Insurance Regulations 1998

# Insurance Regulations 1998

## TABLE OF PROVISIONS

| Regulation | Title | Paragraph |
|------------|-------|-----------|
| 1 | Short title and commencement | [INS 10,005] |
| 2 | Fees | [INS 10,010] |
| 3 | Forms | [INS 10,015] |
| 4 | Prescribed deposit requirement for insurers | [INS 10,020] |
| 5 | Prescribed deposit requirement for brokers | [INS 10,025] |
| 6 | Prescribed investments | [INS 10,030] |
| 7 | Prescribed form and amount of professional indemnity and fidelity guarantee insurance required by brokers | [INS 10,035] |
| 8 | Prescribed returns and reports to be disclosed by insurers | [INS 10,040] |
| 9 | Prescribed returns and reports to be disclosed by brokers | [INS 10,045] |
| 10 | Prescribed classes for notification of expiration of insurance cover | [INS 10,050] |
| 11 | Prescribed interest rate for settlement of life claims | [INS 10,055] |
| 12 | Repeal | [INS 10,060] |
| SCHEDULE 1 — FEES | | [INS 10,160] |
| SCHEDULE 2 — FORMS | | [INS 10,165] |
| FORM 1 — PLACEMENT OF INSURANCE BUSINESS WITH AN UNLICENSED OFFSHORE INSURER | | [INS 10,175] |
| FORM 2 — APPLICATION FOR LICENSING AS AN INSURER | | [INS 10,180] |
| FORM 3 — APPLICATION FOR LICENSING AS A BROKER | | [INS 10,185] |
| FORM 4 — APPLICATION FOR LICENSING AS AN AGENT | | [INS 10,190] |
| FORM 5 — APPLICATION FOR APPROVAL OF APPOINTED AUDITOR | | [INS 10,195] |
| FORM 6A — UNDERWRITING ACCOUNT | | [INS 10,200] |
| FORM 6B — PROFIT AND LOSS STATEMENT | | [INS 10,205] |
| FORM 6C — BALANCE SHEET | | [INS 10,210] |
| FORM 6D — STATEMENT OF PREMIUMS | | [INS 10,215] |
| FORM 6E — STATEMENT OF CLAIMS AND COMMISSIONS | | [INS 10,220] |
| FORM 6F — STATEMENT OF CLAIMS RUN-OFF BY ACCIDENT YEAR | | [INS 10,230] |
| FORM 6G — STATEMENT OF GENERAL EXPENSES | | [INS 10,235] |

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## LAWS OF FIJI

| Title | Paragraph |
|-------|-----------|
| FORM 6H — STATEMENT OF UNEARNED PREMIUMS | [INS 10,240] |
| FORM 6I — STATEMENT OF REINSURANCE ARRANGEMENTS | [INS 10,245] |
| FORM 6J — STATEMENT OF GROSS AGGREGATE EXPOSURES | [INS 10,250] |
| FORM 6K — BUDGET PROJECTIONS | [INS 10,255] |
| FORM 7A — OPERATING ACCOUNT | [INS 10,260] |
| FORM 7B — BALANCE SHEET | [INS 10,265] |
| FORM 8A — STATEMENT OF REVENUE AND DISTRIBUTION | [INS 10,270] |
| FORM 8B — STATEMENT OF REVENUE AND DISTRIBUTION | [INS 10,275] |
| FORM 8C — BALANCE SHEET | [INS 10,280] |
| FORM 8D — STATEMENT OF PREMIUM AND COMMISSION | [INS 10,285] |
| FORM 8E — STATEMENT OF POLICY PAYMENTS | [INS 10,290] |
| FORM 8F — STATEMENT OF BUSINESS PROFILE | [INS 10,295] |
| FORM 8G — STATEMENT OF GENERAL EXPENSES | [INS 10,300] |
| FORM 8H — BUDGET PROJECTION | [INS 10,305] |
| FORM 9A — STATEMENTS OF REVENUE AND DISTRIBUTION | [INS 10,310] |
| FORM 9B — BALANCE SHEET | [INS 10,315] |
| FORM 10A — PROVISIONS RELATING TO THE PREPARATION OF ACTUARIAL ABSTRACTS | [INS 10,320] |
| FORM 10B — SUMMARY AND VALUATION OF POLICIES | [INS 10,325] |
| FORM 10C — VALUATION BALANCE SHEET | [INS 10,330] |
| FORM 11 — PROVISIONS RELATING TO THE PREPARATION OF STATEMENTS OF LIFE INSURANCE BUSINESS | [INS 10,335] |
| FORM 12A — PROFIT AND LOSS STATEMENT | [INS 10,340] |
| FORM 12B — BALANCE SHEET | [INS 10,345] |
| FORM 12C — INSURANCE BROKING ACCOUNT | [INS 10,350] |
| FORM 12D — INSURANCE BROKING ACCOUNT | [INS 10,355] |
| FORM 12E — STATEMENT OF PREMIUMS | [INS 10,360] |
| FORM 13A — PROFIT AND LOSS STATEMENT | [INS 10,365] |
| FORM 13B — INSURANCE BROKING ACCOUNT | [INS 10,370] |
| FORM 13C — INSURANCE BROKING ACCOUNT | [INS 10,375] |
| FORM 13D — STATEMENT OF OFFSHORE CLAIM REMITTANCES | [INS 10,380] |
| FORM 14 — STATEMENT OF UNCLAIMED MONEYS | [INS 10,385] |
| FORM 15 — STATEMENT OF MONEYS PAID | [INS 10,390] |

