{"kind":"expression","expression":{"expr_id":"93","doc_id":"93","label":"2003 Revision","is_as_enacted":"f","commenced_on":null,"superseded_on":null,"valid_from":null,"valid_to":null,"is_current":"t","incorporating":null,"akn_expr_iri":"\/akn\/ky\/act\/sl\/1980\/15\/eng@2003-01-01","akn_envelope":"{\"_canary\": {\"iri\": {\"work\": \"\/akn\/ky\/act\/sl\/1980\/15\", \"expression\": \"\/akn\/ky\/act\/sl\/1980\/15\/eng@2003-01-01\", \"manifestation\": \"\/akn\/ky\/act\/sl\/1980\/15\/eng@2003-01-01.pdf\"}, \"pdf\": {\"md5\": \"3821d08ed09cca68bc727837958321cf\", \"path\": \"\/Users\/q\/kyleg-data\/working\/SUBORDINATE\/1980\/1980-0015\/1980-0015_2003 Revision.pdf\", \"pages\": 33, \"filename\": \"1980-0015_2003 Revision.pdf\"}, \"errors\": [], \"extraction\": {\"model\": null, \"stats\": {\"word_count\": 5957, \"paragraph_count\": 23, \"text_char_count\": 40137}, \"usage\": null, \"method\": \"pymupdf-text\", \"version\": \"kyleg-akn-1.0\", \"extracted_at\": \"2026-06-22\"}, \"classification\": \"text_layer\", \"validation_flags\": [], \"docai_processor_id\": null}, \"akomaNtoso\": {\"act\": {\"body\": [{\"eId\": \"sec_n1\", \"num\": null, \"text\": \"Insurance Law (2003 Revision) PUBLISHING DETAILS Revised under the authority of the Law Revision Law (1999 Revision). The Insurance (Forms) Regulations, 1980 made the 10th day of June, 1980 Consolidated with the - Insurance (Forms) (Amendment) (Licence Applications) Regulations, 2001 made the 12th day of April, 2001. And as amended by the - Cayman Islands (Constitution) (Amendment) Order 2003 (U.K.S.I. 2003 No. 1515) made the 12th day of June, 2003. Consolidated and revised this 8th day of July, 2003. Arrangement of Regulations Insurance Law (2003 Revision) Arrangement of Regulations Regulation 1. 2. 3. 4.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_5\", \"num\": \"5.\", \"text\": \"FIRST SCHEDULE APPLICATION FOR A CLASS \u201cA\u201d INSURER\u2019S LICENCE APPLICATION FOR A CLASS \u201cB\u201d INSURER\u2019S LICENCE APPLICATION FOR AN INSURANCE AGENT\u2019S LICENCE APPLICATION FOR AN INSURANCE BROKER\u2019S LICENCE APPLICATION FOR AN INSURANCE SUB-AGENT\u2019S LICENCE APPLICATION FOR AN UNDERWRITING MANAGER\u2019S LICENCE SECOND SCHEDULE LICENCE THIRD SCHEDULE CERTIFICATE OF COMPLIANCE FOR ALL CLASSES OF INSURERS LICENCES, OTHER THAN LICENCES FOR APPROVED FOURTH SCHEDULE ANNUAL FINANCIAL STATEMENT FOR YEAR ENDING 20 . Regulation 1 Insurance Law (2003 Revision)\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_1\", \"num\": \"1.\", \"text\": \"Citation 1. These regulations may be cited as the Insurance (Forms) Regulations (2003 Revision).\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_2\", \"num\": \"2.\", \"text\": \"Forms of application for licences 2. The forms set out in the First Schedule hereto shall be employed for the respective purposes of the Law and of these regulations specified in the heading to each of such forms.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_3\", \"num\": \"3.\", \"text\": \"Forms of licenses 3. Licences shall be in the form set out in the Second Schedule hereto.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_4\", \"num\": \"4.\", \"text\": \"Certificate of compliance 4. A certificate of compliance furnished under section 7(3) shall be in the form set out in the Third Schedule hereto and each licensed Insurer other than an approved external insurer shall furnish such a certificate in relation to its insurance business during each financial year within six months of the last day of the year. 5. Financial statement 5. The financial statement under section 7(5) shall be in the form set out in the Fourth Schedule hereto. Regulation 5 FIRST SCHEDULE FIRST SCHEDULE (regulation 2) FORM 1 FIRST SCHEDULE INSURANCE LAW (2003 Revision) (2003 Revision) APPLICATION FOR A CLASS \u201cA\u201d INSURER\u2019S LICENCE (Section 4 (2)) Please complete all sections as fully as possible, giving reasons for non- compliance if any, and attaching appendices where appropriate. Note: An applicant seeking a Class \u2018A\u2019 Licence under section 4(7) as an approved external insurer need complete paragraph 1-12 only. 1. Name of applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. 2. Date on which applicant commenced, or intends to commence, carrying on business in or from within the Islands \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 3. Whether business being, or proposed to be, transacted is \u201cgeneral\u201d or \u201clong term\u201d or both (as defined in section 2) \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 4. Address of (a) principal office \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 (b) registered office \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 (c) head office in the islands \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 5. Name of manager or head of office in the Islands \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. FIRST SCHEDULE\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_6\", \"num\": \"6.\", \"text\": \"If the applicant is to depend upon agent or service companies for the provision of underwriting, management, financial or accounting services, please give details of such companies, including evidence of their agreement to provide the services mentioned.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_7\", \"num\": \"7.\", \"text\": \"Name of person resident in the Islands who is authorised to accept service of process in legal proceedings and notices on behalf of the applicant and who is approved or proposed for approval under section 7(2) \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_8\", \"num\": \"8.\", \"text\": \"(a) Branch applicants must provide written confirmation that their head office accepts full responsibility for all policies and contracts issued by the branch and also for all acts, omissions and liabilities of the branch. (b) Where the applicant is a subsidiary company state whether the parent company will provide a guarantee in respect of all policies or contracts issued by the branch and also for all acts omissions and liabilities of the subsidiary.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_9\", \"num\": \"9.\", \"text\": \"In respect of general domestic business state the applicant\u2019s policy regarding availability of funds for prompt settlement of normal claims \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_10\", \"num\": \"10.\", \"text\": \"In respect of long term domestic business state the applicant\u2019s policy regarding investment of consequent annual premium income in the Islands \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_11\", \"num\": \"11.\", \"text\": \"List all insurance agents and insurance brokers, if any, who have or who are to have, the applicant\u2019s underwriting authority to accept domestic business on its behalf \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_12\", \"num\": \"12.\", \"text\": \"To be completed only by an applicant seeking to be licensed as an approved external insurer A Attach (i) latest annual report and audited accounts; or (ii) statutory financial statement FIRST SCHEDULE B Attach (i) latest certificate of solvency; or (ii) certificate of compliance with insurance legislation in country of constitution, together with written confirmation that the certificate attached embraces all liabilities in respect of domestic business\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_13\", \"num\": \"13.\", \"text\": \"Attach a copy of the act, charter, certificate of incorporation and memorandum of association and articles of association or other instrument of constitution of the applicant, as may be appropriate, verified by a statutory declaration made by a director, secretary or partner and duly authenticated as follows - (a) in the case of a company incorporated in the Islands, certified in accordance with the section 27 of the Companies Law (2003 Revision); (b) in the case of a foreign company certified and authenticated under public seal of the country, city or place under the laws of which such company has been incorporated; or (c) or in the case of companies not yet incorporated, the proposed documentation.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_14\", \"num\": \"14.\", \"text\": \"List all names (including any previous names), addresses and nationalities of all shareholders. In those instances where shares are held by a corporate body or bodies, the chain of connection to the ultimate owner must be shown.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_15\", \"num\": \"15.\", \"text\": \"Attach the annual accounts, for the two years preceding the year of application, of each shareholder which is a body corporate holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, together with similar accounts for the parent body, if any, of each such body corporate.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_16\", \"num\": \"16.\", \"text\": \"Attach curricula vitae of all directors, managers and officers, including any previous names, and with particular emphasis on experience in the insurance profession.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_17\", \"num\": \"17.\", \"text\": \"Attach not less than three references acceptable to the Authority, including one character reference for, and one reference verifying the good financial standing of- (a) each director, manager and officer of the applicant; and (b) each shareholder and each beneficial shareholder who is a natural person holding more than ten percent of the applicant\u2019s issued share capital or total voting rights, and, for each such director, manager, officer or shareholder, a police or other certificate satisfactory to the Authority that such director, manager, officer or shareholder has not been convicted of a serious crime or any offence involving dishonesty.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_18\", \"num\": \"18.\", \"text\": \"FIRST SCHEDULE (a) Name and address of the principal agent or representative resident in the Islands \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 (b) Address of designated principal office in the Islands where full business records will be kept \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_19\", \"num\": \"19.\", \"text\": \"Name, address and professional qualification of auditors (and the country whose generally accepted accounting principles are to apply) and, if the application includes long term business, similar details of the actuary who will give required statutory certificates. Attach evidence that said auditors and actuary have agreed to accept appointment Auditor Actuary\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_20\", \"num\": \"20.