SEOJK on Monthly Reports of General Insurance and Reinsurance Companies

To:

1. General Insurance Companies;
2. Life Insurance Companies; and
3. Reinsurance Companies

At Your Location.

COPY

CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 3/SEOJK.05/2013

CONCERNING
MONTHLY REPORTS OF INSURANCE COMPANIES AND REINSURANCE COMPANIES

In connection with Financial Services Authority Regulation Number 3/POJK.05/2013 dated 12 September 2013 concerning Monthly Reports of Non-Bank Financial Service Institutions (State Gazette of the Republic of Indonesia Year 2013 Number 150, Supplement to the State Gazette of the Republic of Indonesia Number 5443), it is necessary to regulate implementation provisions regarding the Monthly Reports of Insurance Companies and Reinsurance Companies in this Financial Services Authority Circular Letter as follows:

I. GENERAL PROVISIONS

1. The Financial Services Authority, hereinafter abbreviated as OJK, is an independent institution free from the interference of other parties, which has the function, task, and authority for regulation, supervision, examination, and investigation, as referred to in Law Number 21 of 2011 concerning the Financial Services Authority.

2. Monthly Report is a financial report prepared by non-bank financial service institutions for the benefit of OJK, which covers the period from the 1st to the end of the current month and is submitted according to the format and procedures determined by OJK.

II. FORM AND STRUCTURE OF MONTHLY REPORTS

The form, structure, and guidelines for preparing Monthly Reports for Insurance Companies and Reinsurance Companies are as follows:
a. for General Insurance Companies and Reinsurance Companies as stated in Appendix I; and b. for Life Insurance Companies as stated in Appendix II, which are an inseparable part of this OJK Circular Letter.

III. TIME FOR SUBMISSION OF MONTHLY REPORTS

1. Insurance Companies and Reinsurance Companies are required to submit Monthly Reports to OJK no later than the 10th of the following month.

2. In the event that the 10th date as referred to in item 1 falls on a holiday, the Monthly Report must be submitted on the next working day.

IV. SUBMISSION PROCEDURES

1. Submission of Monthly Reports is done online through the OJK data communication network system.

2. In the event that the OJK data communication network system is not yet available, Monthly Reports are submitted online via the company's official email by attaching a softcopy of the Monthly Report in spreadsheet format to LB.Asuransi_Reasuransi@ojk.go.id.

3. In the event that Monthly Reports are submitted offline, submission is done via a letter signed by the board of directors and addressed to:

Financial Services Authority
Attention: Director of Insurance Supervision
Sumitro Djojohadikusumo Building, 14th Floor
Jl. Lapangan Banteng Timur Number 2-4
Jakarta 10710

4. Offline submission of Monthly Reports as referred to in item 3 can be done as follows:
   a. handed in directly to the OJK office; b. sent via registered mail; or
   c. sent via a courier/courier service company.

5. Insurance Companies and Reinsurance Companies are deemed to have submitted Monthly Reports with the following provisions:
   a. for submission via online email, evidenced by an email receipt from OJK, b. for offline submission, evidenced by:

1. a receipt letter from OJK, if the report is handed in directly to the OJK office; or
2. a shipping receipt from the post office or courier/courier service company, if the report is sent via the post office or courier/courier service company.

6. In the event of changes to the OJK email address as referred to in item 2 and/or changes to the OJK office address as referred to in item 3, OJK will communicate the address changes via letter or announcement.

V. SANCTION PROVISIONS

1. OJK establishes administrative sanctions in the form of a first written warning as regulated in Article 6 paragraph (3) of OJK Regulation Number 3/POJK.05/2013 concerning Monthly Reports of Non-Bank Financial Service Institutions, with a deadline for fulfilling the obligation to submit Monthly Reports of no more than 30 (thirty) days from the establishment of the administrative sanction in the form of a first written warning.

2. If within the time period as referred to in item 1 the obligation to submit Monthly Reports has not been fulfilled, OJK establishes administrative sanctions in the form of a second written warning as regulated in Article 6 paragraph (4) of OJK Regulation Number 3/POJK.05/2013 concerning Monthly Reports of Non-Bank Financial Service Institutions, with a deadline for fulfilling the obligation to submit Monthly Reports of no more than 30 (thirty) days from the establishment of the administrative sanction in the form of a second written warning.

3. If within the time period as referred to in item 2 the obligation to submit Monthly Reports has not been fulfilled, OJK establishes administrative sanctions in the form of a third written warning as regulated in Article 6 paragraph (4) of OJK Regulation Number 3/POJK.05/2013 concerning Monthly Reports of Non-Bank Financial Service Institutions, with a deadline for fulfilling the obligation to submit Monthly Reports of no more than 30 (thirty) days from the establishment of the administrative sanction in the form of a third written warning.

VI. TRANSITIONAL PROVISIONS

1. Insurance Companies and Reinsurance Companies are required to submit Monthly Reports to OJK for the reporting period of September 2013 through the reporting period of August 2014 no later than the end of the following month.

2. In the event that the end date of the following month as referred to in item 1 falls on a holiday, the Monthly Report must be submitted on the next working day.

3. During the reporting period of September 2013 through the reporting period of August 2014, Insurance Companies and Reinsurance Companies are not required to submit reports for September 2013, December 2013, March 2014, and June 2014.

VII. CLOSING

This OJK Circular Letter takes effect on the date of establishment.
To ensure that everyone knows, it orders the announcement of this OJK Circular Letter by placing it in the State Gazette of the Republic of Indonesia.

