Draft Decision on Insurance Agent Business Statement Forms

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In the name of Allah, the Most Gracious, the Most Merciful

[Central Bank of Jordan Logo]

Number: 8610 / 1 / 12
Date: 19 / 10 / 1444
Corresponding to: 9 / 5 / 2023

Dear Insurance Agents,

Subject: Draft Decision on Insurance Agent Business Statement Forms

Greetings,

Attached is the draft decision on insurance agent business statement forms, which includes the forms that the insurance agent must periodically provide to the Central Bank, for your review and to provide us with your comments - if any - within two weeks from the date of this letter.

Please accept our respect,

Governor
Dr. Adel Al-Sharkas

Attachment/
Copy to/ Dear Insurance Companies

Form 1/1-1444
P.O. Box 27 • Amman 11118 Jordan • Tel 4630301 Fax 4638889 • Website: www.cbj.gov.jo • Email: info@cbj.gov.jo

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[Central Bank of Jordan Logo]
Central Bank of Jordan
Form No. (9-1) Agency Business Statement for General Insurance

Agency business statement for general insurance conducted by the insurance agent on behalf of ........................................ company
During the period from ..../..../........ to ..../..../........

General Insurance Business Branches	Current Period	Comparative Period	Notes
	Total Premium	Commission Rate	Commission Value	Total Premium	Commission Value
Total

Number of pages:
Note:
"Total Premium" refers to the value of the basic premium plus any additional fees such as (issuance fees, stamps, tax .... etc.).

Agent: ........................................
Signature: ........................................
Registration No.: ........................................
Date: ........................................

CBJ/Agent/F9-1/V1

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[Central Bank of Jordan Logo]
Central Bank of Jordan
Form No. (9-2) Agency Business Statement for Life Insurance

Agency business statement for life insurance conducted by the insurance agent on behalf of ........................................ company
During the period from ..../..../........ to ..../..../........

Life Insurance Business Branches	Current Period	Comparative Period	Notes
	Total Premium	Commission Rate	Commission Value	Total Premium	Commission Value
Total

Number of pages:
Note:
"Total Premium" refers to the value of the basic premium plus any additional fees such as (issuance fees, stamps, tax .... etc.).

Agent: ........................................
Signature: ........................................
Registration No.: ........................................
Date: ........................................

CBJ/Agent/F9-2/V1

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[Central Bank of Jordan Logo]
Central Bank of Jordan
Form No. (10-1) Agency Business Statement for General Insurance for each of the Insurance Company's Agents

Agency business statement for general insurance conducted by the insurance agent on behalf of ........................................ company
During the period from ..../..../........ to ..../..../........

General Insurance Business Branches	Current Period	Comparative Period	Notes
	Total Premium	Commission Rate	Commission Value	Total Paid Compensations	Loss Ratio (Total Compensations / Total Premiums) %	Total Premium	Commission Value	Total Paid Compensations	Loss Ratio (Total Compensations / Total Premiums) %
Total

Number of pages:
Note:
"Total Premium" refers to the value of the basic premium plus any additional fees such as (issuance fees, stamps, tax .... etc.).

Agent: ........................................
Signature: ........................................
Date: ........................................

CBJ/Agent/F10-1/V1

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[Central Bank of Jordan Logo]
Central Bank of Jordan
Form No. (10-2) Agency Business Statement for Life Insurance for each of the Insurance Company's Agents

Agency business statement for life insurance conducted by the insurance agent on behalf of ........................................ company
During the period from ..../..../........ to ..../..../........

Life Insurance Business Branches	Current Period	Comparative Period	Notes
	Total Premium	Commission Rate	Commission Value	Total Life Insurance Compensations (Paid, Entitlements, and Policy Liquidations)	Total Premium	Commission Value	Total Life Insurance Compensations (Paid, Entitlements, and Policy Liquidations)
Total

Number of pages:
Note:
"Total Premium" refers to the value of the basic premium plus any additional fees such as (issuance fees, stamps, tax .... etc.).

Agent: ........................................
Signature: ........................................
Registration No.: ........................................
Date: ........................................

CBJ/Agent/F10-2/V1

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