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## INSURANCE REGULATIONS 1998

| Title | Paragraph |
|-------|-----------|
| FORM 16 — MEMORANDUM OF TRANSFER | [INS 10,395] |
| FORM 17 — APPOINTMENT WHERE NOMINEE IS A MINOR | [INS 10,400] |

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## LAWS OF FIJI

[The next page is 403,321]

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## Insurance Regulations 1998

### TABLE OF AMENDMENTS

Insurance Regulations 1998 (LN 152 of 1998) commenced on 1 January 1999, as amended by:

| Amending Legislation | Date of Commencement |
|----------------------|----------------------|
| Insurance (Amendment) Regulations 2002 (LN 108 of 2002) | 31 December 2002 |

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## LAWS OF FIJI

[The next page is 403,421]

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## [INS 10,005] Short title and commencement

1. These Regulations may be cited as the Insurance Regulations 1998 and shall come into force on the day appointed for the commencement of the Act.

## [INS 10,010] Fees

2. (1) The fees set out in column 3 of Schedule 1 are payable in respect of the matters respectively set out in column 2.  
   (2) All prescribed fees are VAT exclusive.

## [INS 10,015] Forms

3. The forms referred to in Schedule 2 (or similar forms) are to be used in respect of the matters provided for by the section of the Act to which each form respectively relates.

## [INS 10,020] Prescribed deposit requirement for insurers

4. For the purpose of section 20(1) of the Act, the deposit must be—  
   (a) any Fiji Government Security; or  
   (b) a deposit with a financial institution licensed under the Banking Act 1995.

## [INS 10,025] Prescribed deposit requirement for brokers

5. For the purpose of section 20(2) of the Act, the deposit or guarantee must be—  
   (a) any Fiji Government Security;  
   (b) a deposit with a financial institution licensed under the Banking Act 1995; or  
   (c) a bond or guarantee.

## [INS 10,030] Prescribed investments

6. (1) For the purpose of section 37 of the Act, at least 20% of the net insurance fund assets of a life insurer must be invested in Fiji Government Securities and at least a further 10% of the net insurance fund assets invested in—  
   (a) securities charged on the revenues of the Government;  
   (b) loans or securities guaranteed fully as regards principal and interest by the Government;  
   (c) loans to statutory bodies not guaranteed by the Government;  
   (d) loans to local government authorities not guaranteed by the Government; or  
   (e) loans to Home Finance Company Limited.  
   (2) Investment of assets of both life insurers and general insurers must be carried out with due regard to sufficient security, liquidity and income.