Established in Jakarta on 25 November 2013

EXECUTIVE HEAD OF IKNB SUPERVISOR
FINANCIAL SERVICES AUTHORITY,
Signed,
FIRDAUS DJAELANI

Copy matches the original
Head of Legal Assistance Division
Legal Directorate
Signed,
Mufli Asmawidjaja

STATE GAZETTE OF THE REPUBLIC OF INDONESIA NUMBER 7 DATED 24 JANUARY YEAR 2014

APPENDIX I
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 3/SEOJK.05/2013 CONCERNING MONTHLY REPORTS OF INSURANCE COMPANIES AND REINSURANCE COMPANIES

To:
Respected Financial Services Authority
Attention: Directorate of Insurance Supervision Sumitro Djojohadikusumo Building, 14th Floor Jl. Lapangan Banteng Timur 1 - 4 Jakarta - 10710

MONTHLY REPORT
GENERAL INSURANCE / REINSURANCE COMPANY
For ... / Month ... Year …
PT XYZ
(Company Address)

(in millions of rupiah)

Description	SAK Balance	SAP Balance
(1)	(2)	(3)
ASSETS
Investments
Time Deposits and Deposit Certificates	-	-
Stocks	-	-
Corporate Bonds and Corporate Sukuk	-	-
Securities Issued by the RI State	-	-
Securities Issued by Countries Other Than RI	-	-
Securities Issued by Indonesian Banks	-	-
Securities Issued by Multinational Institutions	-	-
Mutual Funds	-	-
Asset-Backed Securities Collective Investment Contracts	-	-
Real Estate Investment Funds	-	-
Direct Investments	-	-
Buildings with Strata Rights or Land with Buildings for Investment	-	-
Purchase of Receivables for Financing Companies and/or Banks	-	-
Pure Gold	-	-
Loans Secured by Mortgage Rights	-	-
Other Investments	-	-
Total Investments	-	-
Non-Investments
Cash and Banks	-	-
Direct Written Premium Receivables	-	-
Co-insurance Claim Receivables	-	-
Reinsurance Receivables	-	-
Investment Receivables	-	-
Investment Income Receivables	-	-
Buildings with Strata Rights or Land with Buildings for Own Use	-	-
Other Fixed Assets	-	-
Other Assets	-	-
Total Non-Investments	-	-
TOTAL ASSETS	-	-
LIABILITIES AND EQUITY
Liabilities
Payables
Claim Payables	-	-
Co-insurance Payables	-	-
Reinsurance Payables	-	-
Commission Payables	-	-
Tax Payables	-	-
Accrued Expenses	-	-
Other Payables	-	-
Total Payables	-	-
Technical Reserves
Premium Reserves	-	-
Reserves for Premiums Not Yet Earned Income	-	-
Claim Reserves	-	-
Total Technical Reserves	-	-
Total Liabilities	-	-
Subordinated Loans	-	-
Equity
Paid-up Capital	-	-
Share Premium	-	-
Retained Earnings	-	-
Other Equity Components	-	-
Difference in Valuation Based on SAK and SAP	-	-
Assets Not Included in AYD	-	-
Total Equity	-	-
TOTAL LIABILITIES AND EQUITY	-	-

PT XYZ
GENERAL INSURANCE COMPANY
FINANCIAL POSITION REPORT
Non-Consolidated
For ….

(in millions of rupiah)

Description	Month … Year …
(1)	(2)
UNDERWRITING INCOME
Gross Premiums
a. Direct Written Premiums
b. Indirect Written Premiums
c. Commissions Paid
Total Gross Premiums	-
Reinsurance Premiums
a. Reinsurance Premiums Paid
b. Reinsurance Commissions Received
Total Reinsurance Premiums	-
Net Premiums	-
Decrease (Increase) in Premium Reserves and CAPYBMP
a. Decrease (Increase) in Premium Reserves
b. Decrease (Increase) in CAPYBMP
Decrease (Increase) in Premium Reserves and CAPYBMP	-
Total Net Premium Income	-
Other Net Underwriting Income
UNDERWRITING INCOME	-
UNDERWRITING EXPENSES
Claim Expenses
a. Gross Claims
b. Reinsurance Claims
c. Increase (Decrease) in Claim Reserves
Total Net Claim Expenses	-
Other Net Underwriting Expenses
TOTAL UNDERWRITING EXPENSES	-
UNDERWRITING RESULT	-
Investment Result
Operating Expenses:
a. Marketing Expenses
b. General and Administrative Expenses:
- Employee and Management Expenses
- Education and Training Expenses
- Other General and Administrative Expenses
Total Operating Expenses	-
INSURANCE OPERATING PROFIT (LOSS)	-
Other (Expenses) Income
PROFIT (LOSS) BEFORE TAX	-
Income Tax
PROFIT AFTER TAX	-
OTHER COMPREHENSIVE INCOME
TOTAL COMPREHENSIVE PROFIT (LOSS)	-

PT XYZ
GENERAL INSURANCE COMPANY
COMPREHENSIVE INCOME / LOSS STATEMENT
For the Period Ending On
Date …

Note:
The figures in this report are cumulative figures for the period from January 1 to the reporting date of the current period.

(in millions of rupiah)

Description	Month … Year …
(1)	(2)
BEGINNING CASH AND BANK BALANCE
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Premiums
b. Co-insurance Claims
c. Reinsurance Claims
d. Commissions
e. Receivables
f. Others
Total Cash Inflows	-
Cash Outflows
a. Reinsurance Premiums
b. Claims
c. Commissions
d. Expenses
e. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES	-
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows
a. Investment Income Receipts
b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows	-
Cash Outflows
a. Investment Placements
b. Purchase of Fixed Assets
c. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM INVESTING ACTIVITIES	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Subordinated Loans
b. Capital Deposits
c. Others
Total Cash Inflows	-
Cash Outflows
a. Dividend Payments
b. Subordinated Loan Payments
c. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES	-
ENDING CASH AND BANK BALANCE	-

PT XYZ
GENERAL INSURANCE COMPANY
CASH FLOW STATEMENT
For ….