\", \"text\": \"(a) (For an existing insurer). Attach annual accounts for the three years preceding the date of this application. (b) (For an applicant for a new insurer\u2019s licence). Attach a written undertaking to provide at least the minimum net worth requirements set out in section 4(9), together with a statement as to how said net worth is to be calculated.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_21\", \"num\": \"21.\", \"text\": \"Attach a business plan. The Authority may indicate that any part of the information included in the business plan shall not form part of this application for the purpose of sections 4(3) and 7(2).\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_22\", \"num\": \"22.\", \"text\": \"Have any of the parties connected with this application ever applied, either individually or in conjunction with others, for authority to transact insurance in any other jurisdiction? If so please give details. Application is accordingly hereby made for the licence specified above and it is certified that all the particulars contained in this Application and in the documents accompanying it or otherwise furnished in support hereof are true and correct. Dated this day of , 20 . \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... [Name of applicant] by its *Director\/*Secretary\/* or other person duly authorised. Signed:\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. WITNESS: Name: Occupation: Address: *Delete words which are not applicable FIRST SCHEDULE FORM 2 INSURANCE LAW (2003 Revision) (2003 Revision) APPLICATION FOR A CLASS \u201cB\u201d INSURER\u2019S LICENCE (Section 4(2)) Please complete all sections as fully as possible, giving reasons for non- compliance if any, and attaching appendices where appropriate. 1. Name of applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 2. Whether licence applied for is Restricted or Unrestricted. 3. Date on which applicant commenced, or intends to commence, carrying on business in or from within the Islands. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 4. Whether business being, or proposed to be, transacted is \u201cgeneral\u201d or \u201clong term\u201d or both (as defined in section 2). \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... 5. Address of - (a) principal office \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. (b) registered office \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. 6. If the applicant is to depend upon agent or service Companies for the provision of underwriting, management, financial or accounting services, please give details of such companies including evidence of their agreement to provide the services mentioned. 7. Attach evidence of the proper incorporation of the applicant pursuant to section 5 of the Companies Law (2003 Revision), and a copy of the memorandum of association and articles of association, or other instrument of constitution of the applicant, as may be appropriate or, in the case of companies not yet incorporated, the proposed documentation. 8. List all names (including any previous names), addresses and nationalities of all shareholders. In those instances where shares are held by a corporate body or bodies the chain of connection to the ultimate owner must be shown. FIRST SCHEDULE 9. Attach the annual accounts, for the two years preceding the year of application, of each shareholder which is a body corporate holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, together with similar accounts for the parent body, if any, of each such body corporate. 10. Attach curricula vitae of all directors, managers, and officers, including any previous names, and with particular emphasis on experience in the insurance profession. 11. Attach not less than three references acceptable to the Authority, including one character reference for and one reference verifying the good financial standing of- (a) each director, manager and officer of the applicant; and (b) each shareholder and each beneficial shareholder who is a natural person holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, and, for each such director, manager, officer or shareholder, a police or other certificate satisfactory to the Authority that such director, manager, officer or shareholder has not been convicted of a serious crime or any offence involving dishonesty. 12. (a) Name and address of the principal agent or representative resident in the Cayman Islands \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 (b) Address of designated principal office in the Islands where full business records will be kept \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 13. Name, address and professional qualification of auditors and the country whose generally accepted accounting principles are to apply. Attach evidence that said auditors have agreed to accept appointment 14. Name and address of person resident in the Islands who is authorised to accept service of process in legal proceedings and notices on behalf of the applicant and who is approved or proposed for approval under section 7(2). \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. 15. (a) (For an existing insurer). Attach annual accounts for three years preceding the date of this application. FIRST SCHEDULE (b) (For an applicant for a new unrestricted class \u201cB\u201d insurer\u2019s licence).Attach a written undertaking to provide at least the minimum net worth requirements set out in section 4(8), together with a statement as to how said net worth is to be calculated. 16. Attach a business plan. The Authority may indicate that any part of the information included in the business plan shall not form part of this application for the purpose of sections 4(3) and 7(2). 17. Have any of the parties connected with this application ever applied, either individually or in conjunction with others, for authority to transact insurance business in any other jurisdiction? If so please give details. Application is accordingly hereby made for the licence specified above and it is certified that all the particulars contained in this application and in the documents accompanying it or otherwise furnished is support hereof are true or correct. Dated this day of , 20 . \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. [Name of applicant] by its *Director\/*Secretary\/* or other person duly authorised. Signed:\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 WITNESS: Name: Occupation: Address: *Delete words which are not applicable FIRST SCHEDULE FORM 3 INSURANCE LAW (2003 Revision) (2003 Revision) APPLICATION FOR AN INSURANCE AGENT\u2019S LICENCE (Section 4(2)) Please complete all sections as fully as possible, giving reasons for non- compliance if any, and attaching appendices where appropriate. 1. Name of applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 2. Date on which applicant commenced, or proposes to commence, carrying on business in or from within the Islands, and with which principal company. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... 3. Address of main or registered office in the Islands. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... 4. If incorporated- (a) Attach evidence of proper incorporation under section 5 of the Companies Law (2003 Revision) and a copy of the memorandum of association and articles of association or other instrument of constitution of the applicant as may be appropriate or, if not yet incorporated, the proposed documentation. (b) List all names (including any previous names), addresses and nationalities of all share holders. In those instances where shares are held by a corporate body or bodies the chain of connection to the ultimate owner must be shown. (c) Attach curricula vitae of all directors, managers and officers. 5. Attach the annual accounts, for the two years preceding the year of application, of each shareholder which is a body corporate holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, together with similar accounts for the parent body, if any, of each such body corporate. 6. If not incorporated, names, addresses, nationalities and curricula vitae of the applicant and any person acting as a manager, or other officer or partner, as the case may be. FIRST SCHEDULE 7. If incorporated, attach not less than three references acceptable to the Authority, including one character reference for and one reference verifying the good financial standing of - (a) each director, manager and officer of the applicant; and (b) each shareholder and each beneficial shareholder who is a natural person holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, and, for each such director, manager, officer or shareholder, a police or other certificate satisfactory to the Authority that such director, manager, officer or shareholder has not been convicted of a serious crime or any offence involving dishonesty. 8. If not incorporated, attach not less than three references acceptable to the Authority, including one character reference for, and one reference verifying the good financial standing of, the applicant and any person acting as a manager, or other officer or partner, as the case may be; and for each such person, a police or other certificate satisfactory to the Authority that the person has not been convicted of a serious crime or any offence involving dishonesty. 9. Attach evidence of the existence of a power of attorney, agency agreement or guarantee, or of professional indemnity insurance as required under section 8(3). 10. Attach a list of all sub-agents authorised by the applicant to solicit domestic business on his behalf, and of all insurance agents associated with the applicant company. 11. Have any of the parties connected with this application ever applied, either individually or in conjunction with others, for authority to transact insurance business in any other jurisdiction? If so, please give details. Application is accordingly hereby made for the Licence specified above, and it is certified that all the particulars contained in this application and in the documents accompanying it or otherwise furnished in support hereof are true and correct. Dated this day of , 20 . \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. [Name of Applicant] Signature of applicant, if an individual \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 WITNESS: Name: Occupation: Address: OR by its *Director\/*Secretary\/ or *other person duly authorised FIRST SCHEDULE Signed\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 WITNESS: Name: Occupation: Address: *Delete words which are not applicable In the case of personal Life Agents the application should be witnessed by the principal officer of the general agents in the Islands with whom the applicant is or will be associated. FIRST SCHEDULE FORM 4 INSURANCE LAW (2003 Revision) (2003 Revision) APPLICATION FOR AN INSURANCE BROKER\u2019S LICENCE (Section 4 (2) ) Please complete all sections as fully as possible, giving reasons for non- compliance if any, and attaching appendices where appropriate. 