Monkton
Insurance Services Limited
Form 3 - Statutory Open Year Business Revenue Statement (General Business)
Form 7 - Statutory Statement of Income (Section 24(6) Composite)
Form 1 - Statutory Balance Sheet (General Business)
ASSETS
1. CASH AND TIME DEPOSIT
2. QUOTED INVESTMENTS:
a) Bonds and Debentures
b)
Equities (preferred and ordinary)
c) Other quoted investments
d) Total quoted
investments
3. UNQUOTED INVESTMENTS:
a) Bonds and Debentures
b) Equities
(preferred and ordinary)
c) Total unquoted investments
4. INVESTMENTS IN
AND ADVANCES TO AFFILIATES
5. INVESTMENTS IN MORTGAGE LOANS ON REAL ESTATE:
a)
First liens
b) Other than first liens
c) Total investment in mortgage loans
on real estate
7. REAL ESTATE:
a) Occupied by the company (less encumbrances)
b)
Other properties (less encumbrances)
c) Total real estate
8. COLLATERAL
LOANS
9. INVESTMENT INCOME DUE AND ACCRUED
10. ACCOUNTS AND PREMIUMS
RECEIVABLE
11. REINSURANCE BALANCES RECEIVABLE
12. FUNDS HELD BY CEDING
COMPANIES
13. SUNDRY ASSETS:
a)
b)
c)
14. LETTERS OF CREDIT,
GUARANTEES AND OTHER INSTRUMENTS
a)
b)
c)
15. TOTAL
GENERAL
BUSINESS INSURANCE RESERVES, OTHER LIABILITIES AND STATUTORY CAPITAL AND SURPLUS
INSURANCE
RESERVES
16. UNEARNED PREMIUM
17. LOSS AND LOSS EXPENSES PROVISIONS
18.
OTHER INSURANCE RESERVES - GENERAL BUSINESS
19. TOTAL GENERAL BUSINESS INSURANCE
RESERVES
OTHER LIABILITIES
28. INSURANCE AND REINSURANCE BALANCES
PAYABLE
29. COMMISSIONS, EXPENSES, FEES AND TAXES PAYABLE
30. LOANS
AND NOTES PAYABLE
31. a) INCOME TAXES PAYABLE
31. b) DEFERRED INCOME TAXES
32.
AMOUNTS DUE TO AFFILIATES
33. ACCOUNTS PAYABLE AND ACCRUED LIABILITIES
34.
FUNDS HELD UNDER REINSURANCE CONTRACTS
35. DIVIDENDS PAYABLE
36. SUNDRY
LIABILITIES:
a)
b)
c)
37. LETTERS OF CREDIT, GUARANTEES AND OTHER
INSTRUMENTS
38. TOTAL OTHER LIABILITIES
39. TOTAL GENERAL BUSINESS
INSURANCE RESERVES AND OTHER LIABILITIES
STATUTORY CAPITAL AND SURPLUS
40.
TOTAL STATUTORY CAPITAL AND SURPLUS
41. TOTAL
Form 2 - Statutory Statement of Income (General Business)
UNDERWRITING INCOME
1. GROSS PREMIUMS WRITTEN
2. REINSURANCE
PREMIUMS CEDED
3. NET PREMIUMS WRITTEN
4. INCREASE (DECREASE) IN UNEARNED
PREMIUMS
5. NET PREMIUMS EARNED
6. OTHER INSURANCE INCOME
7.
UNDERWRITING
EXPENSES
8. NET LOSS INCURRED AND NET LOSS EXPENSES INCURRED
9.
COMMISSIONS AND BROKERAGE
OTHER UNDERWRITING EXPENSES
10. GENERAL
AND ADMINISTRATIVE
11. PERSONNEL COSTS
12. OTHER
13.
14.
UNDERWRITING PROFIT (LOSS)
15. TRANSFERRED FROM (TO) OPEN YEAR BUSINESS REVENUE
STATEMENT
16. NET UNDERWRITING PROFIT (LOSS)
17. GENERAL BUSINESS INVESTMENT
INCOME - NET
18. INCOME BEFORE THE UNDERNOTED ITEMS
37. OTHER INCOME
(DEDUCTIONS)
38. INCOME BEFORE TAXES
39. INCOME TAXES (IF APPLICABLE):
a)
Current
b) Deferred
c) Total
40. INCOME BEFORE REALIZED GAINS (LOSSES)
41.