(in millions of rupiah)

Description	Month … Year …
(1)	(2)
Solvency Ratio
Permitted Assets	-
Liabilities (excluding Subordinated Loans)	-
Total Solvency Ratio	-
Risk-Based Capital Minimum (RBCM)
Schedule A
Schedule B
Schedule C
Schedule D
Schedule E
Schedule F
Schedule G
Total RBCM	-
Surplus (Deficit) of Solvency Ratio	-
Solvency Achievement Ratio (in %)	1) #DIV/0!
1) Total Solvency Ratio divided by Total RBCM
In the event the Company experiences a solvency deficit, the amount of funds needed to reach a 100.00% RBC ratio
120.00% RBC ratio

PT XYZ
GENERAL INSURANCE COMPANY
SOLVENCY RATIO REPORT
Solvency Achievement Ratio
For ….

Maturity	Rupiah Valas 3) Total	Rupiah Valas 3) Total	Rupiah Valas 3) Total
≤ 1 year	#DIV/0!	#DIV/0!	#DIV/0!
1 year < maturity < 5 years	#DIV/0!	#DIV/0!	#DIV/0!
5 years ≤ maturity < 10 years	#DIV/0!	#DIV/0!	#DIV/0!
≥ 10 years	#DIV/0!	#DIV/0!	#DIV/0!
Total

(in percentage)

Description	Rupiah	Valas	Total
Current Assets to Non-Current Assets Ratio	#DIV/0!	#DIV/0!	#DIV/0!
Current Liabilities to Non-Current Liabilities Ratio	#DIV/0!	#DIV/0!	#DIV/0!

Note:

1. In millions of rupiah
2. In percentage
3. Already converted to rupiah currency

Current assets/liabilities are assets/liabilities with a maturity of less than 1 year up to 1 year. Non-current assets/liabilities are assets/liabilities with a maturity of more than 1 year.

Established in Jakarta on 25 November 2013

EXECUTIVE HEAD OF IKNB SUPERVISOR
FINANCIAL SERVICES AUTHORITY
Signed,
FIRDAUS DJAELANI

Copy matches the original
Head of Legal Assistance Division
Legal Directorate
Signed,
Mufli Asmawidjaja

Description	PT.XYZ
ASSET AND LIABILITY RECAPITULATION BASED ON CURRENCY AND MATURITY
For … Month … Year …
Maturity	Assets 1)	Liabilities 1)	Asset to Liability Ratio 2)

GUIDELINES FOR PREPARING MONTHLY FINANCIAL REPORTS GENERAL INSURANCE COMPANY / REINSURANCE COMPANY

I. GENERAL

1. This financial report is prepared specifically for the development and supervision of the insurance business. Therefore, the form, content, and structure of the financial report are made in accordance with applicable legislation in the insurance business field (Statutory Accounting Practices/SAP) as regulated in Minister of Finance Regulation Number 53 of 2012 and its implementing regulations.

2. The content and structure of the Financial Report of General Insurance Companies/Reinsurance Companies are as follows:
   a. Financial Position Report of General Insurance Companies/Reinsurance Companies b. Comprehensive Income/Loss Report of General Insurance Companies/Reinsurance Companies
   c. Cash Flow Report of General Insurance Companies/Reinsurance Companies
   d. Solvency Ratio Report of General Insurance Companies/Reinsurance Companies e. Recapitulation of Assets and Liabilities Based on Currency and Maturity

3. The form, content, and structure of the aforementioned financial reports are used for monthly financial reports.

4. Financial reports are presented for the current period.

5. If there are rows or columns that must be filled but the value is 0 (zero) or non-existent, write 0 (zero).

6. Rupiah figures in all financial report formats are written in millions of rupiah with 2 (two) decimal places after the comma.

7. Negative figures are indicated in parentheses (xxxx).

8. Permitted Assets, hereinafter abbreviated as AYD, are assets permitted to be calculated in the solvency ratio calculation as referred to in legislation in the insurance field.

9. General Insurance Companies/Reinsurance Companies (Company) are Insurance Companies as referred to in the Law on insurance business.

10. Others
    a. The company name must be clearly written on every format title available. On the front page (cover), the name and address of the General Insurance Company/Reinsurance Company must be filled in the available row (see instructions in the format). b. The monthly financial reporting period must be filled in according to the end date of the current reporting period. For example, for the September 2013 report, fill in as of 30 September 2013.

II. FINANCIAL REPORTS

1. Financial Position Report
   The Financial Position Report in this report consists of a Financial Position Report prepared based on Financial Accounting Standards (SAK) and Statutory Accounting Practice (SAP) presented according to the end of the current period. a. SAK Financial Position Report The accounts in this Financial Position Report have been reclassified according to the purpose of their inclusion, so the accounts do not necessarily have to be the same as the accounts in SAK reporting. The purpose of including the SAK Financial Position Report is to have comparative figures for SAP Financial Position Report accounts, especially for assets, so as to facilitate analysis by analysts. b. SAP Financial Position Report Assets and liabilities listed in the SAP Financial Position Report are AYD, the accounts of which are filled in based on regulations in Minister of Finance Regulation Number 53 of 2012 and its implementing regulations.

Differences in valuation between SAK and SAP can arise due to differences in asset and liability valuation based on SAK and SAP. Differences in asset valuation between SAK and SAP arise due to differences in the recognition of the value of the asset. Generally, SAP recognizes assets at fair value, while SAK recognizes assets at historical cost. For liabilities, differences can arise because SAK provides several options in technical reserve calculation methods, allowing Companies to choose technical reserve calculation methods based on SAK that differ from technical reserve calculations as regulated in legislation.

