Appendix No. (1)

Company: ..................................

As of 31/12/20xx

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Form No. (1-A)

Company xxx
Consolidated Statement of Financial Position as of
Assets	Current Year	Previous Year
Deposits with banks
Financial assets at fair value through profit or loss
Financial assets at fair value through other comprehensive income
Financial assets at amortized cost
Investments in associates
Investments in subsidiaries and associates (in unconsolidated statements only)
Investment property
Right-of-use assets
Loans to life policyholders and others
Total investments
Cash in hand and at banks
Receivables and cheques for collection
Debtors - net
Reinsurers' share - receivable
Deferred tax assets
Property and equipment - net
Intangible assets
Other assets
Total Assets
Liabilities and Equity
Liabilities
Unearned premium reserve - net
Unexpired risk reserve - net
Claims reserve - net
Actuarial reserve - net
Total insurance contract liabilities
Creditors banks
Creditors
Accrued expenses
Reinsurers' share - payable
Various provisions
Income tax provision
Loans
Deferred tax liabilities
Other liabilities
Subordinated loans
Total Liabilities
Equity
Authorized and paid-up capital
Less: Treasury shares
Share premium (discount)
Mandatory reserve
Voluntary reserve
Special reserve
Foreign currency translation differences
Fair value reserve
Profit (loss) for the year after tax
Retained earnings (accumulated losses)
Total Shareholders' Equity
Non-controlling interests
Total Equity
Total Liabilities and Equity

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Form No. (1-B)

Company xxx
Statement of Financial Position for Life Insurance Business as of
Assets	Current Year	Previous Year
Deposits with banks
Financial assets at fair value through profit or loss
Financial assets at fair value through other comprehensive income
Financial assets at amortized cost
Investments in associates
Investments in subsidiaries and associates (in unconsolidated statements only)
Investment property
Loans to life policyholders and others
Total investments
Cash in hand and at banks
Receivables and cheques for collection
Debtors - net
Reinsurers' share - receivable
Deferred tax assets
Property and equipment - net
Intangible assets
Other assets
Total Assets
Liabilities and Equity
Liabilities
Unearned premium reserve - net
Unexpired risk reserve - net
Claims reserve - net
Actuarial reserve - net
Total insurance contract liabilities
Creditors banks
Creditors
Accrued expenses
Reinsurers' share - payable
Various provisions
Income tax provision
Loans
Deferred tax liabilities
Other liabilities
Subordinated loans
Total Liabilities
Shareholders' Equity
Authorized and paid-up capital
Less: Treasury shares
Share premium (discount)
Mandatory reserve
Voluntary reserve
Special reserve
Foreign currency translation differences
Fair value reserve
Profit (loss) for the year after tax
Retained earnings (accumulated losses)
Total Shareholders' Equity
Non-controlling interests
Total Equity
Total Liabilities and Equity

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Form No. (2)

Income Statement for the Year Ended
Item	Current Year	Previous Year
Revenues
Gross premiums written
Less: Reinsurers' share
Net premiums written
Net change in unearned premium reserve
Net change in unexpired risk reserve
Net change in actuarial reserve
Net earned premiums
Commission income
Insurance contract issuance fees
Interest income
Net gains (losses) on financial assets and investments
Other income
Total Revenues
Claims, Losses, and Expenses
Claims paid
Policy claims and settlements
Less: Recoveries
Less: Reinsurers' share
Net claims paid
Net change in claims reserve
Allocated employee expenses
Allocated administrative and general expenses
Loss ratio adjustments
Policy acquisition costs
Other underwriting-specific expenses
Net claims burden
Unallocated employee expenses
Depreciation and amortization
Unallocated administrative and general expenses
Provision for bad debts
Amortization/provision/impairment loss on financial assets at amortized cost
Impairment loss on investment property
Impairment loss on property and equipment
Other expenses
Total Expenses
Dividends from subsidiaries and associates (subsidiaries shown in unconsolidated financial statements)
Profit (Loss) before Tax
Income tax
Net Profit (Loss) for the Year
Attributable to:
Shareholders of the Company
Non-controlling interests
Earnings (Loss) per Share

