Draft Decision on Insurance Broker Business Statement Forms

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

CENTRAL BANK OF JORDAN

Number: 1614 / 3 / 1 Date: 19 / 7 / 1444 AH Corresponding to: 9 / 2 / 2023 AD

Dear Esteemed Insurance Brokers,

Subject: Draft Decision on Insurance Broker Business Statement Forms

Greetings,

Attached herewith is the draft decision on insurance broker business statement forms, for your kind review and to provide us with your comments - if any - within two weeks from the date of this letter.

Please accept our highest regards

Governor Dr. Adel Al-Sharkas

Attachment/ Copy to/ Esteemed Insurance Companies

P.O. Box 37 • 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

Form No. (1-1) Statement of Insurance Brokerage Business for Each Insurance Branch - General Insurance

Insurance Broker's Name: .................................... Insurance Company's Name: .................................... During the period from .................... to ....................

General Insurance Branches	Number of Insurance Contracts	Sum Insured	Basic Premium	Gross Premium	Commission Rate	Total Commissions
Accident Insurance
Medical Insurance
Railway and Bus Insurance
Land Motor Vehicle Insurance
Aircraft Insurance
Ship Insurance
Goods in Transit Insurance
Fire and Natural Hazards Insurance
Other Property Damage Insurance
Land Motor Vehicle Liability Insurance
Aircraft Liability Insurance
Ship Liability Insurance
General Liability Insurance
Credit Insurance
Guarantee Insurance
Miscellaneous Financial Loss Insurance
Legal Expenses Insurance
Assistance Insurance
Total

Note: 1- Gross premium refers to the value of the basic premium plus any additional fees such as (issuance fees, stamps, tax.. etc.). 2- The statement is to be submitted for each insurance company dealt with and in total for all brokerage business with all insurance companies.

Broker's Name: .................................... Signature: .................................... Registration Number: .................................... Date: ....................................

3J/broker/F1-1/V1

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CENTRAL BANK OF JORDAN

Form No. (1-2) Statement of Insurance Brokerage Business for Each Insurance Branch - Life Insurance

Insurance Broker's Name: .................................... Insurance Company's Name: .................................... During the period from .................... to ....................

Life Insurance Branches	Number of Insurance Contracts	Sum Insured	Basic Premium	Gross Premium	Commission Rate	Total Commissions
Life Insurance
Marriage and Birth Insurance
Life Annuity Insurance
Investment-Linked Insurance
Permanent Health Insurance
Collective Pension Fund Management Branch
Supplementary Insurance (Personal Accident Insurance)
Medical Insurance
Total

Note: 1- Gross premium refers to the value of the basic premium plus any additional fees such as (issuance fees, stamps, tax.. etc.). 2- The statement is to be submitted for each insurance company dealt with and in total for all brokerage business with all insurance companies.

Broker's Name: .................................... Signature: .................................... Registration Number: .................................... Date: ....................................

IJ/broker/F1-2/V1

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CENTRAL BANK OF JORDAN

Form No. (1-3) Statement of Brokerage Business Conducted by the Insurance Broker (Total for Each Insurance Company Dealt With, Classified by General Insurance and Life Insurance)

Insurance Broker's Name: .................................... During the period from .................... to ....................

	Insurance Company	All General Insurance Business Branches	All Life Insurance Business Branches	Total Premiums	Commission Rate	Commission Value	Notes
1
2
3
4
5
	Total
	Grand Total	All General Insurance Business Branches	All Life Insurance Business Branches

Note: Gross premium refers to the value of the basic premium plus any additional fees such as (issuance fees, stamps, tax .... etc.).

Number of Pages: ....................

Broker: .................................... Signature: .................................... Registration Number: .................................... Date: 2023/03/21

CBJ/broker/F1-3/V1