In the event of differences in asset and liability valuation between SAP and SAK, the difference can increase or decrease SAP equity. Differences in asset valuation can occur because, generally, asset valuation based on SAP results in larger amounts compared to asset valuation based on SAK, thus resulting in an increase in SAP equity. For liabilities, generally, Companies will use valuation based on SAP which can provide smaller valuations compared to liability valuation based on SAK, thus resulting in an increase in SAP equity.

Whereas Non-Permitted Assets arise due to limitations in the recognition of Company assets so that not all assets recognized based on SAK can be recognized as assets based on SAP. Thus, the non-recognition of such assets results in a decrease in SAP equity.

The presentation of reinsurance assets in this Financial Position Report is presented as assets that are part of reinsurance receivables and included in AYD in the calculation of financial health ratios. The value of reinsurance assets consists of:

1. The value of reinsurance assets over future policy benefit liabilities,
   determined consistently with the approach used in determining future policy benefit liabilities, based on the terms and conditions of the reinsurance contract.
2. The value of reinsurance assets over unearned premiums,
   determined consistently with the approach used in determining unearned premiums, based on the terms and conditions of the reinsurance contract.
3. The value of reinsurance assets over estimated claim liabilities,
   determined consistently with the approach used in determining estimated claim liabilities, based on the terms and conditions of the reinsurance contract.

2. Comprehensive Income/Loss Report
   The SAP Comprehensive Income/Loss Report may differ from the SAK Comprehensive Income/Loss Report due to differences in recognition treatment (technical reserve expenses) and differences in account classification. Account classifications for SAP reports have been adjusted to existing regulations. Thus, the final result of this Comprehensive Income/Loss Report (i.e., profit or loss) can differ between SAP reports and SAK reports. The Comprehensive Income/Loss Report presented is the Comprehensive Income/Loss Report for the beginning of the current fiscal year up to the reporting date (cumulatively). For example, for the September 2013 report, the income recorded is income obtained from January 1, 2013, to September 30, 2013. The components for determining Gross Premiums in this report are gross premiums as referred to in Government Regulation Number 73 of 1992 concerning the Conduct of Insurance Business as amended by Government Regulation Number 63 of 1999.

3. Cash Flow Report
   The Cash Flow Report in this report is filled in based on information in the columns provided in the existing format. The beginning cash and bank balance of the current month is filled in with the beginning cash and bank balance of the current year. The ending cash and bank balance in the Cash Flow Report must be the same as the cash and bank balance in the Financial Position Report. For example, for the beginning cash and bank balance of the Cash Flow Report for September 2013, fill in the cash and bank balance as of January 1, 2013. Whereas the ending cash and bank balance in the Cash Flow Report for September 2013 must be the same as the cash and bank balance in the Financial Position Report as of September 30, 2013.

4. Solvency Ratio Report - Solvency Achievement Ratio
   Companies are required to meet a minimum solvency ratio of at least 120% of the risk-based capital minimum as referred to in Minister of Finance Regulation Number 53/PMK.010/2012. The total solvency referred to consists of AYD and Liabilities (excluding subordinated loans).

5. Recapitulation of Assets and Liabilities Based on Currency and Maturity
   Matching assets and liabilities based on currency and maturity is necessary to know differences in asset and liability values in foreign currencies, as well as fluctuations in foreign currency exchange rates against the rupiah. The columns in this detail are filled in based on SAK values.

APPENDIX II
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 3/SEOJK.05/2013 CONCERNING MONTHLY REPORTS OF INSURANCE COMPANIES AND REINSURANCE COMPANIES

To:
Respected Financial Services Authority
Attention: Directorate of Insurance Supervision Sumitro Djojohadikusumo Building, 14th Floor Jl. Lapangan Banteng Timur 1 - 4 Jakarta - 10710

MONTHLY REPORT
LIFE INSURANCE COMPANY
For …………./ Month ………. Year ………..
PT XYZ
(Company Address)

(in millions of rupiah)

Description	SAK Balance	SAP Balance
(1)	(2)	(3)
ASSETS
Investments
Time Deposits and Deposit Certificates	-	-
Stocks	-	-
Corporate Bonds and Corporate Sukuk	-	-
Securities Issued by the RI State	-	-
Securities Issued by Countries Other Than RI	-	-
Securities Issued by Indonesian Banks	-	-
Securities Issued by Multinational Institutions	-	-
Mutual Funds	-	-
Asset-Backed Securities Collective Investment Contracts	-	-
Real Estate Investment Funds	-	-
Direct Investments	-	-
Buildings with Strata Rights or Land with Buildings for Investment	-	-
Purchase of Receivables for Financing Companies and/or Banks	-	-
Pure Gold	-	-
Loans Secured by Mortgage Rights	-	-
Other Investments	-	-
Total Investments	-	-
Non-Investments
Cash and Banks	-	-
Direct Written Premium Receivables	-	-
Co-insurance Claim Receivables	-	-
Reinsurance Receivables	-	-
Investment Receivables	-	-
Investment Income Receivables	-	-
Policy Loans	-	-
Buildings with Strata Rights or Land with Buildings for Own Use	-	-
Other Fixed Assets	-	-
Other Assets	-	-
Total Non-Investments	-	-
TOTAL ASSETS	-	-
LIABILITIES AND EQUITY
Liabilities
Payables
Claim Payables	-	-
Co-insurance Payables	-	-
Reinsurance Payables	-	-
Commission Payables	-	-
Tax Payables	-	-
Accrued Expenses	-	-
Other Payables	-	-
Total Payables	-	-
Technical Reserves
Premium Reserves	-	-
Reserves for Premiums Not Yet Earned Income	-	-
Claim Reserves	-	-
Total Technical Reserves	-	-
Total Liabilities	-	-
Subordinated Loans	-	-
Equity
Paid-up Capital	-	-
Share Premium	-	-
Retained Earnings	-	-
Other Equity Components	-	-
Difference in Valuation Based on SAK & SAP	-	-
Assets Not Included in AYD	-	-
Total Equity	-	-
TOTAL LIABILITIES AND EQUITY	-	-

PT XYZ
LIFE INSURANCE COMPANY
FINANCIAL POSITION REPORT
Non-Consolidated
For ….