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Form No. (3)

Statement of Comprehensive Income for the Period Ended
	Current Year	Previous Year
Profit / Loss for the Year
Add: Other Comprehensive Income items:
Foreign currency translation differences
Change in fair value
Gain (loss) on sale of financial assets at fair value through other comprehensive income
Total Other Comprehensive Income Items
Total Comprehensive Income for the Year
Attributable to:
Shareholders of the Company
Non-controlling interests

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Form No. (4)

Statement of Changes in Equity for the Period Ended
	Paid-up Capital	Treasury Shares	Share Premium (Discount)	Mandatory Reserve	Voluntary Reserve	Special Reserve	Fair Value Reserve	Foreign Currency Translation Differences	Retained Earnings (Losses)	Total	Non-controlling Interests	Total Equity
Opening Balance
Effect of applying new and amended standards
Adjusted Opening Balance
Profit (Loss) for the Year
Foreign currency translation differences
Change in fair value
Gain (loss) on sale of financial assets at fair value through other comprehensive income
Total Comprehensive Income
Increase in Capital
Transfers from Reserves
Dividends Distributed
Treasury Shares (at cost)
Closing Balance
Year ............
Opening Balance
Effect of applying new and amended standards
Adjusted Opening Balance
Profit (Loss) for the Year
Foreign currency translation differences
Change in fair value
Gain (loss) on sale of financial assets at fair value through other comprehensive income
Total Comprehensive Income
Increase in Capital
Transfers from Reserves
Dividends Distributed
Treasury Shares (at cost)
Closing Balance

• This item includes unrealized profits amounting to ..... JD, the disposal of which is prohibited in accordance with Central Bank instructions.
  Of the retained earnings, an amount of ..... JD as of ..... is restricted in disposal in accordance with Central Bank instructions.

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Form No. (5)

Underwriting Revenue Account for Life Insurance Business for the Year Ended
	Life		Marriage & Birth		Life Pensions		Investment-Linked		General Health		Social Pension Fund Management		Additional Insurance		Total
	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year
Premiums Written
Incoming Voluntary Reinsurance
Total Premiums
Less
External Reinsurance Premiums
Net Premiums
Add
Unearned Premium Reserve
Less: Reinsurers' share
Net Unearned Premium Reserve
Actuarial Reserve
Less: Reinsurers' share
Net Actuarial Reserve
Net change in unexpired risk reserve
Net Earned Premiums from Written Premiums

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Form No. (6)

Claims Cost Account for Life Insurance Business for the Period Ended
	Life		Marriage & Birth		Life Pensions		Investment-Linked		General Health		Social Pension Fund Management		Additional Insurance		Total
	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year
Claims Paid
Policy Claims and Settlements
Less
Recoveries
Local Reinsurers' Share
External Reinsurers' Share
Net Claims Paid
Add
End-of-Period Claims Reserve
Reported
Unreported
Less: Reinsurers' share
Reported
Unreported
Net End-of-Period Claims Reserve
Less
Beginning-of-Period Claims Reserve
Reported
Unreported
Less: Reinsurers' share
Reported
Unreported
Net Beginning-of-Period Claims Reserve
Net Claims Cost

Note: Only the portion retained by the company in its books is reported for co-insurance.