## [INS 10,035] Prescribed form and amount of professional indemnity and fidelity guarantee insurance required by brokers

7. For the purpose of section 44(1) of the Act—  
   (a) a policy must indemnify the broker against any breach of professional duty to an insured, against fraud and against any misconduct resulting in a breach of section 65 of the Act and must—  
      (i) be in the name of the broker;  
      (ii) state the sum insured;

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## [INS 10,035] LAWS OF FIJI reg 7

   (iii) state the deductible or excess applicable under the policy;  
   (iv) state the period of cover;  
   (v) state the name of the insurer;  
   (vi) state that at least one reinstatement is provided and in the case of a group policy covering a number of intermediaries, multiple reinstatements are required;  
   (vii) clearly state what exclusions are applicable under the policy;  
   (viii) clearly state the activities covered under the policy;  
   (ix) include a non-avoidance of claims clause (such as where the broker failed to comply with a duty of disclosure or by misrepresentation); and  
   (x) state that any claim under the policy will be governed by the laws of Fiji;  
   (b) the prescribed amount of cover for each policy must not be less than $1,000,000, or 50% of gross premiums handled during the previous calendar year, whichever is the greater;  
   (c) the maximum amount of cover required for each policy is $2,500,000.

## [INS 10,040] Prescribed returns and reports to be disclosed by insurers

8. For the purpose of section 56(1) of the Act, the prescribed returns or reports are—  
   (a) the audit report provided pursuant to section 53(1) of the Act;  
   (b) Forms 6B and 6C for general insurers; and  
   (c) Forms 8A, 8B and 8C for life insurers.

## [INS 10,045] Prescribed returns and reports to be disclosed by brokers

9. For the purpose of section 56(2) of the Act, the prescribed returns or reports are—  
   (a) the audit report provided pursuant to section 53(1) of the Act; and  
   (b) Forms 12A and 12B.

## [INS 10,050] Prescribed classes for notification of expiration of insurance cover

10. For the purpose of section 125(2) of the Act, other prescribed classes of insurance include compulsory third party insurance.

## [INS 10,055] Prescribed interest rate for settlement of life claims

11. For the purpose of section 142(2) of the Act, the prescribed rate is a compounded amount equivalent to the commercial banks’ average lending rate as determined by the Reserve Bank.

## [INS 10,060] Repeal

12. The Insurance Regulations, 1979 is repealed.

[The next page is 403,621]

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## [INS 10,160] SCHEDULE 1 (Regulation 2) FEES

| # | Description | $ |
|---|-------------|----|
| 1. | Application fee for insurer’s licence — section 24(3) | 3,000 |
| 2. | Replacement of insurer’s licence fee — section 26(4) | 100 |
| 3. | Annual fee for insurer’s licence — section 30(1) | 3,000 |
| 4. | Application fee for broker’s licence — section 42(2)(a) | 2,000 |
| 5. | Application fee for corporate agent’s licence — section 42(2)(a) | 400 |
| 6. | Application fee for individual agent’s licence — section 42(2)(a) | 200 |
| 7. | Replacement of intermediary’s licence fee — section 45(3) | 50 |
| 8. | Fee to inspect register — section 164(2) | 5 |

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## [INS 10,165] SCHEDULE 2 Regulation 3 FORMS

[Sch 2 am LN 108 of 2002 reg 2, opn 31 Dec 2002]

| Form No. | Form Description |
|----------|------------------|
| 1. | Offshore placement notice — section 17(4) |
| 2. | Application for licensing as an insurer — section 24(3) |
| 3. | Application for licensing as a broker — section 42(2) |
| 4. | Application for licensing as an agent — section 42(2) |
| 5. | Application for approval of appointed auditor — section 52(2) |
| 6. | Annual returns for general insurers — section 60(1) |
| 7. | Quarterly returns for general insurers — section 60(2) |
| 8. | Annual returns for life insurers — section 60(1) |
| 9. | Quarterly returns for life insurers — section 60(2) |
| 10. | Preparation of actuarial abstracts — section 62(1) |
| 11. | Preparation of statement of life insurance business — section 62(4) |
| 12. | Annual returns for brokers — section 66(1) |
| 13. | Quarterly returns for brokers — section 66(2) |
| 14. | Statement of unclaimed moneys — section 144(1) |
| 15. | Statement of moneys paid — section 144(3) |
| 16. | Memorandum of transfer — section 147(3)(a) |
| 17. | Appointment where nominee is a minor — section 152(2) |

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## [INS 10,175] LAWS OF FIJI FORM 1

### INSURANCE ACT 1998  
**FORM 1**  
PLACEMENT OF INSURANCE BUSINESS WITH AN UNLICENSED OFFSHORE INSURER  
CLIENT ACKNOWLEDGEMENT  
INSURANCE ACT 1998 (Section 17(4))

**ACKNOWLEDGEMENT BY AN INTENDING INSURED THAT AN INSURANCE CONTRACT IS TO BE ARRANGED OR EFFECTED WITH AN UNLICENSED OFFSHORE INSURER**

**NOTICE TO THE INSURED**

Your insurance contract is to be arranged or effected wholly or partly with an unlicensed offshore insurer that is not licensed under the Insurance Act 1998 to conduct insurance business in Fiji. Such insurers are not subject to the provisions of the Insurance Act 1998 and are not supervised by the Reserve Bank of Fiji.