(in millions of rupiah)

Description	Month … Year …
(1)	(2)
UNDERWRITING INCOME
Gross Premiums
a. Direct Written Premiums
b. Indirect Written Premiums
c. Commissions Paid
Total Gross Premiums	-
Reinsurance Premiums
a. Reinsurance Premiums Paid
b. Reinsurance Commissions Received
Total Reinsurance Premiums	-
Net Premiums	-
Decrease (Increase) in Premium Reserves and CAPYBMP
a. Decrease (Increase) in Premium Reserves
b. Decrease (Increase) in CAPYBMP
Decrease (Increase) in Premium Reserves and CAPYBMP	-
Total Net Premium Income	-
Other Net Underwriting Income
UNDERWRITING INCOME	-
UNDERWRITING EXPENSES
Claim Expenses
a. Gross Claims
b. Reinsurance Claims
c. Increase (Decrease) in Claim Reserves
Total Net Claim Expenses	-
Other Net Underwriting Expenses
TOTAL UNDERWRITING EXPENSES	-
UNDERWRITING RESULT	-
Investment Result
Operating Expenses:
a. Marketing Expenses
b. General and Administrative Expenses:
- Employee and Management Expenses
- Education and Training Expenses
- Other General and Administrative Expenses
Total Operating Expenses	-
INSURANCE OPERATING PROFIT (LOSS)	-
Other (Expenses) Income
PROFIT (LOSS) BEFORE TAX	-
Income Tax
PROFIT AFTER TAX	-
OTHER COMPREHENSIVE INCOME
TOTAL COMPREHENSIVE PROFIT (LOSS)	-

PT XYZ
LIFE INSURANCE COMPANY
COMPREHENSIVE INCOME / LOSS STATEMENT
For the Period Ending On
Date …

Note:
The figures in this report are cumulative figures for the period from January 1 to the reporting date of the current period.

(in millions of rupiah)

Description	Month … Year …
(1)	(2)
BEGINNING CASH AND BANK BALANCE
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Premiums
b. Co-insurance Claims
c. Reinsurance Claims
d. Commissions
e. Receivables
f. Others
Total Cash Inflows	-
Cash Outflows
a. Reinsurance Premiums
b. Claims
c. Commissions
d. Expenses
e. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES	-
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows
a. Investment Income Receipts
b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows	-
Cash Outflows
a. Investment Placements
b. Purchase of Fixed Assets
c. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM INVESTING ACTIVITIES	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Subordinated Loans
b. Capital Deposits
c. Others
Total Cash Inflows	-
Cash Outflows
a. Dividend Payments
b. Subordinated Loan Payments
c. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES	-
ENDING CASH AND BANK BALANCE	-

PT XYZ
LIFE INSURANCE COMPANY
CASH FLOW STATEMENT
For ….

(in millions of rupiah)

Description	Month … Year …
(1)	(2)
Solvency Ratio
Permitted Assets	-
Liabilities (excluding Subordinated Loans)	-
Total Solvency Ratio	-
Risk-Based Capital Minimum (RBCM)
Schedule A
Schedule B
Schedule C
Schedule D
Schedule E
Schedule F
Schedule G
Total RBCM	-
Surplus (Deficit) of Solvency Ratio	-
Solvency Achievement Ratio (in %)	1) #DIV/0!
1) Total Solvency Ratio divided by Total RBCM
In the event the Company experiences a solvency deficit, the amount of funds needed to reach a 100.00% RBC ratio
120.00% RBC ratio

PT XYZ
LIFE INSURANCE COMPANY
SOLVENCY RATIO REPORT
Solvency Achievement Ratio
For ….

Maturity	Rupiah Valas 3) Total	Rupiah Valas 3) Total	Rupiah Valas 3) Total
≤ 1 year	#DIV/0!	#DIV/0!	#DIV/0!
1 year < maturity < 5 years	#DIV/0!	#DIV/0!	#DIV/0!
5 years ≤ maturity < 10 years	#DIV/0!	#DIV/0!	#DIV/0!
≥ 10 years	#DIV/0!	#DIV/0!	#DIV/0!
Total

(in percentage)

Description	Rupiah	Valas	Total
Current Assets to Non-Current Assets Ratio	#DIV/0!	#DIV/0!	#DIV/0!
Current Liabilities to Non-Current Liabilities Ratio	#DIV/0!	#DIV/0!	#DIV/0!

Note:

1. In millions of rupiah
2. In percentage
3. Already converted to rupiah currency

Current assets/liabilities are assets/liabilities with a maturity of less than 1 year up to 1 year. Non-current assets/liabilities are assets/liabilities with a maturity of more than 1 year.

Established in Jakarta on 25 November 2013

EXECUTIVE HEAD OF IKNB SUPERVISOR
FINANCIAL SERVICES AUTHORITY
Signed,
FIRDAUS DJAELANI

Copy matches the original
Head of Legal Assistance Division
Legal Directorate
Signed,
Mufli Asmawidjaja

Description	PT.XYZ
ASSET AND LIABILITY RECAPITULATION BASED ON CURRENCY AND MATURITY
For … Month … Year …
Maturity	Assets 1)	Liabilities 1)	Asset to Liability Ratio 2)

GUIDELINES FOR PREPARING MONTHLY FINANCIAL REPORTS LIFE INSURANCE COMPANY

I. GENERAL

1. This financial report is prepared specifically for the development and supervision of the insurance business. Therefore, the form, content, and structure of the financial report are made in accordance with applicable legislation in the insurance business field (Statutory Accounting Practices/SAP) as regulated in Minister of Finance Regulation Number 53 of 2012 and its implementing regulations.

