Modifying Circular 2/22 of the Single Insurance and Surety Circular

DOF: 11/01/2022

Modifying Circular 2/22 of the Single Insurance and Surety Circular

A logo appears at the margin, which says: National Commission of Insurance and Sureties.

MODIFYING CIRCULAR 2/22 OF THE SINGLE INSURANCE AND SURETY CIRCULAR

(Chapters 32.3., 32.4. and 32.5.; Provision 32.10.10; Annexes 32.3.8., 32.3.9. and 32.10.10.)

The National Commission of Insurance and Sureties, based on what is established in articles 91, 92, 93, 94, 366, fraction II, 367, fraction II, 372, fractions VI, XXII and XLII, 373 and 381 of the Law of Insurance and Surety Institutions, and

CONSIDERING

That articles 91 and 92 of the Law of Insurance and Surety Institutions establish that the activity of intermediation for the contracting of insurance or sureties is reserved for insurance or surety agents, as applicable.

That article 93 of the aforementioned Law provides that, for the exercise of the activity of insurance agent or surety agent, authorization from this Commission will be required, which may be granted in the operations and lines of insurance, as well as lines and sub-lines of sureties that this Decentralized Body determines, having the character of non-transferable. Likewise, that provision establishes that the authorization for insurance or surety agent may be granted to natural and legal persons through attorneys who meet the requirements established in the respective Regulation.

That article 94 of the Law of Insurance and Surety Institutions establishes that the activities carried out by insurance agents and surety agents will be subject, among others, to the general provisions determined by this Commission.

In this sense, in Chapters 32.3, 32.4 and 32.5 of the Single Insurance and Surety Circular, the documents and requirements necessary for obtaining the authorization to carry out the activity of insurance agent, surety agent or authorized representative of a legal person agent are established, as well as for its renewal.

That the last paragraph of article 10 of the Regulation of Insurance and Surety Agents in force, empowers this Commission to determine the documents and information that must be provided with the application for authorization or renewal to exercise the activities of intermediation.

That, as a regulatory improvement action, this Commission through the use of information technologies has determined that the procedure for obtaining the card referred to in article 14 of the Regulation of Insurance and Surety Agents, in which the authorization or renewal to act as an insurance agent, surety agent, or authorized representative of a legal person agent is recorded, be carried out digitally, in substitution of the in-person procedure. Likewise, it has determined to simplify the procedure to request authorization as a Legal Person Agent, eliminating requirements and extending the validity period of the assessment referred to in Provision 32.5.2 of the Single Insurance and Surety Circular from 90 to 180 calendar days.

Finally, through the incorporation of Annex 32.10.10., natural person agents and authorized representatives of legal person agents are provided with a format that facilitates them to comply with what is already provided in Provision 32.18.8., regarding the determination of the insured amount of the professional liability insurance for errors and omissions, which insurance and surety agents must contract regarding the exercise of the intermediation activity.

That in view of the considerations set forth, this Commission issues the following modification to the Single Insurance and Surety Circular in the following terms:

MODIFYING CIRCULAR 2/22 OF THE SINGLE INSURANCE AND SURETY CIRCULAR

(Chapters 32.3., 32.4. and 32.5.; Provision 32.10.10; Annexes 32.3.8., 32.3.9. and 32.10.10.)

FIRST.- Chapters 32.3., 32.4., 32.5., and Provision 32.10.10. of the Single Insurance and Surety Circular are modified, to read as follows:

CHAPTER 32.3.

ON THE AUTHORIZATION OF NATURAL PERSON AGENTS

AND AUTHORIZED REPRESENTATIVES

32.3.1.

The authorization for Natural Person Agents or Authorized Representatives of Legal Person Agents will be recorded in a digital card that will have a validity of three years and which the Commission will issue to natural persons who meet the requirements set forth in the Regulation of Insurance and Surety Agents, and comply with what is provided in these Provisions.

32.3.2.

Interested parties, in addition to meeting the requirements established in the Regulation of Insurance and Surety Agents, when applying for authorization must send through the Appointments and People Registration System (SICREP), the following documentation:

I.

Recent photograph, infant size, color, in .JPG format with 160 pixels wide by 200 high, 24-bit depth and a maximum size of 50 kb;

II.

Copy of valid official identification, with photograph;

III.

Copy of birth certificate or, in its absence, copy of the National Military Service card or valid passport;

IV.

Copy of the certificate of studies with a minimum level of high school or equivalent or, in its absence, professional licenses or academic records from institutions incorporated into the National Education System that accredit said level of studies;

V.