1. Name of Applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 2. Date on which applicant commenced, or proposes to commence carrying on business in or from within the Islands \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... 3. Address of principal or registered office \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. 4. If incorporated - (a) Attach evidence of proper incorporation under section 5 of the Companies Law (2003 Revision) and a copy of the memorandum of association and articles of association or other instrument of constitution of the applicant as may be appropriate; or if not yet incorporated, the proposed documentation. (b) List all names (including any previous names), addresses and nationalities of all shareholders. In those instances where shares are held by a corporate body or bodies the chain of connection to the ultimate owner must be shown. (c) Attach curricula vitae of all directors, managers and officers. 5. Attach the annual accounts, for the two years preceding the year of application, of each shareholder which is a body corporate holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, together with similar accounts for the parent body, if any, of each such body corporate. 6. If not incorporated, names, addresses, nationalities and curricula vitae of the applicant and any person acting as a manager, or other officer or partner, as the case may be. FIRST SCHEDULE 7. If incorporated, attach not less than three references acceptable to the Authority, including one character reference for and one reference verifying the good financial standing of - (a) each director, manager and officer of the applicant; and (b) each shareholder and each beneficial shareholder who is a natural person holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, and, for each such director, manager, officer or shareholder, a police or other certificate satisfactory to the Authority that the person has not been convicted of a serious crime or any offence involving dishonesty. 8. If not incorporated, attach not less than three references acceptable to the Authority, including one character reference for, and one reference verifying the good financial standing of, the applicant and any person acting as a manager, or other officer or partner, as the case may be; and for each such person, a police or other certificate satisfactory to the Authority that the person has not been convicted of a serious crime or any offence involving dishonesty. 9. Attach evidence of the existence of professional indemnity insurance as required under section 9(2). 10. Attach a list of all sub-agents authorised by the applicant to solicit domestic business on his behalf, and of all Insurance agents that may be associated with the applicant. 11. Attach a list of all insurers with whom the applicant has entered into any form of agency agreement. 12. Attach a business plan. 13. Have any of the parties connected with this application ever applied, either individually or in conjunction with others, for authority to transact insurance business in any other jurisdiction? If so, please give details. Application is accordingly hereby made for the licence specified above and it is certified that all the particulars contained in this application and in the documents accompanying it or otherwise furnished in support hereof are true and correct. Dated this day of , 20 . \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. [Name of Applicant] Signature of applicant, if an individual \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 WITNESS: Name: Occupation: Address: FIRST SCHEDULE OR by its *Director\/*Secretary\/ *or other person duly authorised Signed\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 WITNESS: Name: Occupation: Address: *Delete words which are not applicable FIRST SCHEDULE FORM 5 INSURANCE LAW (2003 Revision) (2003 Revision) APPLICATION FOR AN INSURANCE SUB-AGENT\u2019S LICENCE (Section 4(2)) Please complete all sections as fully as possible, giving reasons for non- compliance if any, and attaching appendices where appropriate. 1. Name and address of applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 2. Date on which applicant commenced, or proposes to commence, carrying on business in or from within the Islands. 3. Attach not less than three references acceptable to the Authority, including one character reference for, and one reference verifying the good financial standing of, the applicant. 4. Attach a police or other certificate satisfactory to the Authority that the applicant has not been convicted of a serious crime or any offence involving dishonesty. 5. Details of the applicant\u2019s experience in the business of insurance. 6. Have any of the parties connected with this application ever applied, either individually or in conjunction with others, for authority to transact insurance business in any other jurisdiction? If so, please give details. Application is accordingly hereby made for the Licence specified above and it is certified that all the particulars contained in this application and in the documents accompanying it or otherwise furnished in support hereof are true and correct. Dated this day of , 20 . \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. Signature of Applicant WITNESS: Name: Occupation: Address: FIRST SCHEDULE FORM 6 INSURANCE LAW (2003 Revision) (2003 Revision) APPLICATION FOR AN UNDERWRITING MANAGER\u2019S LICENCE (Section 4 (2) ) Please complete all sections as fully as possible, giving reasons for non- compliance if any, and attaching appendices where appropriate. 1. Name of Applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 2. Date on which applicant commenced, or proposes to commence carrying on business in or from within the Islands, and with which principal company. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... 3. Address of main or registered office in the Islands \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. 4. If incorporated- (a) Attach evidence of proper incorporation pursuant to section 5 of the Companies Law (2003 Revision) and a copy of the memorandum of association and articles of association or other instrument of constitution of the applicant as may be appropriate; or if not yet incorporated, the proposed documentation. (b) List all names (including any previous names), addresses and nationalities of all shareholders. In those instances where shares are held by a corporate body or bodies the chain of connection to the ultimate owner must be shown. (c) Attach curricula vitae of all directors, managers and officers. 5. Attach the annual accounts, for the two years preceding the year of application, of each shareholder which is a body corporate holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, together with similar accounts for the parent body, if any, of each such body corporate. 6. If not incorporated, names, addresses, nationalities and curricula vitae of the applicant and any person acting as a manager, or other officer or partner, as the case may be. FIRST SCHEDULE 7. If incorporated, attach not less than three references acceptable to the Authority, including one character reference for and one reference verifying the good financial standing of - (a) each director, manager and officer of the applicant; and (b) each shareholder and each beneficial shareholder who is a natural person holding more than ten per cent of the applicant\u2019s issued share capital or total voting rights, and, for each such director, manager, officer or shareholder, a police or other certificate satisfactory to the Authority that the person has not been convicted of a serious crime or any offence involving dishonesty. 8. If not incorporated, attach not less than three references acceptable to the Authority, including one character reference for, and one reference verifying the good financial standing of, the applicant and any person acting as a manager, or other officer or partner, as the case may be; and for each such person, a police or other certificate satisfactory to the Authority that the person has not been convicted of a serious crime or any offence involving dishonesty. 9. Attach a list of all insurers for whom the applicant is, or will be engaged to act as manager or consultant. 10. Attach a business plan. 11. Have any of the parties connected with this application ever applied, either individually or in conjunction with others, for authority to transact insurance business in any other jurisdiction? If so, please give details. Application is accordingly hereby made for the licence specified above and it is certified that all the particulars contained in this application and in the documents accompanying it or otherwise furnished in support hereof are true and correct. Dated this day of , 20 . \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. [Name of Applicant] Signature of applicant if an individual \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 WITNESS: Name: Occupation: Address: OR by its *Director\/*Secretary\/ *or other person duly authorised Signed\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 WITNESS: Name: Occupation: FIRST SCHEDULE Address: *Delete words which are not applicable SECOND SCHEDULE SECOND SCHEDULE INSURANCE LAW (2003 Revision) regulation 4 (2003 Revision) LICENCE is hereby licensed under the Insurance Law (2003 Revision), to carry on business in or from within the Cayman Islands as \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026under section\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 of the Law , subject to the provisions of the said Law and, in particular, to the condition that the Licensee shall forthwith notify the Governor of any change in the information supplied in the application for this Licence. Given this day of , 20 at George Town on the Island of Grand Cayman. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... Governor in Cabinet THIRD SCHEDULE THIRD SCHEDULE regulation 5 INSURANCE LAW (2003 Revision) (2003 Revision) CERTIFICATE OF COMPLIANCE FOR ALL CLASSES OF INSURERS LICENCES, OTHER THAN LICENCES FOR APPROVED EXTERNAL INSURERS (Section 7 (3)) I\/We\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. [Name] of\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... [Full business address] DO HEREBY CERTIFY as follows- 1. That I\/we am\/are- *(a) the duly appointed independent auditor(s) or (b) the underwriting manager of \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. [Name of Licensed Insurer] Which is the holder of a currently valid \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..Licence No. [Category of Licence] under the abovementioned Law. 2. That, to the best of our knowledge and belief and subject to the exceptions or qualifications, if any, mentioned below, the said licence holder has during the period____________________to ______________________________ carried on its insurance business in accordance with the information provided in its licence application, subject to changes approved by the Governor. This certificate relates only to the following of such information:- (a) The classes of insurance business conducted by the licence holder. THIRD SCHEDULE (b) The particulars described in the application, in the case of Class \u2018A\u2019 insurers at paragraphs 4 to 7, 11, 13, 14, 18 and 19 and in the case of Class \u2018B\u2019 insurers at paragraphs 5 to 8 and 12 to 14. (c) The Business Plan (excluding information which the Authority has indicated does not form part of the application for purposes of sections 4 (3) and 7 (2). EXCEPTIONS OR QUALIFICATIONS Dated at this day of , 20 . ..\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 [Signature of person[s] furnishing this Certificate] Name and position of individual signing above certificate. *Delete if inappropriate. FOURTH SCHEDULE FOURTH SCHEDULE regulation 6 INSURANCE LAW (2003 Revision) (2003 Revision) ANNUAL FINANCIAL STATEMENT FOR YEAR ENDING 20 . (section 7 (5)) Licence No. Name of Company: Part A Please attach directors report [if any], and audited financial statement in the normal published form. Part B Balance Sheet Current year Previous year 1. Investment assets (per Part C) 2. Real estate held for own use 3. Other fixed assets 4. Investment income receivable 5. Cash at bank (non invested) 6. Premiums receivable 7. Other assets ______________ ________________ ______________ ________________ 8. Unearned premiums 9. Reinsurance premium payable 10. Other liabilities FOURTH SCHEDULE Current year Previous year 11. Insurance funds- 11.1 General business (per part E) 11.2 Long term business ______________ ________________ ______________ ________________ Shareholders equity- 12.1 Share capital 12.2 Retained earnings (per part D) 12.3 Other (describe) ______________ ________________ ______________ ________________ Part C Investment Assets Current year Previous year Total Invested Total Invested within Cayman within Cayman Islands Islands 1. Fixed deposits with banks and financial institutions. 2. Government and Government guaranteed issues- 2.1 Treasury bills 2.2 Bonds 2.3 Other (describe) 3. Quoted Investments- 3.1 Bonds and commercial paper 3.2 Ordinary shares 3.3 Preference shares 3.4 Other (describe) 4. Unquoted Investments- 4.1 Bonds and commercial paper FOURTH SCHEDULE 4.2 Ordinary shares 4.3 Preference shares 4.4 Other (describe) 5. Loans- 5.1 To policy holders 5.2 Mortgages on real estate 5.3 Secured other than on real estate 5.4 Unsecured 5.5 Other (describe) 6. Real Estate- 6.1 Undeveloped land 6.2 Rented property 6.3 Other (describe) 7. Other (describe) Note (a) The above amounts should be stated net of provisions for permanent diminution in value and net of provision for losses. (b) Please supply details of market and\/or net realisable values of each category of assets if less than the above stated carrying values. (c) Give details of any charges or encumbrances on the above assets. (d) Related party assets should be separately disclosed. FOURTH SCHEDULE Part D Statement of Income and Retained Earnings Current year Previous year 1. Transfer from (to) revenue accounts- 1.1 General business account (per Part E) 1.2 Long term business account 2. Investment income not allocated to revenue accounts. 3. Administration and general expenses not allocated to revenue accounts ( ) ( ) 4. Other items (describe) _________ __________ 5. Net income 6. Retained earnings at beginning of year. 7. Appropriations from (to) share-holders reserves (describe) 8. Dividends paid ( ) ( ) _________ __________ 9. Retained earnings at end of year _________ __________ Part E General business revenue account Current year Previous year Total Cayman Total Cayman Is. domestic Is. domestic business business 1. Fund brought forward at beginning of year- 1.1 Reserve for outstanding reported losses FOURTH SCHEDULE 1.2 Reserve for losses incurred but not reported. 1.3 Other (describe) _________ _________ _________ Sub-total _________ _________ _________ 2. Earned Premiums- 2.1 Unearned premium brought forward 2.2 Premiums written (net of refunds and rebates) 2.3 Unearned premiums carried forward Sub-total _________ _________ _________ 3. Investment income 4. Other items (describe) 5. Transfer from statement of income and retained earnings _________ _________ _________ 6. Total of items 1 to 5 7. Claims paid including costs of settlement 8. Commission and underwriting expenses 9. Administration and general expenses 10. Other items (describe) 11. Transfer to statement of income and retained earnings. _________ _________ _________ 12. Total of items 7 to 11 13. Fund carried forward at end of year- 13.1 Reserve for outstanding reported losses. 13.2 Reserve for losses incurred but not reported. FOURTH SCHEDULE 13.3 Others (describe) Sub-total _________ _________ _________ 14. Total of items 12 and 13 _________ _________ _________ Notes: (i) Items should be net of outwards reinsurance. (ii) Line 6 should equal line 14. Notes Re Part F Underwriting Analysis Notes: 1. Column 2 should show all underwriting expense but not management expenses. 2. Column 8 should be shown before any IBNR provision. 3. Columns 13, 14 and 15 are to be completed in respect of 1980 underwriting year only. This return to be completed for each underwriting year, commencing with 1980, open during the financial year to which the whole of the Fourth Schedule relates. The 1980 underwriting year analysis will always include entries in columns 13, 14 and 15 until such time as all previous liability has been extinguished. Notes Re Part G: General business Summary of re-insurance ceded Notes: 1. This Schedule may be completed on an underwriting year basis if preferred, subsequent returns showing information for the next underwriting year together with any changes in coverage relating to earlier years. 2. Facultative re-insurance need only be included where the premium for any particular cover exceeds ten per cent of the gross premium for the class. 3. Cessions to other re-insurers may be grouped geographically, e.g. U.S. market, London market, Far East market, etc. FOURTH SCHEDULE Part H AUDITORS CERTIFICATE WE HEREBY CERTIFY that the financial information contained in accompanying Annual Accounts has been prepared from the company\u2019s records and audited annual accounts as at attached hereto. In our\/my opinion the accompanying Annual Accounts presents fairly the information required under section 7(4) of the Insurance Law (2003 Revision). Dated at this day of , 20 . \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... [Signature of person[s] furnishing this certificate] \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026... [Name and position of individual signing above certificate] Name of company\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 Address\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. Publication in consolidated and revised form authorised by the Governor in Cabinet this 8th day of July, 2003. Carmena Watler Clerk of the Cabinet\", \"element\": \"section\", \"heading\": null}], \"meta\": {\"notes\": null, \"workflow\": null, \"lifecycle\": {\"source\": \"#cilegis\", \"eventRef\": [{\"eId\": \"e_commence_2003_01_01\", \"date\": \"2003-01-01\", \"type\": \"generation\", \"source\": \"#cilegis\"}]}, \"references\": {\"source\": \"#canary\", \"TLCRole\": [], \"TLCEvent\": [{\"eId\": \"ev_commencement\", \"href\": \"\/akn\/ontology\/canary\/event\/commencement\", \"showAs\": \"commencement\"}], \"TLCPerson\": [], \"TLCConcept\": [{\"eId\": \"inForce\", \"href\": \"\/akn\/ontology\/canary\/concept\/temporal\/in-force\", \"showAs\": \"in force\"}], \"TLCProcess\": [], \"TLCLocation\": [], \"TLCOrganization\": [{\"eId\": \"cilegis\", \"href\": \"\/akn\/ontology\/canary\/organization\/editor\/cilegis\", \"showAs\": \"Cayman Islands legislation mirror (kyleg)\"}]}, \"temporalData\": {\"source\": \"#cilegis\", \"temporalGroup\": [{\"eId\": \"tg_inforce_2003_01_01\", \"timeInterval\": [{\"end\": null, \"start\": \"#e_commence_2003_01_01\", \"duration\": null, \"refersTo\": \"#inForce\"}]}]}, \"classification\": null, \"identification\": {\"source\": \"#cilegis\", \"FRBRWork\": {\"FRBRuri\": \"\/akn\/ky\/act\/sl\/1980\/15\", \"FRBRdate\": [{\"date\": \"2003-01-01\", \"name\": \"generation\"}], \"FRBRthis\": \"\/akn\/ky\/act\/sl\/1980\/15\/!main\", \"FRBRalias\": [{\"name\": \"cmsId\", \"value\": \"1980-0015\"}], \"FRBRauthor\": [{\"as\": \"#editor\", \"href\": \"\/akn\/ontology\/canary\/organization\/editor\/cilegis\"}], \"FRBRnumber\": \"15 of 1980\", \"FRBRcountry\": \"ky\", \"FRBRsubtype\": \"subordinate\"}, \"FRBRExpression\": {\"FRBRuri\": \"\/akn\/ky\/act\/sl\/1980\/15\/eng@2003-01-01\", \"FRBRdate\": [{\"date\": \"2003-01-01\", \"name\": \"generation\"}], \"FRBRthis\": \"\/akn\/ky\/act\/sl\/1980\/15\/eng@2003-01-01\/!main\", \"FRBRauthor\": [{\"as\": \"#editor\", \"href\": \"\/akn\/ontology\/canary\/organization\/editor\/cilegis\"}], \"FRBRlanguage\": \"eng\"}, \"FRBRManifestation\": {\"FRBRuri\": \"\/akn\/ky\/act\/sl\/1980\/15\/eng@2003-01-01.xml\", \"FRBRdate\": [{\"date\": \"2026-06-22\", \"name\": \"generation\"}], \"FRBRthis\": \"\/akn\/ky\/act\/sl\/1980\/15\/eng@2003-01-01.xml\", \"FRBRauthor\": [{\"as\": \"#editor\", \"href\": \"\/akn\/ontology\/canary\/organization\/editor\/cilegis\"}], \"FRBRformat\": \"application\/xml\"}}}, \"name\": \"act\", \"header\": {\"title\": \"Insurance (Forms) Regulations\", \"actNumber\": \"15 of 1980\", \"longTitle\": null}}, \"doc\": null, \"bill\": null, \"judgment\": null}}","akn_full_text":"CAYMAN ISLANDS\n\nInsurance Law\nINSURANCE (FORMS) REGULATIONS\n\n(2003 Revision)\nSupplement No. 4 published with Gazette No. 16 of 11th August, 2003.\n\nPage 2\nRevised as at 8th day of July, 2003\nc\n\nPUBLISHING DETAILS\nRevised under the authority of the Law Revision Law (1999 Revision).\nThe Insurance (Forms) Regulations, 1980 made the 10th day of June, 1980\nConsolidated with the -\nInsurance (Forms) (Amendment) (Licence Applications) Regulations, 2001 made the\n12th day of April, 2001.\nAnd as amended by the -\nCayman Islands (Constitution) (Amendment) Order 2003 (U.K.S.I. 2003 No. 1515) made\nthe 12th day of June, 2003.\nConsolidated and revised this 8th day of July, 2003.\n\nInsurance (Forms) Regulations\nArrangement of Regulations\n\nc\nRevised as at 8th day of July, 2003\nPage 3\n\nCAYMAN ISLANDS\n\nInsurance Law\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nArrangement of Regulations\nRegulation\nPage\n1.