2. The content and structure of the Financial Report of Life Insurance Companies are as follows:
   a. Financial Position Report of Life Insurance Companies b. Comprehensive Income/Loss Report of Life Insurance Companies
   c. Cash Flow Report of Life Insurance Companies
   d. Solvency Ratio Report of Life Insurance Companies e. Recapitulation of Assets and Liabilities Based on Currency and Maturity

3. The form, content, and structure of the aforementioned financial reports are used for monthly financial reports.

4. Financial reports are presented for the current period.

5. If there are rows or columns that must be filled but the value is 0 (zero) or non-existent, write 0 (zero).

6. Rupiah figures in all financial report formats are written in millions of rupiah with 2 (two) decimal places after the comma.

7. Negative figures are indicated in parentheses (xxxx).

8. Permitted Assets, hereinafter abbreviated as AYD, are assets permitted to be calculated in the solvency ratio calculation as referred to in legislation in the insurance field.

9. Life Insurance Companies (Company) are Insurance Companies as referred to in the Law on insurance business.

10. Others
    a. The company name must be clearly written on every format title available. On the front page (cover), the name and address of the Life Insurance Company must be filled in the available row (see instructions in the format). b. The monthly financial reporting period must be filled in according to the end date of the current reporting period. For example, for the September 2013 report, fill in as of 30 September 2013.

II. FINANCIAL REPORTS

1. Financial Position Report
   The Financial Position Report in this report consists of a Financial Position Report prepared based on Financial Accounting Standards (SAK) and Statutory Accounting Practice (SAP) presented according to the end of the current period. a. SAK Financial Position Report The accounts in this Financial Position Report have been reclassified according to the purpose of their inclusion, so the accounts do not necessarily have to be the same as the accounts in SAK reporting. The purpose of including the SAK Financial Position Report is to have comparative figures for SAP Financial Position Report accounts, especially for assets, so as to facilitate analysis by analysts. b. SAP Financial Position Report Assets and liabilities listed in the SAP Financial Position Report are AYD, the accounts of which are filled in based on regulations in Minister of Finance Regulation Number 53 of 2012 and its implementing regulations.

Differences in valuation between SAK and SAP can arise due to differences in asset and liability valuation based on SAK and SAP. Differences in asset valuation between SAK and SAP arise due to differences in the recognition of the value of the asset. Generally, SAP recognizes assets at fair value, while SAK recognizes assets at historical cost. For liabilities, differences can arise because SAK provides several options in technical reserve calculation methods, allowing Companies to choose technical reserve calculation methods based on SAK that differ from technical reserve calculations as regulated in legislation.

In the event of differences in asset and liability valuation between SAP and SAK, the difference can increase or decrease SAP equity. Differences in asset valuation can occur because, generally, asset valuation based on SAP results in larger amounts compared to asset valuation based on SAK, thus resulting in an increase in SAP equity. For liabilities, generally, Companies will use valuation based on SAP which can provide smaller valuations compared to liability valuation based on SAK, thus resulting in an increase in SAP equity.

Whereas Non-Permitted Assets arise due to limitations in the recognition of Company assets so that not all assets recognized based on SAK can be recognized as assets based on SAP. Thus, the non-recognition of such assets results in a decrease in SAP equity.

The presentation of reinsurance assets in this Financial Position Report is presented as assets that are part of reinsurance receivables and included in AYD in the calculation of financial health ratios. The value of reinsurance assets consists of:

1. The value of reinsurance assets over future policy benefit liabilities,
   determined consistently with the approach used in determining future policy benefit liabilities, based on the terms and conditions of the reinsurance contract.
2. The value of reinsurance assets over unearned premiums,
   determined consistently with the approach used in determining unearned premiums, based on the terms and conditions of the reinsurance contract.
3. The value of reinsurance assets over estimated claim liabilities,
   determined consistently with the approach used in determining estimated claim liabilities, based on the terms and conditions of the reinsurance contract.

2. Comprehensive Income/Loss Report
   The SAP Comprehensive Income/Loss Report may differ from the SAK Comprehensive Income/Loss Report due to differences in recognition treatment (technical reserve expenses) and differences in account classification. Account classifications for SAP reports have been adjusted to existing regulations. Thus, the final result of this Comprehensive Income/Loss Report (i.e., profit or loss) can differ between SAP reports and SAK reports. The Comprehensive Income/Loss Report presented is the Comprehensive Income/Loss Report for the beginning of the current fiscal year up to the reporting date (cumulatively). For example, for the September 2013 report, the income recorded is income obtained from January 1, 2013, to September 30, 2013. The components for determining Gross Premiums in this report are gross premiums as referred to in Government Regulation Number 73 of 1992 concerning the Conduct of Insurance Business as amended by Government Regulation Number 63 of 1999.

3. Cash Flow Report
   The Cash Flow Report in this report is filled in based on information in the columns provided in the existing format. The beginning cash and bank balance of the current month is filled in with the beginning cash and bank balance of the current year. The ending cash and bank balance in the Cash Flow Report must be the same as the cash and bank balance in the Financial Position Report. For example, for the beginning cash and bank balance of the Cash Flow Report for September 2013, fill in the cash and bank balance as of January 1, 2013. Whereas the ending cash and bank balance in the Cash Flow Report for September 2013 must be the same as the cash and bank balance in the Financial Position Report as of September 30, 2013.