Copy of the Unique Population Registry Key;

VI.

Copy of the Tax Identification Card or, in its absence, the Registration with the Tax Administration Service, the Format of Notice of Modification of Worker Salaries issued by the Mexican Social Security Institute, or the contribution receipt to the Retirement Savings System;

VII.

Copy of proof of address, with a maximum age of three months, which may be a property tax payment slip, rent payment receipt, water, telephone, electricity, gas or bank statements issued by a financial institution;

VIII.

Proof of having made the payment of corresponding fees, in accordance with the Federal Fees Law;

IX.

In the case of Category G referred to in fraction XI of Provision 32.3.6, copy of the commercial commission contract entered into with the corresponding Insurance Institution; and

X.

For the case of authorization due to not having renewed in a timely manner, they must send copies of the professional liability insurance policies for errors and omissions corresponding to the three years prior to the expiration of their last card, in accordance with Chapter 32.10 of these Provisions, as well as the proof of payment thereof.

In the case of prospects for Natural Person Agents or Authorized Representatives of Legal Person Agents of foreign origin, in addition to the documentation previously mentioned, they must send a copy of the migratory form that allows them to carry out the activity in national territory or a certificate of naturalization.

In the case of Natural Person Agents linked to an Institution by an employment relationship, and Authorized Representatives of Legal Person Agents, the authorization request contained in Annex 32.3.4 with the name and signature of the legal representative of the Institution or the Legal Person Agent, as applicable, must be attached, for which the power of attorney and identification of this person will be accompanied.

The documents referred to in fractions II to X above must be sent in .PDF format, and the originals of said documents must be available in case the Commission requires them in the exercise of its inspection and supervision powers.

32.3.3.

Interested parties, in addition to complying with what is provided in Provision 32.3.2., must accredit their technical capacity before the Commission, in accordance with Chapter 32.7 of these Provisions.

32.3.4.

Interested parties must send their authorization request to the Commission in the terms indicated in Annex 32.3.4 and its delivery will be made through the Appointments and People Registration System (SICREP), indicated in Chapters 39.1 and 39.4 of these Provisions.

32.3.5.

Once the requirements provided for in this Chapter are met, the Commission, within a maximum period of ten business days following the sending of the information, will notify the interested party regarding the admissibility of their application and, if applicable, will issue the corresponding digital card.

32.3.6.

Authorizations will be issued by Categories, each of them will authorize the Natural Person Agent or Authorized Representative of Legal Person Agent to intermediated in the operations or lines indicated in the respective card, but in a restricted manner to the placement of products included in the following market segments or specialties:

I.

Category A. Personal and family risks.

a)

Life operation:

1)

Individual life; and

2)

Private pensions.

b)

Accident and illness operation:

1)

Personal accidents;

2)

Medical expenses; and

3)

Health.

c)

Damage operation:

1)

Automobiles:

i.

Cars;

ii.

Pick-up trucks; and

iii.

Trucks.

2)

Home:

i.

Fire and additional risks;

ii.

Miscellaneous:

a. Theft of contents;

b. Breakage of glass;

c. Money and valuables; and

d. Household and electronic equipment.

iii. Civil liability, tenant and family;

iv. Personal accidents; and

v. Assistance services.

3)

Small pleasure vessels.

II.

Category A1. Personal and family risks of life insurance.

a)

Life operation:

1)

Individual life; and

2)

Private pensions.

b)

Accident and illness operation:

1)

Personal accidents;

2)

Medical expenses; and

3)

Health.

III.

Category A2. Personal and family risks of damage insurance.

a)

Accident and illness operation:

1)

Personal accidents;

2)

Medical expenses; and

3)

Health.

b)

Damage operation:

1)

Automobiles:

i.

Cars;

ii.

Pick-up trucks; and

iii.

Trucks.

2)

Home:

i.

Fire and additional risks;

ii.

Miscellaneous:

a. Theft of contents;

b. Breakage of glass;

c. Money and valuables; and

d. Household and electronic equipment.

iii. Civil liability, tenant and family;

iv. Personal accidents; and

v. Assistance services.

3)

Small pleasure vessels.

IV.

Category B. Business risks of life and damage insurance.

a)

Life operation:

1)

Group life (includes private pensions); and

2)

Key person (technical or executives) and partner insurance.

b)

Accident and illness operation:

1)

Medical expenses; and

2)

Collective accidents and illnesses.

c)

Damage operation:

1)

Automobiles:

i.