\nCitation ......................................................................................................................................5\n2.\nForms of application for licences ................................................................................................5\n3.\nForms of licenses.......................................................................................................................5\n4.\nCertificate of compliance ............................................................................................................5\n5.\nFinancial statement ....................................................................................................................5\nFIRST SCHEDULE\n7\nAPPLICATION FOR A CLASS \u201cA\u201d INSURER\u2019S LICENCE\n7\nAPPLICATION FOR A CLASS \u201cB\u201d INSURER\u2019S LICENCE\n11\nAPPLICATION FOR AN INSURANCE AGENT\u2019S LICENCE\n14\nAPPLICATION FOR AN INSURANCE BROKER\u2019S LICENCE\n17\nAPPLICATION FOR AN INSURANCE SUB-AGENT\u2019S LICENCE\n20\nAPPLICATION FOR AN UNDERWRITING MANAGER\u2019S LICENCE\n21\nSECOND SCHEDULE\n24\nLICENCE\n24\nTHIRD SCHEDULE\n25\nCERTIFICATE OF COMPLIANCE FOR ALL CLASSES OF INSURERS LICENCES, OTHER\nTHAN LICENCES FOR APPROVED\n25\nFOURTH SCHEDULE\n27\nANNUAL FINANCIAL STATEMENT FOR YEAR ENDING 20\n.\n27\n\nInsurance (Forms) Regulations\nRegulation 1\n\nc\nRevised as at 8th day of July, 2003\nPage 5\n\nCAYMAN ISLANDS\n\nInsurance Law\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\n\n1.\nCitation\n1.\nThese regulations may be cited as the Insurance (Forms) Regulations (2003\nRevision).\n2.\nForms of application for licences\n2.\nThe forms set out in the First Schedule hereto shall be employed for the respective\npurposes of the Law and of these regulations specified in the heading to each of\nsuch forms.\n3.\nForms of licenses\n3.\nLicences shall be in the form set out in the Second Schedule hereto.\n4.\nCertificate of compliance\n4.\nA certificate of compliance furnished under section 7(3) shall be in the form set out\nin the Third Schedule hereto and each licensed Insurer other than an approved\nexternal insurer shall furnish such a certificate in relation to its insurance business\nduring each financial year within six months of the last day of the year.\n5.\nFinancial statement\n5.\nThe financial statement under section 7(5) shall be in the form set out in the Fourth\nSchedule hereto.\n\nRegulation 5\nInsurance (Forms) Regulations\n\nPage 6\nRevised as at 8th day of July, 2003\nc\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 7\n\n FIRST SCHEDULE\n(regulation 2)\nFORM 1\nCAYMAN ISLANDS\nFIRST SCHEDULE\nINSURANCE LAW\n(2003 Revision)\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nAPPLICATION FOR A CLASS \u201cA\u201d INSURER\u2019S LICENCE\n(Section 4 (2))\nPlease complete all sections as fully as possible, giving reasons for non- compliance if\nany, and attaching appendices where appropriate.\nNote:\nAn applicant seeking a Class \u2018A\u2019 Licence under section 4(7) as an approved\nexternal insurer need complete paragraph 1-12 only.\n1.\nName of applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\n2.\nDate on which applicant commenced, or intends to commence, carrying on business\nin or from within the Islands\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n3.\nWhether business being, or proposed to be, transacted is \u201cgeneral\u201d or \u201clong term\u201d or\nboth (as defined in section 2)\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n4.\nAddress of\n(a)\nprincipal office\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n(b) registered office\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n(c)\nhead office in the islands\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n5.\nName of manager or head of office in the Islands\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n\nFIRST SCHEDULE\nInsurance (Forms) Regulations\n\nPage 8\nRevised as at 8th day of July, 2003\nc\n\n6.\nIf the applicant is to depend upon agent or service companies for the provision of\nunderwriting, management, financial or accounting services, please give details of\nsuch companies, including evidence of their agreement to provide the services\nmentioned.\n7.\nName of person resident in the Islands who is authorised to accept service of\nprocess in legal proceedings and notices on behalf of the applicant and who is\napproved or proposed for approval under section 7(2)\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n8.\n(a)\nBranch applicants must provide written confirmation that their head\noffice accepts full responsibility for all policies and contracts issued by\nthe branch and also for all acts, omissions and liabilities of the branch.\n(b) Where the applicant is a subsidiary company state whether the parent\ncompany will provide a guarantee in respect of all policies or contracts\nissued by the branch and also for all acts omissions and liabilities of the\nsubsidiary.\n9.\nIn respect of general domestic business state the applicant\u2019s policy regarding\navailability of funds for prompt settlement of normal claims\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n10. In respect of long term domestic business state the applicant\u2019s policy regarding\ninvestment of consequent annual premium income in the Islands\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\n11. List all insurance agents and insurance brokers, if any, who have or who are to have,\nthe applicant\u2019s underwriting authority to accept domestic business on its behalf\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n12. To be completed only by an applicant seeking to be licensed as an approved\nexternal insurer\nA\nAttach\n(i)\nlatest annual report and audited accounts; or\n(ii) statutory financial statement\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 9\n\nB\nAttach\n(i)\nlatest certificate of solvency; or\n(ii) certificate of compliance with insurance legislation in country of\nconstitution,\ntogether with written confirmation that the certificate attached embraces all\nliabilities in respect of domestic business\n13. Attach a copy of the act, charter, certificate of incorporation and memorandum of\nassociation and articles of association or other instrument of constitution of the\napplicant, as may be appropriate, verified by a statutory declaration made by a\ndirector, secretary or partner and duly authenticated as follows -\n(a)\nin the case of a company incorporated in the Islands, certified in\naccordance with the section 27 of the Companies Law (2003 Revision);\n(b) in the case of a foreign company certified and authenticated under public\nseal of the country, city or place under the laws of which such company\nhas been incorporated; or\n(c)\nor in the case of companies not yet incorporated, the proposed\ndocumentation.\n14. List all names (including any previous names), addresses and nationalities of all\nshareholders. In those instances where shares are held by a corporate body or\nbodies, the chain of connection to the ultimate owner must be shown.\n15. Attach the annual accounts, for the two years preceding the year of application, of\neach shareholder which is a body corporate holding more than ten per cent of the\napplicant\u2019s issued share capital or total voting rights, together with similar accounts\nfor the parent body, if any, of each such body corporate.\n16. Attach curricula vitae of all directors, managers and officers, including any previous\nnames, and with particular emphasis on experience in the insurance profession.\n17. Attach not less than three references acceptable to the Authority, including one\ncharacter reference for, and one reference verifying the good financial standing of-\n(a)\neach director, manager and officer of the applicant; and\n(b) each shareholder and each beneficial shareholder who is a natural person\nholding more than ten percent of the applicant\u2019s issued share capital or\ntotal voting rights,\nand, for each such director, manager, officer or shareholder, a police or other\ncertificate satisfactory to the Authority that such director, manager, officer or\nshareholder has not been convicted of a serious crime or any offence involving\ndishonesty.\n18.\n\nFIRST SCHEDULE\nInsurance (Forms) Regulations\n\nPage 10\nRevised as at 8th day of July, 2003\nc\n\n(a)\nName and address of the principal agent or representative resident in the\nIslands\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n(b) Address of designated principal office in the Islands where full business\nrecords will be kept\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n19. Name, address and professional qualification of auditors (and the country whose\ngenerally accepted accounting principles are to apply) and, if the application\nincludes long term business, similar details of the actuary who will give required\nstatutory certificates. Attach evidence that said auditors and actuary have agreed to\naccept appointment\nAuditor\n\nActuary\n20. (a)\n(For an existing insurer). Attach annual accounts for the three years preceding\nthe date of this application.\n(b) (For an applicant for a new insurer\u2019s licence). Attach a written\nundertaking to provide at least the minimum net worth requirements set\nout in section 4(9), together with a statement as to how said net worth is\nto be calculated.\n21. Attach a business plan. The Authority may indicate that any part of the information\nincluded in the business plan shall not form part of this application for the purpose\nof sections 4(3) and 7(2).\n22. Have any of the parties connected with this application ever applied, either\nindividually or in conjunction with others, for authority to transact insurance in any\nother jurisdiction? If so please give details.\nApplication is accordingly hereby made for the licence specified above and it is\ncertified that all the particulars contained in this Application and in the documents\naccompanying it or otherwise furnished in support hereof are true and correct.\nDated this day of\n, 20 .\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n[Name of applicant]\nby its *Director\/*Secretary\/* or other person duly authorised.\nSigned:\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.. WITNESS:\nName:\nOccupation:\nAddress:\n*Delete words which are not applicable\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 11\n\nFORM 2\nCAYMAN ISLANDS\nINSURANCE LAW\n(2003 Revision)\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nAPPLICATION FOR A CLASS \u201cB\u201d INSURER\u2019S LICENCE\n(Section 4(2))\nPlease complete all sections as fully as possible, giving reasons for non- compliance if\nany, and attaching appendices where appropriate.\n1.\nName of applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n2.\nWhether licence applied for is Restricted or Unrestricted.