REALIZED GAINS (LOSSES)
42. NET INCOME
Form 3 - Statutory Open Year Business Revenue Statement (General Business)
Temporarily omitted
Form 4 - Statutory Balance Sheet (Long-term Business)
ASSETS
1. CASH AND TIME DEPOSIT
2. QUOTED INVESTMENTS:
a) Bonds and Debentures
b)
Equities (preferred and ordinary)
c) Other quoted investments
d) Total quoted
investments
3. UNQUOTED INVESTMENTS:
a) Bonds and Debentures
b) Equities
(preferred and ordinary)
c) Total unquoted investments
4. INVESTMENTS IN
AND ADVANCES TO AFFILIATES
5. INVESTMENTS IN MORTGAGE LOANS ON REAL ESTATE:
a)
First liens
b) Other than first liens
c) Total investment in mortgage loans
on real estate
6. POLICY LOANS
7. REAL ESTATE:
a) Occupied by the
company (less encumbrances)
b) Other properties (less encumbrances)
c) Total
real estate
8. COLLATERAL LOANS
9. INVESTMENT INCOME DUE AND ACCRUED
10.
ACCOUNTS AND PREMIUMS RECEIVABLE
11. REINSURANCE BALANCES RECEIVABLE
12.
FUNDS HELD BY CEDING COMPANIES
13. SUNDRY ASSETS:
a)
b)
c)
14.
LETTERS OF CREDIT, GUARANTEES AND OTHER INSTRUMENTS
a)
b)
c)
15.
TOTAL
LONG-TERM BUSINESS INSURANCE RESERVES, OTHER LIABILITIES AND STATUTORY
CAPITAL AND SURPLUS
LONG-TERM BUSINESS INSURANCE RESERVES
20. RESERVES
FOR REPORTED CLAIMS
21. RESERVES FOR UNREPORTED CLAIMS
22. POLICY RESERVES
- LIFE
23. POLICY RESERVES - ACCIDENT AND HEALTH
24. POLICYHOLDERS'
FUNDS ON DEPOSIT
25. LIABILITY FOR FUTURE POLICYHOLDERS' DIVIDENDS
26.
OTHER INSURANCE RESERVES - LONG-TERM
27. TOTAL LONG-TERM BUSINESS INSURANCE
RESERVES
OTHER LIABILITIES
28. INSURANCE AND REINSURANCE BALANCES
PAYABLE
29. COMMISSIONS, EXPENSES, FEES AND TAXES PAYABLE
30. LOANS
AND NOTES PAYABLE
31. a) INCOME TAXES PAYABLE
31. b) DEFERRED INCOME TAXES
32.
AMOUNTS DUE TO AFFILIATES
33. ACCOUNTS PAYABLE AND ACCRUED LIABILITIES
34.
FUNDS HELD UNDER REINSURANCE CONTRACTS
35. DIVIDENDS PAYABLE
36. SUNDRY
LIABILITIES:
a)
b)
c)
37. LETTERS OF CREDIT, GUARANTEES AND OTHER
INSTRUMENTS
38. TOTAL OTHER LIABILITIES
39. TOTAL GENERAL BUSINESS
INSURANCE RESERVES AND OTHER LIABILITIES
STATUTORY CAPITAL AND SURPLUS
40.
TOTAL STATUTORY CAPITAL AND SURPLUS
41. TOTAL
Form 5 - Statutory Statement of Income (Long-term Business)
19. PREMIUMS AND OTHER CONSIDERATIONS:
a) Life
b) Annuities
c) Accident
and Health
d) Total Premiums and Other Considerations
20. LONG-TERM BUSINESS
INVESTMENT INCOME - NET
21. OTHER INSURANCE INCOME
22.
DEDUCTIONS
23.
Claims - Life
24. Policyholders' Dividends
25. Surrenders
26.
Maturities
27. Annuities
28. Accident and Health Benefits
29.
Commissions
30. Other
31.
32. OPERATING EXPENSES
33.
34.
INCREASE (DECREASE) IN POLICY RESERVES (Actuarial Liabilities)
a) Life
b) Annuities
c)
Accident and Health
d) Total Increase (Decrease) in policy reserves
35.
INCOME BEFORE THE UNDERNOTED ITEMS
37. OTHER INCOME (DEDUCTIONS)
38.
INCOME BEFORE TAXES
39. INCOME TAXES (IF APPLICABLE)
a) Current
b) Deferred
c)
Total
40. INCOME BEFORE REALIZED GAINS (LOSSES)
41. REALIZED GAINS
(LOSSES)
42. NET INCOME
Form 6 - Statutory Balance Sheet (Section 24(6) Composite)
ASSETS
1. CASH AND TIME DEPOSIT
2. QUOTED INVESTMENTS:
a) Bonds and Debentures
b)
Equities (preferred and ordinary)
c) Other quoted investments
d) Total quoted
investments
3. UNQUOTED INVESTMENTS:
a) Bonds and Debentures
b) Equities
(preferred and ordinary)
c) Total unquoted investments
4. INVESTMENTS IN
AND ADVANCES TO AFFILIATES
5. INVESTMENTS IN MORTGAGE LOANS ON REAL ESTATE:
a)
First liens
b) Other than first liens
c) Total investment in mortgage loans
on real estate
6. POLICY LOANS
7. REAL ESTATE:
a) Occupied by the
company (less encumbrances)
b) Other properties (less encumbrances)
c) Total
real estate
8. COLLATERAL LOANS
9. INVESTMENT INCOME DUE AND ACCRUED
10.
