Document ID: chunk:federal_register_of_legislation:F2017L00435:body:0:p12
Version: federal_register_of_legislation:F2017L00435
Segment Type: other
Provision Reference: 
Character Range: 51159–59121

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 information in respect of these years to the extent that they HAVE NOT been closed into a 1999 or subsequent year of account

Lloyd's Agent in Australia:
..........................................................................                                                                    ..................................................................................  ....................................................
Name                                                                                                                                           Signature                                                                          Date

FORM L5 (AUDITED)

Insurance Act 1973                                                                                                                                    ANNUAL STATEMENT OF PREMIUMS AND CLAIMS
                                                                                                                                                      AGGREGATE BUSINESS ON AND FROM 1/7/98
Form L5 (Audited)                                                                                                                                     ("NEW BUSINESS 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                                                                                                                                            Current yr
NET PREMIUMS#                                                                                                                                         Previous yr
                                                                                                                                                      2 yrs previous
                                                                                                                                                      (etc)
                                                                                                                                                      1998*
                                                                                                                                                      1997*
                                                                                                                                                      1996*
                                                                                                                                                      1995*
                                                                                                                                                      1994*
                                                                                                                                                      1993*
                                                                                                                                                      TOTAL

GROSS KNOWN                                                                                                                                           Current yr
OUTSTANDING                                                                                                                                           Previous yr
CLAIMS (at year end)                                                                                                                                  2 yrs previous
                                                                                                                                                      (etc)
                                                                                                                                                      1998*
                                                                                                                                                      1997*
                                                                                                                                                      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 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

[1] Note, in accordance with paragraph 13(1)(b) of the Legislation Act 2003, expressions used in this instrument have the same meaning as in the Act.  In particular, 'covered', 'insurance liability', 'Lloyd's', 'qualified corporation', 'secured' and 'security trust fund' have the same meaning as in the Act.