CAP. 36]

Life Insurance Companies.

THIRD SCHEDULE.

[s. 11.]

REVENUE ACCOUNTS of the

for the year ending 19

(No. 1) LIFE ASSURANCE ACCOUNT.

(Date.) Amount of life assurance fund at the beginning of

the year

Premiums received on new

policies, assuring on

$

,

during the year after

deduction of

reassurance premiums

Renewal premiums

received during the

year on policies, assuring

$

after

deduction of reassurance premiums

Consideration received for annuities granted during the year

All other premiums received during the year, after deduction of reassurance premiums

Interest & dividends

Other receipts

(accounts specified)

$ c.

$ c.

(Date.) Claims under life policies, and additions thereto, after

deduction of sums reassured

Surrenders

Annuities

Dividends to policy holders

Other payments to policy holders

(items to be given)

Commission on first premiums

Commission on renewal premiums

Agents' travelling expenses & salaries

Medical fees

Salaries of other officers and employees

Advertising

Other expenses of management (accounts to be specified)

Dividends & bonuses to shareholders

Other payments (accounts to be specified)

Amount of life assurance fund at the end of the year, as per Fourth Schedule....

Note.-Companies having separate accounts for annuities to return the particulars of their annuity business in a separate statement. "Premiums received on new policies" means premiums of the first year actually received or falling due within the year of account.

300

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