\n3.\nDate on which applicant commenced, or intends to commence, carrying on business\nin or from within the Islands.\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n4.\nWhether business being, or proposed to be, transacted is \u201cgeneral\u201d or \u201clong term\u201d or\nboth (as defined in section 2).\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n5.\nAddress of -\n(a)\nprincipal office\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\n(b) registered office\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\n6.\nIf the applicant is to depend upon agent or service Companies for the provision of\nunderwriting, management, financial or accounting services, please give details of\nsuch companies including evidence of their agreement to provide the services\nmentioned.\n7.\nAttach evidence of the proper incorporation of the applicant pursuant to section 5 of\nthe Companies Law (2003 Revision), and a copy of the memorandum of association\nand articles of association, or other instrument of constitution of the applicant, as\nmay be appropriate or, in the case of companies not yet incorporated, the proposed\ndocumentation.\n8.\nList all names (including any previous names), addresses and nationalities of all\nshareholders. In those instances where shares are held by a corporate body or bodies\nthe chain of connection to the ultimate owner must be shown.\n\nFIRST SCHEDULE\nInsurance (Forms) Regulations\n\nPage 12\nRevised as at 8th day of July, 2003\nc\n\n9.\nAttach the annual accounts, for the two years preceding the year of application, of\neach shareholder which is a body corporate holding more than ten per cent of the\napplicant\u2019s issued share capital or total voting rights, together with similar accounts\nfor the parent body, if any, of each such body corporate.\n10. Attach curricula vitae of all directors, managers, and officers, including any\nprevious names, and with particular emphasis on experience in the insurance\nprofession.\n11. Attach not less than three references acceptable to the Authority, including one\ncharacter reference for and one reference verifying the good financial standing of-\n(a)\neach director, manager and officer of the applicant; and\n(b) each shareholder and each beneficial shareholder who is a natural person\nholding more than ten per cent of the applicant\u2019s issued share capital or\ntotal voting rights,\nand, for each such director, manager, officer or shareholder, a police or other\ncertificate satisfactory to the Authority that such director, manager, officer or\nshareholder has not been convicted of a serious crime or any offence involving\ndishonesty.\n12.\n(a)\nName and address of the principal agent or representative resident in the\nCayman Islands\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n(b) Address of designated principal office in the Islands where full business\nrecords will be kept\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n13. Name, address and professional qualification of auditors and the country\nwhose generally accepted accounting principles are to apply. Attach evidence that said\nauditors have agreed to accept appointment\n14. Name and address of person resident in the Islands who is authorised to accept\nservice of process in legal proceedings and notices on behalf of the applicant and\nwho is approved or proposed for approval under section 7(2).\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n15.\n(a)\n(For an existing insurer). Attach annual accounts for three years\npreceding the date of this application.\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 13\n\n(b) (For an applicant for a new unrestricted class \u201cB\u201d insurer\u2019s\nlicence).Attach a written undertaking to provide at least the minimum net\nworth requirements set out in section 4(8), together with a statement as to\nhow said net worth is to be calculated.\n16. Attach a business plan. The Authority may indicate that any part of the information\nincluded in the business plan shall not form part of this application for the purpose\nof sections 4(3) and 7(2).\n17. Have any of the parties connected with this application ever applied, either\nindividually or in conjunction with others, for authority to transact insurance\nbusiness in any other jurisdiction? If so please give details.\nApplication is accordingly hereby made for the licence specified above and it is\ncertified that all the particulars contained in this application and in the documents\naccompanying it or otherwise furnished is support hereof are true or correct.\nDated this day of\n, 20 .\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n[Name of applicant]\nby its *Director\/*Secretary\/* or other person duly authorised.\nSigned:\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\nWITNESS:\nName:\nOccupation:\nAddress:\n*Delete words which are not applicable\n\nFIRST SCHEDULE\nInsurance (Forms) Regulations\n\nPage 14\nRevised as at 8th day of July, 2003\nc\n\nFORM 3\nCAYMAN ISLANDS\nINSURANCE LAW\n(2003 Revision)\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nAPPLICATION FOR AN INSURANCE AGENT\u2019S LICENCE\n(Section 4(2))\nPlease complete all sections as fully as possible, giving reasons for non- compliance if\nany, and attaching appendices where appropriate.\n1.\nName of applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n2.\nDate on which applicant commenced, or proposes to commence, carrying on\nbusiness in or from within the Islands, and with which principal company.\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n3.\nAddress of main or registered office in the Islands.\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n4.\nIf incorporated-\n(a)\nAttach evidence of proper incorporation under section 5 of the\nCompanies Law (2003 Revision) and a copy of the memorandum of\nassociation and articles of association or other instrument of constitution\nof the applicant as may be appropriate or, if not yet incorporated, the\nproposed documentation.\n(b) List all names (including any previous names), addresses and\nnationalities of all share holders. In those instances where shares are held\nby a corporate body or bodies the chain of connection to the ultimate\nowner must be shown.\n(c)\nAttach curricula vitae of all directors, managers and officers.\n5.\nAttach the annual accounts, for the two years preceding the year of\napplication, of each shareholder which is a body corporate holding more than ten\nper cent of the applicant\u2019s issued share capital or total voting rights, together with\nsimilar accounts for the parent body, if any, of each such body corporate.\n6.\nIf not incorporated, names, addresses, nationalities and curricula vitae of the\napplicant and any person acting as a manager, or other officer or partner, as the case\nmay be.\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 15\n\n7.\nIf incorporated, attach not less than three references acceptable to the Authority,\nincluding one character reference for and one reference verifying the good financial\nstanding of -\n(a)\neach director, manager and officer of the applicant; and\n(b) each shareholder and each beneficial shareholder who is a natural person\nholding more than ten per cent of the applicant\u2019s issued share capital or\ntotal voting rights,\nand, for each such director, manager, officer or shareholder, a police or other\ncertificate satisfactory to the Authority that such director, manager, officer or\nshareholder has not been convicted of a serious crime or any offence involving\ndishonesty.\n8.\nIf not incorporated, attach not less than three references acceptable to the Authority,\nincluding one character reference for, and one reference verifying the good financial\nstanding of, the applicant and any person acting as a manager, or other officer or\npartner, as the case may be; and for each such person, a police or other certificate\nsatisfactory to the Authority that the person has not been convicted of a serious\ncrime or any offence involving dishonesty.\n9.\nAttach evidence of the existence of a power of attorney, agency agreement or\nguarantee, or of professional indemnity insurance as required under section 8(3).\n10. Attach a list of all sub-agents authorised by the applicant to solicit domestic\nbusiness on his behalf, and of all insurance agents associated with the applicant\ncompany.\n11. Have any of the parties connected with this application ever applied, either\nindividually or in conjunction with others, for authority to transact insurance\nbusiness in any other jurisdiction? If so, please give details.\nApplication is accordingly hereby made for the Licence specified above, and it is\ncertified that all the particulars contained in this application and in the documents\naccompanying it or otherwise furnished in support hereof are true and correct.\nDated this day of\n, 20 .\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\n[Name of Applicant]\nSignature of applicant, if an individual\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\nWITNESS:\nName:\nOccupation:\nAddress:\nOR by its *Director\/*Secretary\/ or *other person duly authorised\n\nFIRST SCHEDULE\nInsurance (Forms) Regulations\n\nPage 16\nRevised as at 8th day of July, 2003\nc\n\nSigned\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\nWITNESS:\nName:\nOccupation:\nAddress:\n*Delete words which are not applicable\nIn the case of personal Life Agents the application should be witnessed by the\nprincipal officer of the general agents in the Islands with whom the applicant is or\nwill be associated.\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 17\n\nFORM 4\nCAYMAN ISLANDS\nINSURANCE LAW\n(2003 Revision)\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nAPPLICATION FOR AN INSURANCE BROKER\u2019S LICENCE\n(Section 4 (2) )\nPlease complete all sections as fully as possible, giving reasons for non- compliance if\nany, and attaching appendices where appropriate.\n1.\nName of Applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n2.\nDate on which applicant commenced, or proposes to commence carrying on\nbusiness in or from within the Islands\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n3.\nAddress of principal or registered office\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n4.\nIf incorporated -\n(a)\nAttach evidence of proper incorporation under section 5 of the\nCompanies Law (2003 Revision) and a copy of the memorandum of\nassociation and articles of association or other instrument of constitution\nof the applicant as may be appropriate; or if not yet incorporated, the\nproposed documentation.\n(b) List all names (including any previous names), addresses and\nnationalities of all shareholders. In those instances where shares are held\nby a corporate body or bodies the chain of connection to the ultimate\nowner must be shown.