Draft Decision on Insurance Agent Business Statement Models

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

[Logo of the Central Bank of Jordan]

Number: 1611 / 3 / 15
Date: 19 / 10 / 1444
Corresponding to: 9 / 5 / 2023

Dear Insurance Companies,

Subject: Draft Decision on Insurance Agent Business Statement Models

Greetings,

We enclose for you the draft decision on Insurance Agent Business Statement Models, which includes the forms that insurance companies are required to periodically provide to the Central Bank regarding the business conducted by their agents. Please review and provide us with your comments, if any, within two weeks from the date of this letter.

Please accept our highest respect.

Governor
Dr. Adel Al-Sharkas
[Signature]

Enclosed/

P.O. Box 37 • Amman 11118 Jordan • Phone 4630301 Fax 4638889 • Website: www.cbj.gov.jo • Email: info@cbj.gov.jo Form (1/1) - (1/1)

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[Logo of the Central Bank of Jordan]

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

General Insurance Agency Business conducted by the insurance agent as an agent for the company ........................................................
During the period from ..../..../........ to ..../..../........

Agent Name: ........................................................

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

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

Date: ........................
Registration Number: ........................
Signature: ........................
Agent: ........................

CBJ/Agent/F9-1/V1
5

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[Logo of the Central Bank of Jordan]

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

Life Insurance Agency Business conducted by the insurance agent as an agent for the company ........................................................
During the period from ..../..../........ to ..../..../........

Agent Name: ........................................................

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

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

Date: ........................
Registration Number: ........................
Signature: ........................
Agent: ........................

CBJ/Agent/F9-2/V1
2

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[Logo of the Central Bank of Jordan]

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

General Insurance Agency Business conducted by the insurance agent as an agent for the company ........................................................
During the period from ..../..../........ to ..../..../........

Agent Name: ........................................................

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

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

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

CBJ/Agent/F10-1/V1
1

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[Logo of the Central Bank of Jordan]

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

Life Insurance Agency Business conducted by the insurance agent as an agent for the company ........................................................
During the period from ..../..../........ to ..../..../........

Agent Name: ........................................................

Life Insurance Business Branches	Current Period					Comparative Period			Notes
	Total Premium	Commission Rate	Commission Value	Total Life Insurance Claims (Benefits and Policy Settlements)	Total Premium	Commission Value	Total Life Insurance Claims (Benefits and Policy Settlements)
Total

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

Date: ........................
Registration Number: ........................
Signature: ........................
Agent: ........................

CBJ/Agent/F10-2/V1
2

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