                      1994*
                                                                                                                                                      1993*
                                                                                                                                                      TOTAL

NET PREMIUMS
SIGNED IN
CALENDAR YEAR
(to date)

GROSS CLAIMS
PAID IN CALENDAR
YEAR (to date)
#  Cumulative net premiums to the report date since commencement of the particular years of account
*  Only report information in respect of these years to the extent that they HAVE been closed into the year of account being reported on this return

Lloyd's Agent in Australia:

..................................................................                                                                                    ..................................................................................  .........................................
Name                                                                                                                                                  Signature                                                                           Date

Attachment D – Audited accounts and statements

Part 1 - Commentary
     1.           The accounts and statements required for subparagraph 23(a) are:

       (a)          Form L3—Annual Statement of Reported Claims Outstanding for 1992 and Prior Business—"Equitas Fund" (to be lodged within 4 months of the balance date;

       (b)          Form L4—Annual Statement of Premiums and Claims for 1/1/93 to 30/6/98 Business—"Interim Fund" (to be lodged within 4 months of the balance date); and

       (c)          Form L5—Annual Statement of Premiums and Claims for Aggregate Business on and from 1/7/98—"New Business Fund" (to be lodged within 4 months of the balance date);

as set out in Part 2 of this Attachment.

2.             Dollar amounts are to be rounded to the nearest multiple of $1,000.  For example, $10,500 is to be rounded down to $10,000 and $10,501 is to be rounded up to $11,000.

3.             The statements are to be completed in accordance with any directions noted on the form and are to be signed by Lloyd's Agent in Australia.

4.             An audit certificate in the form approved under subparagraph 23(b) must be lodged within 4 months of the annual balance date.

Part 2 - Forms
FORM L3 (AUDITED)

Insurance Act 1973  ANNUAL STATEMENT OF REPORTED CLAIMS OUTSTANDING
Form L3 (Audited)   1992 AND PRIOR BUSINESS   ("EQUITAS FUND" AS DEFINED)

Report for Year Ended:  ..................................

GROSS KNOWN             RESERVING   NOMINAL BASE  PLUS $A2M  TOTAL NOMINAL
OUTSTANDING             FACTOR      RESERVE                  RESERVE
CLAIMS (at year end)
              ($A'000)                                       ($A'000)

Lloyd's Agent in Australia:

............................................................................  .........................................................................................      ..............................................
Name                                                                          Signature                                                                                  Date

FORM L4 (AUDITED)

Insurance Act 1973                                                                                                                            ANNUAL STATEMENT OF PREMIUMS AND CLAIMS
Form L4 (Audited)                                                                                                                             1/1/93 TO 30/6/98 BUSINESS ("INTERIM FUND" AS DEFINED)
Report for Year Ended:  ..................................
                                                                                                                                              Originating                                                                                        Long tail business                                   Short tail business   Total business
PARTICULARS                                                                                                                                   (pure) year                                                                                                                               Reserving                           Nominal                    Reserving   Nominal            Nominal
                                                                                                                                              of account                                                                          ($A'000)                                              Factor                              Reserve          ($A'000)  Factor      Reserve  ($A'000)  Reserve

DETAILS OF                                                                                                                                    1998*
NET PREMIUMS#                                                                                                                                 1997*
                                                                                                                                              1996*
                                                                                                                                              1995*
                                                                                                                                              1994*
                                                                                                                                              1993*
                                                                                                                                              TOTAL

GROSS KNOWN                                                                                                                                   1998*
OUTSTANDING                                                                                                                                   1997*
CLAIMS (at year end)                                                                                                                          1996*
                                                                                                                                              1995*
                                                                                                                                              1994*
                                                                                                                                              1993*
                                                                                                                                              TOTAL

NET PREMIUMS
SIGNED IN CALENDAR
YEAR

GROSS CLAIMS
PAID IN CALENDAR
YEAR
#  Cumulative net premiums to the report date since commencement of the particular years of account
*  Only report