Fleet and collective; and

ii.

Business.

2)

Fire and additional risks:

i.

Consequential losses.

3)

Freight transport.

4)

General civil liability:

i.

Traveler civil liability;

ii.

Commerce civil liability;

iii.

Industry civil liability;

iv.

Hotel civil liability; and

v.

Professional civil liability.

5)

Miscellaneous:

i.

Robbery with violence;

ii.

Lighted advertisements;

iii.

Breakage of glass;

iv.

Money and valuables; and

v.

Personal objects.

6)

Various technical lines:

i.

Electronic equipment;

ii.

Machinery breakage;

iii.

Boilers and pressure vessels;

iv.

Contractor equipment;

v.

Erection; and

vi.

Civil works or all risk.

The authorization of Category B will also include the segments corresponding to Category A;

V.

Category B1. Business risks of life insurance.

a)

Life operation:

1)

Group life (includes private pensions); and

2)

Key person (technical or executives) and partner insurance.

b)

Accident and illness operation:

1)

Medical expenses; and

2)

Collective accidents and illnesses.

The authorization of Category B1 will also include the segments corresponding to Category A1;

VI.

Category B2. Business risks of damage insurance.

a)

Accident and illness operation:

1)

Medical expenses; and

2)

Collective accidents and illnesses.

b)

Damage operation:

1)

Automobiles:

i.

Fleet and collective; and

ii.

Business.

2)

Fire and additional risks:

i.

Consequential losses.

3)

Freight transport.

4)

General civil liability:

i.

Traveler civil liability;

ii.

Commerce civil liability;

iii.

Industry civil liability;

iv.

Hotel civil liability; and

v.

Professional civil liability.

5)

Miscellaneous:

i.

Robbery with violence;

ii.

Lighted advertisements;

iii.

Breakage of glass;

iv.

Money and valuables; and

v.

Personal objects.

6)

Various technical lines:

i.

Electronic equipment;

ii.

Machinery breakage;

iii.

Boilers and pressure vessels;

iv.

Contractor equipment;

v.

Erection; and

vi.

Civil works or all risk.

The authorization of Category B2 will also include the segments corresponding to Category A2;

VII.

Category C. Special risks.

a)

Damage operation:

1)

Large risks-fire; and

2)

Maritime and transports:

i.

Ship hulls; and

ii.

Aircraft hulls.

The authorization of Category C will also include the segments corresponding to Categories A and B;

VIII.

Category D. Agricultural insurance, animal insurance and peasant life insurance.

a)

Life operation:

1)

Peasant life insurance.

b)

Damage operation:

1)

Agricultural risks; and

2)

Animal risks.

IX.

Category E. Credit insurance.

X.

Category F. Sureties.

XI.

Category G. Special.

The authorization of Category G will authorize the Agent only to intermediated the products established therein and may not intermediated for several Insurance Institutions that carry out the same operation or line when they do not maintain control ownership links between them;

XII.

Category H. Surety insurance.

XIII.

Category M. Mass Insurance.

The authorization of Category M will authorize the Agent for the advice and commercialization of Mass Insurance contracts related to a single Insurance Institution.

The authorizations of Categories D, E, F, G, H and M will be independent of the other Categories.

32.3.7.

Authorization requests to exercise the activity of Natural Person Agent linked to an Institution by an employment relationship, as well as Category M authorizations referred to in fraction XIII of Provision 32.3.6, will be presented to the Commission through the respective Institution.

The authorization requests referred to in this Chapter will be subject to the terms indicated in Annex 32.3.4 and its delivery will adhere to the procedure indicated in Chapters 39.1 and 39.4 of these Provisions.

32.3.8.

Interested parties wishing to obtain a duplicate of their authorization card as Natural Person Agent or Authorized Representative of Legal Person Agent, must send their request to the Commission in the terms indicated in Annex 32.3.8 through the Appointments and People Registration System indicated in Chapters 39.1 and 39.4 of these Provisions.

Interested parties must attach to their request the proof of payment of the corresponding fees, in accordance with the Federal Fees Law.

32.3.9.

Interested parties wishing to obtain the authorizations provided for in fraction XIII of Provision 32.3.6, will be informed about the admissibility of the requested authorization through the corresponding Insurance Institution, prior to sending the respective information in terms of what is indicated in Annex 32.3.9 and in accordance with what is provided in Chapters 39.1 and 39.3 of these Provisions, so that subsequently, through the Appointments and People Registration System referred to in Chapters 39.1 and 39.4 of these Provisions, the Commission will issue the respective card to each Agent.