4. Solvency Ratio Report - Solvency Achievement Ratio
   Companies are required to meet a minimum solvency ratio of at least 120% of the risk-based capital minimum as referred to in Minister of Finance Regulation Number 53/PMK.010/2012. The total solvency referred to consists of AYD and Liabilities (excluding subordinated loans).

5. Recapitulation of Assets and Liabilities Based on Currency and Maturity
   Matching assets and liabilities based on currency and maturity is necessary to know differences in asset and liability values in foreign currencies, as well as fluctuations in foreign currency exchange rates against the rupiah. The columns in this detail are filled in based on SAK values.

(in millions of rupiah)
Description of Month …
Year …
(1) (2)
INCOME
Premium Income
Reinsurance Premium
Decrease (Increase) CAPYBMP
Total Net Premium Income
Investment Income
Fees from DPLK/Other Management Services
Other Income
TOTAL INCOME
EXPENSES
Insurance Expenses a. Claims and Benefits
(1) Claims and Benefits Paid
(2) Reinsurance Claims
(3) Increase (Decrease) in Premium Reserves
(4) Increase (Decrease) in Claim Reserves
Total Claims and Benefits Expenses b. Acquisition Costs (1) Commission Expenses - First Year (2) Commission Expenses - Subsequent Years (3) Commission Expenses - Overriding (4) Other Expenses Total Acquisition Costs Total Insurance Expenses Operating Expenses:
a. Marketing Expenses b. General and Administrative Expenses:

• Employee and Management Expenses
• Education and Training Expenses
• Other General and Administrative Expenses
  Other Income (Expenses)
  TOTAL EXPENSES
  PROFIT (LOSS) BEFORE TAX
  Income Tax
  PROFIT AFTER TAX
  OTHER COMPREHENSIVE INCOME
  TOTAL COMPREHENSIVE PROFIT (LOSS)
  PT XYZ
  LIFE INSURANCE COMPANY
  COMPREHENSIVE INCOME STATEMENT
  For the Period Ending On
  Date …
  Note:
  Figures in this report are cumulative figures for the period from January 1 to the reporting date of the current period

(in millions of rupiah)
Description Month …
Year …
(1) (2)
BEGINNING BALANCE OF CASH AND BANKS
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows a. Premiums b. Co-insurance Claims
c. Reinsurance Claims
d. Commissions e. Receivables f. Others
Total Cash Inflows -
Cash Outflows a. Reinsurance Premiums b. Claims
c. Commissions
d. Costs e. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES -
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows a. Investment Income Receipts b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows -
Cash Outflows a. Investment Placements b. Purchase of Fixed Assets
c. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM INVESTING ACTIVITIES -
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows a. Subordinated Loans b. Capital Deposits
c. Others
Total Cash Inflows -
Cash Outflows a. Dividend Payments b. Subordinated Loan Payments
c. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES -
ENDING BALANCE OF CASH AND BANKS -
PT XYZ
LIFE INSURANCE COMPANY
CASH FLOW STATEMENT
As of …

(in millions of rupiah)
Description Month …
Year …
(1) (2)
Solvency Level
Permitted Assets
Liabilities (excluding Subordinated Loans)
Total Solvency Level -
Risk-Based Minimum Capital (MMBR)
Schedule A
Schedule B
Schedule C
Schedule D
Schedule E
Schedule F
Schedule G
Schedule H
Total MMBR -
Surplus (Deficit) of Solvency Level Limit -
Solvency Achievement Ratio (in %) 1) #DIV/0!

1. Total Solvency Level divided by Total MMBR
   In the event the Company experiences a solvency deficit, the amount of funds needed to achieve a 100.00% RBC ratio A 120.00% RBC ratio PT XYZ LIFE INSURANCE COMPANY SOLVENCY LEVEL REPORT Solvency Achievement Ratio As of …

Rupiah Foreign Currency 3) Total Rupiah Foreign Currency 3) Total Rupiah Foreign Currency 3) Total ≤ 1 year #DIV/0! #DIV/0! 1 year < age < 5 years #DIV/0! #DIV/0! 5 years ≤ age < 10 years #DIV/0! #DIV/0! ≥ 10 years #DIV/0! #DIV/0! Total (in percentage) Rupiah Foreign Currency Total Current Asset to Non-Current Asset Ratio #DIV/0! #DIV/0! Current Liability to Non-Current Liability Ratio #DIV/0! #DIV/0! Note:

1. In millions of rupiah
2. In percentage
3. Already converted to Rupiah currency
   Current assets/liabilities are assets/liabilities with an age of less than 1 year up to 1 year Non-current assets/liabilities are assets/liabilities with an age of more than 1 year Determined in Jakarta on November 25, 2013 EXECUTIVE HEAD OF SUPERVISOR I IKNB Copy matches the original FINANCIAL SERVICES AUTHORITY Head of Legal Assistance Division Legal Directorate Ttd. Ttd. FIRDAUS DJAELANI Mufli Asmawidjaja Description PT.XYZ RECAPITULATION OF ASSETS AND LIABILITIES BASED ON CURRENCY AND MATURITY As of … Month … Year … Age Assets 1) Liabilities 1) Asset to Liability Ratio 2)