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Form No. (7)

Underwriting Profit (Loss) Account for Life Insurance Business for the Year Ended
	Life		Marriage & Birth		Life Pensions		Investment-Linked		General Health		Social Pension Fund Management		Additional Insurance		Total
	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year
Net Earned Premiums from Written Premiums
Less
Net Claims Cost
Add
Authorized Commissions
Insurance Contract Issuance Fees
Investment Income Attributable to Underwriting Accounts
Other Income
Total Revenues
Less
Policy Acquisition Costs
Loss Ratio Adjustments
Administrative Expenses Specific to Underwriting Accounts
Other Expenses
Total Expenses
Underwriting Profit (Loss)

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Form No. (8)

Underwriting Revenue Account for General Insurance Business for the Year Ended
	Vehicles		Fire & Other Damages		Aviation		Accidents & Other Liabilities		Liability		Credit & Surety		Medical		Other Branches		Total
	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year
Premiums Written
Direct Business
Incoming Voluntary Reinsurance
Total Premiums
Less
Local Reinsurance Premiums
External Reinsurance Premiums
Net Premiums
Add
Opening Balance
Unearned Premium Reserve
Less: Reinsurers' share
Net Unearned Premium Reserve
Less
Closing Balance
Unearned Premium Reserve
Less: Reinsurers' share
Net Unearned Premium Reserve
Net Unexpired Risk Reserve
Change in Unexpired Risk Reserve
Net Earned Premiums from Written Premiums

Note: Only the portion retained by the company in its books is reported for co-insurance.

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Form No. (9)

Claims Cost Account for General Insurance Business for the Period Ended
	Vehicles		Fire & Other Damages		Aviation		Accidents & Other Liabilities		Liability		Credit & Surety		Medical		Other Branches		Total
	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year
Claims Paid
Less
Recoveries
Local Reinsurers' Share
External Reinsurers' Share
Net Claims Paid
Add
End-of-Period Claims Reserve
Reported
Unreported
Less
Reinsurers' Share
Reported
Unreported
Net End-of-Period Claims Reserve
Less
Beginning-of-Period Claims Reserve
Reported
Unreported
Less
Reinsurers' Share
Reported
Unreported
Net Beginning-of-Period Claims Reserve
Net Claims Cost

Note: Only the portion retained by the company in its books is reported for co-insurance.

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Form No. (10)

Underwriting Profit (Loss) Account for General Insurance Business for the Period Ended
	Vehicles		Fire & Other Damages		Aviation		Accidents & Other Liabilities		Liability		Credit & Surety		Medical		Other Branches		Total
	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year
Net Earned Premiums from Written Premiums
Less
Net Claims Cost
Add
Authorized Commissions
Insurance Contract Issuance Fees
Investment Income Attributable to Underwriting Accounts
Other Income
Total Revenues
Less
Policy Acquisition Costs
Loss Ratio Adjustments
Administrative Expenses Specific to Underwriting Accounts
Other Expenses
Total Expenses
Underwriting Profit (Loss)

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Form No. (8)

Underwriting Revenue Account for Life Insurance Business for the Year Ended
	Vehicles		Fire & Other Damages		Aviation		Accidents & Other Liabilities		Liability		Credit & Surety		Medical		Other Branches		Total
	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year
Premiums Written
Direct Business
Incoming Voluntary Reinsurance
Total Premiums
Less
Local Reinsurance Premiums
External Reinsurance Premiums
Net Premiums
Add
Opening Balance
Unearned Premium Reserve
Less: Reinsurers' share
Net Unearned Premium Reserve
Less
Closing Balance
Unearned Premium Reserve
Less: Reinsurers' share
Net Unearned Premium Reserve
Net Unexpired Risk Reserve
Change in Unexpired Risk Reserve
Net Earned Premiums from Written Premiums

Note: Only the portion retained by the company in its books is reported for co-insurance.

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Form No. (11)

Underwriting Revenue Details for Vehicle Insurance Business for the Year Ended
	Local								Border Centers									Total
	Third Party		Comprehensive		Supplementary		Total		Third Party		Comprehensive		Supplementary		Total		Current Year	Previous Year
	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year	Current Year	Previous Year
Premiums Written
Direct Business
Incoming Voluntary Reinsurance
Total Premiums
Less
Local Reinsurance Premiums
External Reinsurance Premiums
Net Premiums
Add
Opening Balance
Unearned Premium Reserve
Less: Reinsurers' share