It is a matter for your consideration whether you should obtain further information from the insurance intermediary involved, on such matters as—  
(a) the name and postal address of the insurer;  
(b) country of incorporation of the insurer and whether that country has a scheme of financial supervision of insurers;  
(c) paid-up capital of the insurer and its financial position; and  
(d) which country’s laws will determine disputes under the contract.

**ACKNOWLEDGEMENT**

I, ……………………………… (full name) of ……………………………… (address) have read the above notice and I acknowledge and understand that the insurance contract is to be arranged or effected wholly or partly with an unlicensed offshore insurer that is not licensed under the Insurance Act 1998 to conduct insurance business in Fiji and is not subject to the supervision of the Reserve Bank of Fiji.

…………………………………… Dated this ……………… day of ……………… in the year ………………

(signature of insured)

……………………………………  
(company stamp if insured is a body corporate)

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## [INS 10,180] LAWS OF FIJI FORM 2

### INSURANCE ACT 1998  
**FORM 2**  
APPLICATION FOR LICENSING AS AN INSURER

I. Name of applicant: …………………………………………………  
II. Date of incorporation: ………………………………………………  
III. Place of incorporation: ……………………………………………  
IV. Whether public/private company or mutual association: …………  
V. (i) If incorporated in Fiji—  
   (a) Address of registered office: …………………………………………  
   (b) Street address of principal place of business (if different to above): …………………………………………  
   (c) Address for service of notices (section 158 of Insurance Act 1998): …………………………………………  
   (d) Postal address: ……………………………………………………  
   (e) Telephone No: ……………………………………………………  
   (f) Fax No: ……………………………………………………………  

(ii) If not incorporated in Fiji—  
   (a) Address of head office: ………………………………………………  
   (b) Street address of principal place of business in Fiji: ……………………  
   (c) Address in Fiji for service of notices (section 158 of Insurance Act 1998): …………………………………………  
   (d) Postal address in Fiji: ………………………………………………  
   (e) Telephone No in Fiji: ……………………………………… Head Office …………………………………………  
   (f) Fax No in Fiji: ……………………………………… Head Office …………………………………………  

VI. Particulars regarding directors:

| Full Name | Address | Qualifications/Experience (particularly in relation to insurance) |
|-----------|---------|---------------------------------------------------------------|
| ………… | ………… | ……………………………………………………………… |
| ………… | ………… | ……………………………………………………………… |

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## [INS 10,180] LAWS OF FIJI FORM 2

| Full Name | Address | Qualifications/Experience (particularly in relation to insurance) |
|-----------|---------|---------------------------------------------------------------|
| ………… | ………… | ……………………………………………………………… |

VII. Particulars regarding principal officer (section 18 of the Insurance Act 1998)—  
(a) Full name: ………………………………………………………………  
(b) Address: ………………………………………………………………  
(c) Citizenship: ……………………………………………………………  
(d) Qualifications/experience (particularly in relation to insurance): ………………………………………………………………  

VIII. (i) Is any director, principal officer, general manager, secretary or other similar person of the applicant a director, principal officer, general manager, secretary or other similar person of any insurer or broker in Fiji, or elsewhere?  
Yes/No  
If “yes” give details: ………………………………………………………………  

(ii) Is any director, principal officer, general manager, secretary or other similar person of the applicant a disqualified person as described in section 23 of the Insurance Act 1998?  
Yes/No  
If “yes” give details: ………………………………………………………………  

IX. State the class or classes of insurance business for which the applicant is seeking a licence in Fiji (e.g. all or certain (specify) classes of general insurance; all or certain (specify) classes of life insurance): ………………………………………………………………  

X. Give particulars of business other than insurance business which the applicant carries on, or proposes to carry on, whether in Fiji or elsewhere: ………………………………………………………………  