\n(c)\nAttach curricula vitae of all directors, managers and officers.\n5.\nAttach the annual accounts, for the two years preceding the year of application, of\neach shareholder which is a body corporate holding more than ten per cent of the\napplicant\u2019s issued share capital or total voting rights,\ntogether with similar accounts for the parent body, if any, of each such body\ncorporate.\n6.\nIf not incorporated, names, addresses, nationalities and curricula vitae of the\napplicant and any person acting as a manager, or other officer or partner, as the case\nmay be.\n\nFIRST SCHEDULE\nInsurance (Forms) Regulations\n\nPage 18\nRevised as at 8th day of July, 2003\nc\n\n7.\nIf incorporated, attach not less than three references acceptable to the Authority,\nincluding one character reference for and one reference verifying the good financial\nstanding of -\n(a)\neach director, manager and officer of the applicant; and\n(b) each shareholder and each beneficial shareholder who is a natural person\nholding more than ten per cent of the applicant\u2019s issued share capital or\ntotal voting rights,\nand, for each such director, manager, officer or shareholder, a police or other\ncertificate satisfactory to the Authority that the person has not been convicted\nof a serious crime or any offence involving dishonesty.\n8.\nIf not incorporated, attach not less than three references acceptable to the Authority,\nincluding one character reference for, and one reference verifying the good financial\nstanding of, the applicant and any person acting as a manager, or other officer or\npartner, as the case may be; and for each such person, a police or other certificate\nsatisfactory to the Authority that the person has not been convicted of a serious\ncrime or any offence involving dishonesty.\n9.\nAttach evidence of the existence of professional indemnity insurance as required\nunder section 9(2).\n10. Attach a list of all sub-agents authorised by the applicant to solicit domestic\nbusiness on his behalf, and of all Insurance agents that may be associated with the\napplicant.\n11. Attach a list of all insurers with whom the applicant has entered into any form of\nagency agreement.\n12. Attach a business plan.\n13. Have any of the parties connected with this application ever applied, either\nindividually or in conjunction with others, for authority to transact insurance\nbusiness in any other jurisdiction? If so, please give details.\nApplication is accordingly hereby made for the licence specified above and it is\ncertified that all the particulars contained in this application and in the documents\naccompanying it or otherwise furnished in support hereof are true and correct.\nDated this day of\n, 20 .\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n[Name of Applicant]\nSignature of applicant, if an individual\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\nWITNESS:\nName:\nOccupation:\nAddress:\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 19\n\nOR by its *Director\/*Secretary\/ *or other person duly authorised\nSigned\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\nWITNESS:\nName:\nOccupation:\nAddress:\n*Delete words which are not applicable\n\nFIRST SCHEDULE\nInsurance (Forms) Regulations\n\nPage 20\nRevised as at 8th day of July, 2003\nc\n\nFORM 5\nCAYMAN ISLANDS\nINSURANCE LAW\n(2003 Revision)\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nAPPLICATION FOR AN INSURANCE SUB-AGENT\u2019S LICENCE\n(Section 4(2))\nPlease complete all sections as fully as possible, giving reasons for non- compliance if\nany, and attaching appendices where appropriate.\n1.\nName and address of applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n2.\nDate on which applicant commenced, or proposes to commence, carrying on\nbusiness in or from within the Islands.\n3.\nAttach not less than three references acceptable to the Authority, including one\ncharacter reference for, and one reference verifying the good financial standing of,\nthe applicant.\n4.\nAttach a police or other certificate satisfactory to the Authority that the applicant\nhas not been convicted of a serious crime or any offence involving dishonesty.\n5.\nDetails of the applicant\u2019s experience in the business of insurance.\n6.\nHave any of the parties connected with this application ever applied, either\nindividually or in conjunction with others, for authority to transact insurance\nbusiness in any other jurisdiction? If so, please give details.\nApplication is accordingly hereby made for the Licence specified above and it is\ncertified that all the particulars contained in this application and in the documents\naccompanying it or otherwise furnished in support hereof are true and correct.\nDated this day of\n, 20 .\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\nSignature of Applicant\nWITNESS:\nName:\nOccupation:\nAddress:\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 21\n\nFORM 6\nCAYMAN ISLANDS\nINSURANCE LAW\n(2003 Revision)\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nAPPLICATION FOR AN UNDERWRITING MANAGER\u2019S LICENCE\n(Section 4 (2) )\nPlease complete all sections as fully as possible, giving reasons for non- compliance if\nany, and attaching appendices where appropriate.\n1.\nName of Applicant\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n2.\nDate on which applicant commenced, or proposes to commence carrying on\nbusiness in or from within the Islands, and with which principal company.\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n3.\nAddress of main or registered office in the Islands\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n4.\nIf incorporated-\n(a)\nAttach evidence of proper incorporation pursuant to section 5 of the\nCompanies Law (2003 Revision) and a copy of the memorandum of\nassociation and articles of association or other instrument of constitution\nof the applicant as may be appropriate; or if not yet incorporated, the\nproposed documentation.\n(b) List all names (including any previous names), addresses and\nnationalities of all shareholders. In those instances where shares are held\nby a corporate body or bodies the chain of connection to the ultimate\nowner must be shown.\n(c)\nAttach curricula vitae of all directors, managers and officers.\n5.\nAttach the annual accounts, for the two years preceding the year of application, of\neach shareholder which is a body corporate holding more than ten per cent of the\napplicant\u2019s issued share capital or total voting rights, together with similar accounts\nfor the parent body, if any, of each such body corporate.\n6.\nIf not incorporated, names, addresses, nationalities and curricula vitae of the\napplicant and any person acting as a manager, or other officer or partner, as the case\nmay be.\n\nFIRST SCHEDULE\nInsurance (Forms) Regulations\n\nPage 22\nRevised as at 8th day of July, 2003\nc\n\n7.\nIf incorporated, attach not less than three references acceptable to the Authority,\nincluding one character reference for and one reference verifying the good financial\nstanding of -\n(a)\neach director, manager and officer of the applicant; and\n(b) each shareholder and each beneficial shareholder who is a natural person\nholding more than ten per cent of the applicant\u2019s issued share capital or\ntotal voting rights,\nand, for each such director, manager, officer or shareholder, a police or other\ncertificate satisfactory to the Authority that the person has not been convicted\nof a serious crime or any offence involving dishonesty.\n8.\nIf not incorporated, attach not less than three references acceptable to the Authority,\nincluding one character reference for, and one reference verifying the good financial\nstanding of, the applicant and any person acting as a manager, or other officer or\npartner, as the case may be; and for each such person, a police or other certificate\nsatisfactory to the Authority that the person has not been convicted of a serious\ncrime or any offence involving dishonesty.\n9.\nAttach a list of all insurers for whom the applicant is, or will be engaged to act as\nmanager or consultant.\n10. Attach a business plan.\n11. Have any of the parties connected with this application ever applied, either\nindividually or in conjunction with others, for authority to transact insurance\nbusiness in any other jurisdiction? If so, please give details.\nApplication is accordingly hereby made for the licence specified above and it is\ncertified that all the particulars contained in this application and in the documents\naccompanying it or otherwise furnished in support hereof are true and correct.\nDated this day of\n, 20 .\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n[Name of Applicant]\nSignature of applicant if an individual\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\nWITNESS:\nName:\nOccupation:\nAddress:\nOR by its *Director\/*Secretary\/ *or other person duly authorised\nSigned\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\nWITNESS:\nName:\nOccupation:\n\nInsurance (Forms) Regulations\nFIRST SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 23\n\nAddress:\n*Delete words which are not applicable\n\nSECOND SCHEDULE\nInsurance (Forms) Regulations\n\nPage 24\nRevised as at 8th day of July, 2003\nc\n\nSECOND SCHEDULE\nINSURANCE LAW\n(2003 Revision)\nregulation 4\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\n\nLICENCE\nNO..................\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026............\u2026\u2026\u2026..\nis hereby licensed under the Insurance Law (2003 Revision), to carry on business in or\nfrom within the Cayman Islands as\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026under section\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 of the\nLaw , subject to the provisions of the said Law and, in particular, to the condition that the\nLicensee shall forthwith notify the Governor of any change in the information supplied in\nthe application for this Licence.\nGiven this day of , 20\nat George Town on the Island of\nGrand Cayman.\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\nGovernor in Cabinet\n\nInsurance (Forms) Regulations\nTHIRD SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 25\n\nTHIRD SCHEDULE\nregulation 5\nCAYMAN ISLANDS\nINSURANCE LAW\n(2003 Revision)\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nCERTIFICATE OF COMPLIANCE FOR ALL CLASSES OF INSURERS\nLICENCES, OTHER THAN LICENCES FOR APPROVED\nEXTERNAL INSURERS\n(Section 7 (3))\nI\/We\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n[Name]\nof\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n[Full business address]\nDO HEREBY CERTIFY as follows-\n1.