Interested parties must attach the proof of payment of the corresponding fees, in terms of what is provided in the Federal Fees Law.

32.3.10.

Insurance Institutions that request authorization for Category M Natural Person Agents, must integrate, under their responsibility, a file for each prospect, which will include, at a minimum, the following documents:

I.

Recent color infant-size photograph of the prospect;

II.

Photostatic copy of valid official identification, with photograph;

III.

Copy of birth certificate or, in its absence, of the National Military Service card or valid passport;

IV.

Copy of the certificate of studies with a minimum level of high school or equivalent or, in its absence, professional licenses or academic records from institutions incorporated into the National Education System that accredit said level of studies;

V.

Copy of the Unique Population Registry Key;

VI.

Copy of the Tax Identification Card or, in its absence, the Registration with the Tax Administration Service, the Format of Notice of Modification of Worker Salaries issued by the Mexican Social Security Institute, or the contribution receipt to the Retirement Savings System;

VII.

Copy of proof of address, with a maximum age of three months, which may be a property tax payment slip, rent payment receipt, water, telephone, electricity, gas or bank statements issued by a financial institution;

VIII.

Certificate or statement of theoretical propaedeutic training; and

IX.

Copy of proof of having made the payment of corresponding fees, in accordance with the Federal Fees Law.

In the case of Category M Natural Person Agent prospects of foreign origin, in addition to the documentation previously mentioned, a copy of the respective migratory form or certificate of naturalization must be integrated into their file.

The files referred to in this Provision must be available in case the Commission requests them in the exercise of its inspection and supervision powers.

CHAPTER 32.4.

ON THE RENEWAL OF THE AUTHORIZATION OF

NATURAL PERSON AGENTS AND AUTHORIZED REPRESENTATIVES

For the purposes of articles 91, 92, 93 and 94 of the LISF:

32.4.1.

The authorizations of Natural Person Agent and Authorized Representative of Legal Person Agent referred to in Chapter 32.3 of these Provisions, must be renewed within the sixty natural days prior to the date of their expiration, at the request of the interested party, or through the Institutions when it comes to Natural Person Agents linked to them by an employment relationship or in the case of the authorizations corresponding to Categories G and M referred to in fractions XI and XIII of Provision 32.3.6.

32.4.2.

The renewals referred to in Provision 32.4.1 must be carried out every three years and will be granted, provided that the requirements established in the Regulation of Insurance and Surety Agents are met and in accordance with what is provided in these Provisions. For this purpose, Natural Person Agents and Authorized Representatives of Legal Person Agents must accredit their technical capacity before the Commission, in accordance with Chapter 32.7 of these Provisions.

32.4.3.

The request for renewal must be sent in the terms indicated in Annex 32.4.3 through the Appointments and People Registration System (SICREP) indicated in Chapters 39.1 and 39.4 of these Provisions, attaching the following documentation:

I.

Recent photograph, infant size, color, recent, in .JPG format with 160 pixels wide by 200 high, 24-bit depth and a maximum size of 50 kb;

II.

Copy of the Unique Population Registry Key;

III.

Copy of proof of address, with a maximum age of three months, which may be a property tax payment slip, rent payment receipt, water, telephone, electricity, gas or bank statements issued by a financial institution;

IV.

Copy of the professional liability insurance policies for errors and omissions that have been contracted in compliance with what is provided in Chapter 32.10 of these Provisions, as well as the proof of payment thereof;

V.

Proof of payment of corresponding fees, in accordance with the Federal Fees Law;

VI.

In the case of Categories G and M referred to in fractions XI and XIII of Provision 32.3.6, copy of the commercial contract entered into with the corresponding Insurance Institution.

In the case of Agents of foreign origin, in addition to the documentation previously mentioned, they must send a copy of the migratory form that allows them to carry out the activity in national territory, or a certificate of naturalization.

The documents referred to in fractions II to VI above must be sent in .PDF format, and the originals of said documents must be available in case the Commission requires them in the exercise of its inspection and supervision powers.

32.4.4.

The deadline to carry out the renewal procedure for the authorizations of Natural Person Agents and Authorized Representatives of Legal Person Agents, whose expiration date coincides with a non-working day, may be carried out no later than the next working day.

32.4.5.

Once the requirements provided for in this Chapter are met, the Commission, within a maximum period of ten business days following the sending of the information, will notify the interested party regarding the admissibility of their application and, if applicable, will issue the corresponding digital card.

