An Act respecting Insurance Companies/Schedule

SCHEDULE—FORMS.

Form A.

Statement to be made by every Life or Accident Insurance Company, except Companies mentioned in Section fifteen.

(Name of the Company.)	$ cts.
Assets of the Company.
Liabilities of do.
Amount of Capital Stock.
Amount paid thereon.
Of what the assets of the Company consist, viz: (insert particulars).
Total premiums received during the year.
Number and amount of Policies issued during the year.
Amount of claims from death (or accident) do.
Expenses of management, agency, &c.
Total premiums received during the year in Canada.
Number and amount of Policies issued do.
Amount at risk on total policies issued in Canada.
Number and amount of policies that have become claims in Canada, during the year by death (or accident)

Form B.

Statement to be made by a Fire or Guarantee Insurance Company, whose deposits are not less than one hundred thousand dollars, (except Companies mentioned in section 15,) referred to in section four.

	$ cts.
Assets of the Company.
Liabilities of the Company.
Amount of Capital Stock.
Amount paid thereon.
Of what the assets of the Company consist, viz: {insert particulars)
Amount of losses paid during the year.
Amount of losses due and unpaid Losses adjusted and not due.
Losses in suspense and waiting further proof.
Losses, the payment of which is resisted and for what cause
All other claims against the Company.
Amount of premiums earned for the past year.
Amount of premiums unearned for the past year.
Number and amount of policies issued during the year.
Amount at risk on total policies in force in Canada.
Losses in Canada paid during the year.
Do.adjusted and not due
Do.in suspense and waiting for further proof
Do.the payment of which is resisted and for what cause.
All other claims against the Company.
Premiums earned in Canada during the year.
Do.unearned dodo

Form C.

Statement to be made by a Fire or Guarantee Insurance Company whose deposits are under one hundred thousand dollars, except those referred to in section four.

	$ cts.
Amount of Premiums received during the year on risks effected in Canada less twenty-five per cent, and the net amount of losses actually paid.
Deposit in conformity with the second section of the said Act.
Assets of the Company.
Liabilities of the Company.
Amount of Capital Stock.
Amount paid thereon.
Of what the assets of the Company consist, viz: {insert particulars)
Amount of losses paid during the year.
Amount of losses due and unpaid.
Losses adjusted and not due.
Losses in suspense and waiting for further proof.
Losses the payment of which is resisted, and for what cause.
All other claims against the Company.
Amount of premiums earned during the past year.
Amount of premiums unearned.
Amount at risk on total policies in force in Canada.
Losses in Canada paid during the year.
Losses in Canada adjusted and not due.
Losses in suspense and waiting for further proof.
Losses the payment of which is resisted and for what cause.
All other claims against the Company.
Premiums earned in Canada during the year.
Premiums unearned in Canada during the year.

Form D.

Statement to be made by an Insurance Companies referred to in Section fifteen.

	$ cts.
Total premiums received during the year, in Canada
Number and amount of policies issued do. do.
Amount at risk in total policies in force in Canada.
Number and amount of policies that have become claims in Canada during the year.
Amount of losses in Canada paid during the year.
Amount of losses in Canada in suspense and waiting further proof.
Losses in Canada the payment of which is resisted and for what cause
Amount of premiums earned for the past year in Canada.
Amount of premiums unearned in Canada.