\nThat I\/we am\/are-\n*(a) the duly appointed independent auditor(s) or\n(b) the underwriting manager of\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\n[Name of Licensed Insurer]\nWhich is the holder of a currently valid\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..Licence No.\n[Category of Licence]\nunder the abovementioned Law.\n2.\nThat, to the best of our knowledge and belief and subject to the exceptions or\nqualifications, if any, mentioned below, the said licence holder has during the\nperiod____________________to ______________________________\ncarried on its insurance business in accordance with the information provided in its\nlicence application, subject to changes approved by the Governor. This certificate\nrelates only to the following of such information:-\n(a)\nThe classes of insurance business conducted by the licence holder.\n\nTHIRD SCHEDULE\nInsurance (Forms) Regulations\n\nPage 26\nRevised as at 8th day of July, 2003\nc\n\n(b) The particulars described in the application, in the case of Class \u2018A\u2019\ninsurers at paragraphs 4 to 7, 11, 13, 14, 18 and 19 and in the case of\nClass \u2018B\u2019 insurers at paragraphs 5 to 8 and 12 to 14.\n(c)\nThe Business Plan (excluding information which the Authority has\nindicated does not form part of the application for purposes of sections 4\n(3) and 7 (2).\n\nEXCEPTIONS OR QUALIFICATIONS\nDated at\nthis day of , 20 .\n..\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\n[Signature of person[s] furnishing this Certificate]\nName and position of individual signing above certificate.\n*Delete if inappropriate.\n\nInsurance (Forms) Regulations\nFOURTH SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 27\n\nFOURTH SCHEDULE\nregulation 6\nCAYMAN ISLANDS\nINSURANCE LAW\n(2003 Revision)\nINSURANCE (FORMS) REGULATIONS\n(2003 Revision)\nANNUAL FINANCIAL STATEMENT FOR YEAR ENDING 20\n.\n(section 7 (5))\nLicence No.\nName of Company:\nPart A\nPlease attach directors report [if any], and audited financial statement in the normal\npublished form.\nPart B\nBalance Sheet\nCurrent year Previous year\n1.\nInvestment assets (per Part C)\n2.\nReal estate held for own use\n3.\nOther fixed assets\n4.\nInvestment income receivable\n5.\nCash at bank (non invested)\n6.\nPremiums receivable\n7.\nOther assets\n\n______________\n________________\n\n______________\n________________\n8.\nUnearned premiums\n9.\nReinsurance premium payable\n10. Other liabilities\n\nFOURTH SCHEDULE\nInsurance (Forms) Regulations\n\nPage 28\nRevised as at 8th day of July, 2003\nc\n\nCurrent year Previous year\n11. Insurance funds-\n11.1 General business (per part E)\n11.2 Long term business\n\n______________\n________________\n\n______________\n________________\nShareholders equity-\n12.1 Share capital\n12.2 Retained earnings (per part D)\n12.3 Other (describe)\n\n______________\n________________\n\n______________\n________________\nPart C\nInvestment Assets\nCurrent year Previous year\n\nTotal Invested\n\nTotal Invested\n\nwithin Cayman\n\nwithin Cayman\n\nIslands\n\nIslands\n1.\nFixed deposits with banks\nand financial institutions.\n2.\nGovernment and Government\nguaranteed issues-\n2.1 Treasury bills\n2.2 Bonds\n2.3 Other (describe)\n3.\nQuoted Investments-\n3.1 Bonds and commercial paper\n3.2 Ordinary shares\n3.3 Preference shares\n3.4 Other (describe)\n4.\nUnquoted Investments-\n4.1 Bonds and commercial paper\n\nInsurance (Forms) Regulations\nFOURTH SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 29\n\n4.2 Ordinary shares\n4.3 Preference shares\n4.4 Other (describe)\n5.\nLoans-\n5.1 To policy holders\n5.2 Mortgages on real estate\n5.3 Secured other than on\nreal estate\n5.4 Unsecured\n5.5 Other (describe)\n6.\nReal Estate-\n6.1 Undeveloped land\n6.2 Rented property\n6.3 Other (describe)\n7.\nOther (describe)\nNote\n(a)\nThe above amounts should be stated net of provisions for permanent\ndiminution in value and net of provision for losses.\n(b) Please supply details of market and\/or net realisable values of each\ncategory of assets if less than the above stated carrying values.\n(c)\nGive details of any charges or encumbrances on the above assets.\n(d) Related party assets should be separately disclosed.\n\nFOURTH SCHEDULE\nInsurance (Forms) Regulations\n\nPage 30\nRevised as at 8th day of July, 2003\nc\n\nPart D\nStatement of Income and Retained Earnings\n\nCurrent year Previous year\n1.\nTransfer from (to) revenue accounts-\n1.1 General business account (per Part E)\n1.2 Long term business account\n2.\nInvestment income not allocated to\nrevenue accounts.\n3.\nAdministration and general expenses\nnot allocated to revenue accounts\n\n(\n\n)\n\n(\n\n)\n4.\nOther items (describe)\n\n_________\n\n__________\n5.\nNet income\n6.\nRetained earnings at beginning of year.\n7.\nAppropriations from (to) share-holders\nreserves (describe)\n8.\nDividends paid\n\n(\n\n)\n\n(\n\n)\n\n_________\n\n__________\n9.\nRetained earnings at end of year\n\n_________\n\n__________\nPart E\nGeneral business revenue account\nCurrent year Previous year\n\nTotal Cayman\n\nTotal Cayman\n\nIs. domestic\n\nIs. domestic\n\nbusiness\n\nbusiness\n1.\nFund brought forward at beginning\nof year-\n1.1 Reserve for outstanding\nreported losses\n\nInsurance (Forms) Regulations\nFOURTH SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 31\n\n1.2 Reserve for losses incurred\nbut not reported.\n1.3 Other (describe)\n\n_________\n_________\n_________\nSub-total\n\n_________\n_________\n_________\n2.\nEarned Premiums-\n2.1 Unearned premium brought\nforward\n2.2 Premiums written (net of\nrefunds and rebates)\n2.3 Unearned premiums carried\nforward\nSub-total\n\n_________\n_________\n_________\n3.\nInvestment income\n4.\nOther items (describe)\n5.\nTransfer from statement of\nincome and retained earnings\n_________\n_________\n_________\n6.\nTotal of items 1 to 5\n7.\nClaims paid including costs\nof settlement\n8.\nCommission\nand underwriting\nexpenses\n9.\nAdministration and general\nexpenses\n10. Other items (describe)\n11. Transfer to statement of income\nand retained earnings.\n\n_________\n_________\n_________\n12. Total of items 7 to 11\n13. Fund carried forward at end of year-\n13.1 Reserve for outstanding\n reported losses.\n13.2 Reserve for losses incurred\nbut not reported.\n\nFOURTH SCHEDULE\nInsurance (Forms) Regulations\n\nPage 32\nRevised as at 8th day of July, 2003\nc\n\n13.3 Others (describe)\nSub-total\n\n_________\n_________\n_________\n14. Total of items 12 and 13\n\n_________\n_________\n_________\nNotes:\n(i)\nItems should be net of outwards reinsurance.\n(ii) Line 6 should equal line 14.\nNotes Re Part F Underwriting Analysis\nNotes:\n1.\nColumn 2 should show all underwriting expense but not management expenses.\n2.\nColumn 8 should be shown before any IBNR provision.\n3.\nColumns 13, 14 and 15 are to be completed in respect of 1980 underwriting year\nonly.\nThis return to be completed for each underwriting year, commencing with 1980, open\nduring the financial year to which the whole of the Fourth Schedule relates. The 1980\nunderwriting year analysis will always include entries in columns 13, 14 and 15 until\nsuch time as all previous liability has been extinguished.\nNotes Re Part G: General business Summary of re-insurance ceded\nNotes:\n1.\nThis Schedule may be completed on an underwriting year basis if preferred,\nsubsequent returns showing information for the next underwriting year together\nwith any changes in coverage relating to earlier years.\n2.\nFacultative re-insurance need only be included where the premium for any\nparticular cover exceeds ten per cent of the gross premium for the class.\n3.\nCessions to other re-insurers may be grouped geographically, e.g. U.S. market,\nLondon market, Far East market, etc.\n\nInsurance (Forms) Regulations\nFOURTH SCHEDULE\n\nc\nRevised as at 8th day of July, 2003\nPage 33\n\nPart H\nAUDITORS CERTIFICATE\nWE HEREBY CERTIFY that the financial information contained in accompanying\nAnnual Accounts has been prepared from the company\u2019s records and audited annual\naccounts as at attached hereto.\nIn our\/my opinion the accompanying Annual Accounts presents fairly the information\nrequired under section 7(4) of the Insurance Law (2003 Revision).\nDated at\nthis\nday of\n\n, 20 .\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n[Signature of person[s] furnishing this certificate]\n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026...\n[Name and position of individual signing above certificate]\nName of company\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\nAddress\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\nPublication in consolidated and revised form authorised by the Governor in Cabinet\nthis 8th day of July, 2003.\nCarmena Watler\nClerk of the Cabinet","akn_extracted_at":"2026-06-22 15:38:43.49235+00","cms_id":"1980-0015","law_type":"subordinate","year":"1980","number":"15","title":"Insurance (Forms) Regulations","status":"in_force"},"provenance":{"files":[{"file_id":"4897","expr_id":"93","kind":"akn_xml","filename":"1980-0015_2003 Revision.akn.xml","source_url":null,"storage_path":"\/Users\/q\/kyleg-data\/working\/SUBORDINATE\/1980\/1980-0015\/1980-0015_2003 Revision.akn.xml","content_md5":"6b31e3bb8340c12d0071f303c7ffd5a1","byte_size":"45100","http_last_modified":null,"fetched_at":"2026-06-22 15:38:43.683929+00"},{"file_id":"185","expr_id":"93","kind":"pristine_pdf","filename":"1980-0015_2003 Revision.pdf","source_url":"\/cms\/images\/LEGISLATION\/SUBORDINATE\/1980\/1980-0015\/1980-0015_2003 Revision.pdf","storage_path":"\/Users\/q\/kyleg-data\/pristine\/SUBORDINATE\/1980\/1980-0015\/1980-0015_2003 Revision.pdf","content_md5":"3821d08ed09cca68bc727837958321cf","byte_size":"619617","http_last_modified":null,"fetched_at":"2026-06-21 23:09:35.660474+00"},{"file_id":"186","expr_id":"93","kind":"working_pdf","filename":"1980-0015_2003 Revision.pdf","source_url":"\/cms\/images\/LEGISLATION\/SUBORDINATE\/1980\/1980-0015\/1980-0015_2003 Revision.pdf","storage_path":"\/Users\/q\/kyleg-data\/working\/SUBORDINATE\/1980\/1980-0015\/1980-0015_2003 Revision.pdf","content_md5":"3821d08ed09cca68bc727837958321cf","byte_size":"619617","http_last_modified":null,"fetched_at":"2026-06-21 23:09:35.660474+00"}],"paragraph_count":13,"latest_history":null},"quality":{"expr_id":"93","doc_id":"93","quality_state":"needs_review","quality_score":"72","needs_human_review":"t","deterministic_categories":"{duplicate_text,page_header_footer_noise,paragraph_numbering_problem}","llm_categories":"{truncated_text,other}","repair_actions":"{collapse_duplicate_text,manual_review,rebuild_paragraphs,reextract_full_text,strip_page_furniture}","finding_severity_counts":"{\"low\": 1, \"medium\": 1}","finding_summary":"Sample appears mostly complete but requires verification of omitted sections and cleaning of stray characters.","assessed_at":"2026-06-22 15:29:45.720207+00","updated_at":"2026-06-22 15:29:45.720207+00"}}