32.4.6.

Persons who have not renewed in a timely manner may request a new authorization, having to meet the requirements established in Provision 32.3.2.

32.4.7.

Institutions may not carry out insurance and surety contracting operations with the intervention of persons whose authorization card is not valid.

CHAPTER 32.5.

ON THE AUTHORIZATION OF LEGAL PERSON AGENTS

For the purposes of articles 91, 92, 93 and 94 of the LISF:

32.5.1.

To exercise the activity of Legal Person Agent, authorization from the Commission is required, for which the petitioner must present the following documents:

I.

Formal written request, addressed to the Commission, indicating:

a)

Name of the petitioner and, if applicable, of their legal representative, attaching to their request the documents with which they accredit the powers with which they promote;

b)

Address and email for hearing and receiving notifications and, if applicable, authorization to persons who may hear and receive them;

c)

The denomination to be adopted; and

d)

Name or denomination of the partners and percentages of their participation.

II.

General project of organization of the society to be constituted organized in accordance with the Regulation of Insurance and Surety Agents, which must provide for:

a)

Curriculum vitae of the partners;

b)

Information contained in Annex 32.3.4 for each of the prospects for Authorized Representatives of Legal Person Agents to intervene in the advice and contracting of insurance or sureties on behalf of the Legal Person Agent to be constituted;

c)

The amount of its social capital;

d)

Copy of the Federal Taxpayer Registry or Fiscal Identification of the partners;

e)

Photocopy of the Unique Population Registry Card of the

partners; and

f)

Authorization from the Ministry of Economy for the use of the

designation.

The proposed designation must not coincide or be similar, to the degree of

confusion, to the designation of a Moral Person Agent with a valid

authorization, unless the consent or authorization of this entity is obtained. The

interested party may request an opinion from the Commission if the proposed designation

coincides or is similar to the degree of confusion, with that of any valid

authorization.

III.

Draft bylaws of the company.

This draft must comply with what is established in the General Law of

Commercial Societies and the Regulation of Insurance and Surety Agents,

additionally establishing:

a)

A corporate governance system that guarantees a sound and

prudent management of the Moral Person Agent's activity, whose implementation

and monitoring will be the responsibility of its board of directors;

b)

The responsibility of the board of directors to establish a

transparent and appropriate organizational structure, a clear and adequate distribution of functions, as well as effective mechanisms to guarantee

the timely transmission of information to its clients; and

c)

The responsibility of the board of directors to implement

internal control and audit mechanisms, in order to verify compliance with internal policies and procedures, as well as with the

applicable legal, regulatory, and administrative provisions.

The submission of the documents referred to in this Provision must be

effected in accordance with the procedure indicated in Chapters 39.1. and

39.6. of these Provisions.

32.5.2.

In the event that the Commission issues a favorable ruling on the request, it will notify it in

writing to the petitioner, delivering the ruling document for authorization,

setting a term of one hundred eighty (180) natural days following the said notification,

for the company to proceed to be incorporated and deliver the following documents:

I.

Certified copy or testimony of the public instrument in which the notarized

constitutive act is recorded, registered in the Public Commerce Registry;

II.

Copy of the civil liability insurance policy for errors and omissions

contracted by the applicant in accordance with what is established in Chapter 32.10. of

these Provisions;

III.

Proof of subscription and payment of the social capital referred to in

subsection c) of fraction II of Provision 32.5.1. It will not be necessary to present

this proof when the public instrument in which the constitutive act is recorded

includes a declaration stating that the social capital has been subscribed and paid;

IV.

Proof of payment of fees for authorization, as provided for in

the Federal Fees Law; and

V.

Registration in the Federal Taxpayer Registry.

32.5.3.

Once the requirements provided for in this Chapter have been met, the Commission will issue the

final authorization document within a maximum term of twenty (20) business days counted from

the day following the submission of the documentation established in

Provision 32.5.2., and the prospects for Moral Person Agent Attorneys

authorized to carry out Insurance or Surety Intermediation activities

on behalf of the Moral Person Agent will proceed as follows:

I.

They must request their respective authorization card from the Commission as

Attorneys of a Moral Person Agent, in accordance with what is provided in Chapter

32.3 of these Provisions; and

II.

In the event that the prospects for Moral Person Agent Attorneys

have authorization as Physical Person Agents, they must send to the

Commission through the Appointments and Persons Registration System the Annex

32.3.4. as well as the proof of payment of fees for the concept of

replacement, in accordance with the Federal Fees Law.

