LIFE INSURANCE COMPANIES.

No. 11 of 1907.

1719

(Form referred to under heading No. 6 in the 5th schedule.)

Consolidated Revenue Account of the

for

years, commencing

and ending

Amount of funds on

19 the beginning of

Premiums (after deduction of

re-assurance premiums).................. Consideration for annuities

granted...

Interest and dividends

Other receipts (accounts to

be specified).

Claims under policies (after

deduction of sums re-assured) Surrenders...

Annuities

Commission

Expenses of management Dividends and bonuses

to shareholders...

Other payments (accounts to

be specified)......

Amount of funds on

19 - the end of the period, as per 1st (or 3rd) schedule

$ c.

(Form referred to under heading No. 7 in the 5th schedule.) Summary and Valuation of the Policies of the

PARTICULARS OF THE

POLICIES FOR

VALUATION.

as at

19

VALUATION.

Value by the Table.

Interest,

per cent.

DESCRIPTION OF TRANSACTIONS,

ASSURANCES.

I. With participation in profits.

For whole terms of life with uniform premiums throughout life

For whole terms of life with

limited premiums...

Other classes (to be specified) Extra premiums payable

Total assurances with

profits

Number of Policies.

Sums Assured, and Bonuses,

Office Yearly Premiums.

Net Yearly Premiums if ascertained.

Sums Assured and Bonuses.

Office Yearly Premiums.

Net Yearly Premiums if computed.

Net Liability.

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