XI. (a) For an applicant which is a stock company, give details of capital:  
   Authorised: …………………… shares of $ …………………… each, totalling $ ………………………  
   Paid Up: …………………… shares of $ …………………… each, totalling $ ………………………  
   Allocation of paid up shares:  
   *Local* | **Foreign**  
   ………… | …………  

(b) Provide the following details in respect of any person who holds 10% or more of the paid up shares of the applicant:

| Name | Citizenship or Place of incorporation | Percentage of paid up shares held | Value of shares $ |
|------|---------------------------------------|-----------------------------------|------------------|
| …… | ……………………………… | …………………… | …………………… |
| …… | ……………………………… | …………………… | …………………… |

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## [INS 10,180] LAWS OF FIJI FORM 2

| Name | Citizenship or Place of incorporation | Percentage of paid up shares held | Value of shares $ |
|------|---------------------------------------|-----------------------------------|------------------|
| …… | ……………………………… | …………………… | …………………… |
| …… | ……………………………… | …………………… | …………………… |

**“Local” means:**  
(a) in the case of an individual, a person who is a citizen of Fiji;  
(b) in the case of a company, a company which is incorporated in Fiji and has its voting power controlled by shareholders who are citizens of Fiji or is otherwise howsoever controlled by shareholders who are citizens of Fiji;  

**“Foreign” means a person or company who is not local in the sense defined above.**

XII. Give details (name, address, business) of any person related to the applicant ('related' is defined in section 2(3) of the Insurance Act 1998): ………………………………………………………………  

XIII. Is the deposit that is required under section 20 of the Insurance Act 1998 lodged with this application? (Note: the deposit must be lodged with the Reserve Bank before a licence can be granted):  
Yes/No  

If “yes”, give particulars of deposit (type of security, amount, term, maturity date etc): ………………………………………………………………  

XIV. If applicant is not incorporated in Fiji:  
(a) Does applicant carry on any insurance business outside Fiji? Yes/No  
(b) If the answer to (a) is “yes”:  
   (i) In which places? ………………………………………………………………  
   (ii) Does the applicant in all respects comply with the laws of that/those place/places relating to the carrying on of that business? (if “no”, attach details)  
   Yes/No  
   (iii) Did the applicant in all respects comply with the law of that/those place/places relating to the carrying on of insurance business during the preceding 5 years? (if “no”, attach details)  
   Yes/No  

XV. Name of bank in Fiji which is designated to be the applicant’s principal bank: ………………………………………………………………  

XVI. For an application to carry on life insurance business, set out the name, address, qualification(s) and actuarial experience of an actuary who is proposed for the purposes of section 61 of the Insurance Act 1998: ………………………………………………………………  

XVII. Particulars of proposed senior staff in Fiji, in particular those responsible for the following functions: ………………………………………………………………  

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## [INS 10,180] LAWS OF FIJI FORM 2

| Name | Qualifications | Experience | Citizenship |
|------|----------------|------------|-------------|
| Accounting | …………………… | …………………… | …………………… |
| Claims | …………………… | …………………… | …………………… |
| Underwriting | …………………… | …………………… | …………………… |
| Agents | …………………… | …………………… | …………………… |

(Provide similar details for any other senior staff)

XVIII. What operations will be handled locally? Give details: ………………………………………………………………  

XIX. What operations will be handled overseas? Give details, including approximate annual cost, and reasons why these cannot be handled locally. Identify what steps, if any, are being or will be taken to ensure that these operations are handled locally and when: ………………………………………………………………  

XX. Attach a summary of reinsurance arrangements, including the following particulars for each class of business—  
(a) Net retention in respect of any one risk, or M.P.L. in respect of any one risk if business is written on that basis;  
(b) Net retention in respect of any one event;  
(c) Details of all reinsurance treaties including—  
   (i) in respect of each quota share treaty, the pool limit, the percentage of limit reinsured, commission rate and the reinsurers and extent of their respective participation;  
   (ii) in respect of each surplus treaty, the retention limit, the maximum number of lines of the treaty, commission rate and the reinsurers and the extent of their respective participation;  
   (iii) in respect of each excess of loss treaty, show deductible or attachment point of cover, the level of cover, the premium rate, commission rate (if any) and the reinsurers and the extent of their respective participation.  

Note: the above summary is to be supported by copies of cover notes and/or placing slips as soon as they become available.

