Recoverable Gross from Amount Reinsurers Net Amount

FORM LI

REVENUE ACCOUNT OF (name of insurer) in respect of class(es)* for the period commencing and ending

Amount of Funds on the beginning of the period

Commissions Payable

(i) Direct Underwriting Business

(ii) Reinsurance Contracts Accepted

Premiums Receivable

Reinsurance Net of Claims Payable Gross Premiums Premiums Coded Reinsurance Premiums

(1) Direct Underwriting Business: Single Premiums Regular Premiums

(ii) Reinsurance Contracts Accepted: Single Premiums Regular Premiums

Interest or Income from Long Term Business Assets

Commissions Receivable

Other Receipts (accounts to be specified)

(i) Direct Underwriting Business: On Death On Surrender By Way of Lump Sums on Maturity By Way of Periodic Payments

(ii) Reinsurance Contracts Accepted: On Death On Surrender By Way of Lump Sums on Maturity By Way of Periodic Payments

Dividends to Policy holders

Other Payments (accounts to be specified) Amount of Funds on the end of the period

Transfer to Profit and Loss Account

* The classes referred to correspond to the classes of Long Term Business set out in Part 2 of the First Schedule.

Transfer from Profit and Loss Account

1988 Ed.] Insurance Companies [CAP. 41 63

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