GUIDELINES FOR PREPARING FINANCIAL REPORTS
LIFE INSURANCE COMPANIES
I. GENERAL

1. These financial reports are prepared specifically for the development and supervision of the insurance business. Therefore, the format, content, and structure of the financial reports are made in accordance with applicable legislation in the insurance business field (Statutory Accounting Practices/SAP) as regulated in Minister of Finance Regulation Number 53 of 2012 and its implementing regulations.
2. The content and structure of the Financial Reports of Life Insurance Companies are as follows:
   a. Statement of Financial Position of Life Insurance Company b. Comprehensive Income Statement of Life Insurance Company
   c. Cash Flow Statement of Life Insurance Company
   d. Solvency Level Report of Life Insurance Company e. Recapitulation of Assets and Liabilities Based on Currency and Maturity
3. The format, content, and structure of these financial reports are used for monthly financial reports.
4. Financial reports are presented for the current period.
5. If there are rows or columns that must be filled but the value is 0 (zero) or non-existent, then 0 (zero) is written.
6. Rupiah figures in all financial report formats are written in millions of rupiah with 2 (two) decimal places.
7. Negative numbers are given in parentheses (xxxx).
8. Permitted Assets, hereinafter abbreviated as AYD, are permitted assets calculated in the solvency level calculation as referred to in legislation in the insurance business field.
9. Life Insurance Company (Company) is an Insurance Company as referred to in the Law on the insurance business.
   10.Others a. The company name must be clearly written on every title of the existing formats. On the front page (cover), the name and address of the Life Insurance Company must be filled in on the available row (see instructions in the format). b. The period of the monthly financial report must be filled in according to the ending date of the current reporting period. For example, for a September 2013 report, it is filled in as As of September 30, 2013.
   II. FINANCIAL REPORTS
10. Statement of Financial Position
    The Statement of Financial Position in this report consists of the Statement of Financial Position prepared based on Financial Accounting Standards (SAK) and Statutory Accounting Practice (SAP) presented according to the end of the current period. a. SAK Statement of Financial Position The accounts in this Statement of Financial Position have been reclassified according to the purpose of their listing, so that the accounts do not have to be the same as the accounts in reporting according to SAK. The purpose of listing the SAK Statement of Financial Position is to have comparative figures for the accounts of the SAP Statement of Financial Position, especially for assets, so as to facilitate analysis by analysts. b. SAP Statement of Financial Position The assets and liabilities listed in the SAP Statement of Financial Position are AYD, the accounts of which are filled in based on regulations set forth in Minister of Finance Regulation Number 53 of 2012 and its implementing regulations. Differences in valuation between SAK and SAP may arise due to differences in asset and liability valuation based on SAK and SAP. Differences in asset valuation between SAK and SAP arise due to differences in the recognition of the value of the assets. Generally, SAP recognizes assets at fair value, while SAK recognizes assets at historical cost. For liabilities, differences may arise because SAK provides several options in the method of calculating technical reserves, allowing the Company to choose a technical reserve calculation method based on SAK that is different from the technical reserve calculation as regulated in legislation. In the event there are differences in asset and liability valuation between SAP and SAK, the difference can increase or decrease SAP equity. Differences in asset valuation can occur because, in general, asset valuation based on SAP results in a larger amount compared to asset valuation based on SAK, thus giving the consequence of adding SAP equity. For liabilities, generally the Company will use valuation based on SAP which can provide a smaller valuation compared to liability valuation based on SAK, thus giving the consequence of adding SAP equity. Whereas Non-Permitted Assets arise due to limitations in the recognition of Company assets so that not all assets recognized based on SAK can be recognized as assets based on SAP. Thus, the non-recognition of these assets gives the consequence of reducing SAP equity. The presentation of reinsurance assets in this Statement of Financial Position is presented as assets that are part of reinsurance receivables and included in AYD in the calculation of financial health levels. The value of reinsurance assets consists of:

1. The value of reinsurance assets over future policy benefit liabilities, determined consistently with the approach used in determining future policy benefit liabilities, based on the terms and conditions of the reinsurance contract.
2. The value of reinsurance assets over unearned premiums, determined consistently with the approach used in determining unearned premiums, based on the terms and conditions of the reinsurance contract.
3. The value of reinsurance assets over estimated claim liabilities, determined consistently with the approach used in determining estimated claim liabilities, based on the terms and conditions of the reinsurance contract.

2. Comprehensive Income Statement
   The SAP Comprehensive Income Statement may differ from the SAK Comprehensive Income Statement due to differences in recognition treatment (technical reserve expenses) and differences in account classification. Account classification for SAP reports has been adjusted to existing regulations. Thus, the final result of this Comprehensive Income Statement (i.e., profit or loss) may differ between SAP reports and SAK reports. The Comprehensive Income Statement presented is the Comprehensive Income Statement for the beginning of the current book year up to the reporting date (cumulatively). For example, for a September 2013 report, the income recorded is income obtained since January 1, 2013 up to September 30, 2013. The components for determining Gross Premium in this report are gross premiums as referred to in Government Regulation Number 73 of 1992 concerning the Conduct of Insurance Business as amended by Government Regulation Number 63 of 1999.

3. Cash Flow Statement
   The Cash Flow Statement in this report is filled in based on information in the columns provided in the existing format. The beginning balance of cash and banks of the current month is filled in with the beginning balance of cash and banks of the current year. The ending balance of cash and banks in the Cash Flow Statement must be the same as the cash and bank balances in the Statement of Financial Position. For example, for the beginning balance of cash and banks in the Cash Flow Statement for September 2013, it is filled in with cash and bank balances as of January 1, 2013. Meanwhile, the ending balance of cash and banks in the Cash Flow Statement for September 2013 must be the same as the cash and bank balances in the Statement of Financial Position as of September 30, 2013.

4. Solvency Level Report - Solvency Achievement Ratio
   Companies are required to meet a minimum solvency level of 120% of the risk-based minimum capital as referred to in Minister of Finance Regulation Number 53/PMK.010/2012. The total solvency referred to consists of AYD and Liabilities (excluding subordinated loans).

5. Recapitulation...

6. Recapitulation of Assets and Liabilities Based on Currency and Maturity
   Matching assets and liabilities based on currency and maturity is necessary to know any differences in the value of assets and liabilities in foreign currency, as well as fluctuations in the exchange rate of foreign currency against the rupiah. The columns in this detail are filled in based on SAK values.