**DECLARATION**

I hereby declare that the above statements and details are correct and accept that any statement or detail found to be incorrect may result in prosecution under the Insurance Act 1998. I also declare that any alterations in particulars stated herein and in attachments submitted will be forthwith communicated to the Reserve Bank of Fiji in writing.

Signed on this …………………… day of ………………………, ………………………………………

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## [INS 10,180] LAWS OF FIJI FORM 2

| Director | Principal Officer |
|----------|-------------------|
| ………… | …………………… |

XXI. Every application must be accompanied by—  
(a) a copy of the Memorandum of Association or other instrument or document by which the applicant is constituted;  
(b) a copy of the Articles of Association or other rules of the applicant;  
(c) a copy of the certificate of incorporation of the applicant or a copy of the certificate of registration of the applicant as a foreign company, whichever is applicable;  
(d) a copy of the last 2 audited accounts and statements (including profit and loss account, appropriation accounts and balance sheet) of the applicant, if applicable. Where the applicant is related to another person pursuant to section 2(3) of the Insurance Act 1998, the last 2 audited accounts of the related person must be lodged with the application;  
(e) statement in accordance with Form 6C for general insurers or Form 8C for life insurers, made at any date not more than 3 months before the date of the application;  
(f) particulars, as specified in Form 5, in respect of the person who is to be, or has been appointed by the applicant to act as its auditor for the purpose of Part 5 of the Insurance Act 1998;  
(g) details of the applicant’s accounting and reporting systems;  
(h) a copy of the applicant’s current and proposed corporate structure and organisational chart; and  
(i) the prescribed fee.  

XXII. Every application for a licence to carry on life insurance business must be accompanied by a feasibility study which must include projections prepared by an actuary of expected results and financial position covering at least 5 years of operation in Fiji containing summaries of revenue accounts, actuarial liabilities and balance sheets made upon 2 bases viz—  
(a) assuming that a conservative amount of new sums insured is written each year; and  
(b) assuming that a reasonably rapid expansion of business occurs, together with—  
   (i) a statement of all assumptions adopted;  
   (ii) a copy of the market survey report or other evidence upon which the amounts of new business assumed in subparagraphs (a) and (b) of paragraph XXII are based;  
   (iii) a certificate signed by an actuary that the projections have been prepared after examination of the aims of the insurer and the types of policy to be adopted and are suitable for inclusion by the insurer in the information supporting the application for licensing; and  
   (iv) a statement as to the manner in which any deficiencies shown in the projections will be financed.  

XXIII. Every application for a licence to carry on any class of insurance business other than life insurance business must be accompanied by a feasibility study which must include a statement of expected results for the next 3 years in the light of all the relevant circumstances and the evidence, such as a market survey report, on which such statement is based.

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## [INS 10,185] LAWS OF FIJI FORM 3

### INSURANCE ACT 1998  
**FORM 3**  
APPLICATION FOR LICENSING AS A BROKER  

NEW APPLICATION □  
RENEWAL APPLICATION □  
(Tick as applicable)

I. Name of applicant: ……………………………………………………  
II. Date of incorporation (applicable only to a corporate broker): ……………………  
III. Place of incorporation (applicable only to a corporate broker): ……………………  
IV. Address of registered office: ……………………………………………………  
V. Street address of principal place of business (if different to above): ……………………  
VI. Address for service of notices (section 158 of Insurance Act 1998): ……………………  
VII. Postal address: ……………………………………………………  
VIII. Telephone No: ……………………………………… Fax No: ………………………………………  

IX. Particulars regarding directors (applicable only to a corporate broker)—  
| Full Name | Address | Qualifications / Experience (particularly in relation to insurance) |
|-----------|---------|---------------------------------------------------------------|
| ………… | ………… | ……………………………………………………………… |
| ………… | ………… | ……………………………………………………………… |

X. Particulars regarding principal officer (section 18 of the Insurance Act 1998)—  
(a) Full name: ………………………………………………………………  
(b) Address: ………………………………………………………………  
(c) Citizenship: ……………………………………………………………  
(d) Qualifications/experience (particularly in relation to insurance): ………………………………………………………………  

XI. (i) Is any director, principal officer, general manager, secretary or other similar person of the applicant a director, principal officer, general manager, secretary or other similar person of any insurer or broker in Fiji, or elsewhere?  
Yes/No  
If “yes” give details: ………………………………………………………………  