The authorization as a Physical Person Agent will be revoked at the moment of

issuing the new authorization as an Attorney of a Moral Person Agent.

Having met the aforementioned requirements, the Commission, within a maximum term of ten (10)

business days following the sending of the information, will notify the interested party regarding the

proceedings of their request and, if applicable, will issue the corresponding card.

32.5.4.

Moral Person Agents, for the registration of their operations, must adhere to

what is indicated in Chapter 22.5 of these Provisions.

SECOND.- Provision 32.10.10. of the Single Insurance and Surety Circular is modified, to read

as follows:

32.10.10.

...

The civil liability insurance policies for errors and omissions, as well as

the proof of payment thereof,

will be sent to the Commission through the

Appointments and Persons Registration System at the time of carrying out the procedure for their

renewal, or when a new authorization is processed due to not having

carried out the renewal in a timely manner or due to the interruption of their activities as a

Physical Person Agent or due to a change in the category of their authorization, must

send the information referred to in Provision 32.10.8., in terms of

Annex 32.10.10.

THIRD.- The "List of Annexes" of the Single Insurance and Surety Circular is modified, to renumber

the relevant ones:

Annex

Changes to:

ANNEX 32.3.9.

FORM AND TERMS FOR THE SUBMISSION OF THE

REQUEST FOR ISSUANCE OF DUPLICATE

CARD OF PHYSICAL PERSON AGENT OR

ATTORNEY OF A MORAL PERSON AGENT.

ANNEX 32.3.8.

FORM AND TERMS FOR THE SUBMISSION OF THE

REQUEST FOR ISSUANCE OF DUPLICATE

CARD OF PHYSICAL PERSON AGENT OR

ATTORNEY OF A MORAL PERSON AGENT.

ANNEX 32.3.11.

FORM AND TERMS FOR THE SUBMISSION OF THE

REQUEST FOR AUTHORIZATION OF PHYSICAL PERSON

AGENT CATEGORY M.

ANNEX 32.3.9.

FORM AND TERMS FOR THE SUBMISSION OF THE

REQUEST FOR AUTHORIZATION OF PHYSICAL PERSON

AGENT CATEGORY M.

FOURTH.- The "List of Annexes" of the Single Insurance and Surety Circular is modified to add

Annex 32.10.10.

TRANSITORY

SINGLE.- This Modifying Circular will enter into force on the next business day following its publication

in the Official Journal of the Federation.

The National Commission of Insurance and Sureties, based on the provisions of articles 91, 92, 93,

94, 366, fraction II, 367, fraction II, 372, fractions VI, XXII and XLII, 373 and 381 of the Law of Insurance and Surety Institutions.

Respectfully,

Mexico City, January 3, 2022. - The President of the National Commission of Insurance and Sureties,

Ricardo Ernesto Ochoa Rodríguez. - Signature.

ANNEX 32.10.10.

SUBMISSION OF INFORMATION REGARDING INTERMEDIATED PREMIUMS

Based on articles 91, 92, 93 and 94 of the Law of Insurance and Surety Institutions, 23 of the

Regulation of Insurance and Surety Agents and Provision 32.10.8. of the Single Insurance and Surety

Circular, I declare the following:

NAME OF PHYSICAL PERSON AGENT

RFC

CURP

INFORMATION ON CIVIL LIABILITY INSURANCE FOR ERRORS AND OMISSIONS CONTRACTED

NAME OF THE

INSTITUTION

POLICY

NO.

DATE OF

ISSUANCE

VALIDITY

INSURED AMOUNT

PRODUCTION REPORT

NAME OF THE

INSTITUTION

PERIOD

DATE OF

ISSUANCE

PREMIUMS PAID

TOTAL

NOTE: THE CORRESPONDING SECTION MUST BE FILLED WITH INFORMATION REGARDING THE

TOTAL OF INTERMEDIATED PREMIUMS BY THE AGENT, WITH RESPECT TO ALL INSTITUTIONS

FOR WHICH IT CARRIED OUT INSURANCE OR SURETY INTERMEDIATION ACTIVITIES, DURING THE

IMMEDIATE PREVIOUS CALENDAR YEAR.

OBSERVATIONS AND

COMMENTS

UNDER OATH I DECLARE THAT THE INFORMATION CONTAINED IN THIS

ANNEX IS TRUE AND THAT THE ATTACHED DOCUMENTATION IS RELIABLE.

NAME AND SIGNATURE OF THE PHYSICAL PERSON AGENT

PLACE AND DATE:

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