(ii) Does any director, principal officer, general manager, secretary or other similar person of the applicant fall within the definition of a disqualified person as described in section 23 of the Insurance Act 1998?  
Yes/No  
If “yes” give details: ………………………………………………………………  

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## [INS 10,185] LAWS OF FIJI FORM 3

XII. State the class or classes of insurance business for which the applicant is seeking a licence in Fiji (e.g. all or certain (specify) classes of general insurance; all or certain (specify) classes of life insurance): ………………………………………………………………  

XIII. Give particulars of business other than insurance business which the applicant carries on, or proposes to carry on, whether in Fiji or elsewhere: ………………………………………………………………  

XIV. (a) For an applicant which is a stock company, give details of capital:  
   Authorised: …………………… shares of $ …………………… each, totalling $ ………………………  
   Paid Up: …………………… shares of $ …………………… each, totalling $ ………………………  
   Allocation of paid up shares:  
   *Local* | **Foreign**  
   ………… | …………  

(b) Provide the following details in respect of any person who holds 10% or more of the paid up shares of the applicant:

| Name | Citizenship or Place of incorporation | Percentage of paid up shares held | Value of shares $ |
|------|---------------------------------------|-----------------------------------|------------------|
| …… | ……………………………… | …………………… | …………………… |
| …… | ……………………………… | …………………… | …………………… |

**“Local” means:**  
(a) in the case of an individual, a person who is a citizen of Fiji;  
(b) in the case of a company, a company which is incorporated in Fiji and has its voting power controlled by shareholders who are citizens of Fiji or is otherwise howsoever controlled by shareholders who are citizens of Fiji;  

**“Foreign” means a person or company who is not local in the sense defined above.**

XV. Is the deposit that is required under section 20 of the Insurance Act 1998 lodged with this application? (Note: the deposit must be lodged with the Reserve Bank before a licence can be granted or renewed):  
Yes/No  

If “yes”, give particulars of deposit (type of security, amount, term, maturity date etc): ………………………………………………………………  

XVI. Give details (name of insurer, amount of cover provided and amount of deductible/excess applicable) of the applicant’s professional indemnity policy of insurance and fidelity guarantee policy of insurance: ………………………………………………………………  

**DECLARATION**

I hereby declare that the above statements and details are correct and accept that any statement or detail found to be incorrect may result in prosecution under the Insurance Act 1998. I also declare that any alterations in particulars stated herein and in attachments submitted will be forthwith communicated to the Reserve Bank of Fiji in writing.

Signed on this …………………… day of ………………………, ………………………………………

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## [INS 10,185] LAWS OF FIJI FORM 3

| Director/Proprietor | Principal Officer |
|---------------------|-------------------|
| ………… | …………………… |

XVII. Every new application must be accompanied by—  
(a) a copy of the Memorandum of Association or other instrument or document by which the applicant is constituted (applicable only to a corporate broker);  
(b) a copy of the Articles of Association or other rules of the applicant (applicable only to a corporate broker);  
(c) a copy of the certificate of incorporation of the applicant or a copy of the certificate of registration of the applicant as a foreign company, whichever is applicable (applicable only to a corporate broker);  
(d) a copy of the last 2 audited accounts and statements (including profit and loss account, appropriation accounts and balance sheet) of the applicant, if applicable. Where the applicant is related to another person pursuant to section 2(3) of the Insurance Act 1998, the last 2 audited accounts of the related person must be lodged with the application (applicable only to a corporate broker);  
(e) statement in accordance with Form 12B made at any date not more than 3 months before the date of the application;  
(f) particulars, as specified in Form 5, in respect of the person who is to be, or has been appointed by the applicant to act as its auditor for the purpose of Part 5 of the Insurance Act 1998;  
(g) a feasibility study which must include a statement of expected results for the next 3 years in the light of all the relevant circumstances and the evidence, such as a market survey report, on which such statement is based;  
(h) details of the applicant’s accounting and reporting systems;  
(i) a copy of the applicant’s current or proposed corporate structure and organisational chart; and  
(j) the prescribed fee.  

XVIII. Every renewal application must be accompanied by—  
(a) particulars, as specified in Form 5, in respect of the person who is to be, or has been appointed by the applicant to act as its auditor for the purpose of Part 5 of the Insurance Act 1998;  
(b) budget projections for the following calendar year; and  
(c) the prescribed fee.