ACCOUNTS AND PREMIUMS RECEIVABLE
11. REINSURANCE BALANCES RECEIVABLE
12.
FUNDS HELD BY CEDING COMPANIES
13. SUNDRY ASSETS:
a)
b)
c)
14.
LETTERS OF CREDIT, GUARANTEES AND OTHER INSTRUMENTS
a)
b)
c)
15.
TOTAL
GENERAL BUSINESS INSURANCE RESERVES, LONG-TERM BUSINESS INSURANCE
RESERVES, OTHER LIABILITIES AND STATUTORY CAPITAL AND SURPLUS
GENERAL BUSINESS
INSURANCE RESERVES
16. UNEARNED PREMIUM
17. LOSS AND LOSS EXPENSES
PROVISIONS
18. OTHER INSURANCE RESERVES - GENERAL BUSINESS
19. TOTAL
GENERAL BUSINESS INSURANCE RESERVES
LONG-TERM BUSINESS INSURANCE RESERVES
20.
RESERVES FOR REPORTED CLAIMS
21. RESERVES FOR UNREPORTED CLAIMS
22.
POLICY RESERVES - LIFE
23. POLICY RESERVES - ACCIDENT AND HEALTH
24.
POLICYHOLDERS' FUNDS ON DEPOSIT
25. LIABILITY FOR FUTURE POLICYHOLDERS' DIVIDENDS
26.
OTHER INSURANCE RESERVES - LONG-TERM
27. TOTAL LONG-TERM BUSINESS INSURANCE
RESERVES
OTHER LIABILITIES
28. INSURANCE AND REINSURANCE
BALANCES PAYABLE
29. COMMISSIONS, EXPENSES, FEES AND TAXES PAYABLE
30.
LOANS AND NOTES PAYABLE
31. a) INCOME TAXES PAYABLE
31. b) DEFERRED INCOME
TAXES
32. AMOUNTS DUE TO AFFILIATES
33. ACCOUNTS PAYABLE AND ACCRUED
LIABILITIES
34. FUNDS HELD UNDER REINSURANCE CONTRACTS
35. DIVIDENDS
PAYABLE
36. SUNDRY LIABILITIES:
a)
b)
c)
37. LETTERS OF CREDIT,
GUARANTEES AND OTHER INSTRUMENTS
38. TOTAL OTHER LIABILITIES
39. TOTAL
GENERAL BUSINESS INSURANCE RESERVES AND OTHER LIABILITIES
STATUTORY CAPITAL
AND SURPLUS
40. TOTAL STATUTORY CAPITAL AND SURPLUS
41. TOTAL
Form 7 - Statutory Statement of Income (Section 24(6) Composite)
UNDERWRITING INCOME
1. GROSS PREMIUMS WRITTEN
2. REINSURANCE
PREMIUMS CEDED
3. NET PREMIUMS WRITTEN
4. INCREASE (DECREASE) IN UNEARNED
PREMIUMS
5. NET PREMIUMS EARNED
6. OTHER INSURANCE INCOME
7.
UNDERWRITING
EXPENSES
8. NET LOSS INCURRED AND NET LOSS EXPENSES INCURRED
9.
COMMISSIONS AND BROKERAGE
OTHER UNDERWRITING EXPENSES
10. GENERAL
AND ADMINISTRATIVE
11. PERSONNEL COSTS
12. OTHER
13.
14.
UNDERWRITING PROFIT (LOSS)
15. TRANSFERRED FROM (TO) OPEN YEAR BUSINESS REVENUE
STATEMENT
16. NET UNDERWRITING PROFIT (LOSS)
17. GENERAL BUSINESS INVESTMENT
INCOME - NET
18. INCOME FROM GENERAL BUSINESS BEFORE THE UNDERNOTED ITEMS
19.
PREMIUMS AND OTHER CONSIDERATIONS:
a) Life
b) Annuities
c) Accident and
Health
d) Total Premiums and Other Considerations
20. LONG-TERM BUSINESS
INVESTMENT INCOME - NET
21. OTHER INSURANCE INCOME
22.
DEDUCTIONS
23.
Claims - Life
24. Policyholders' Dividends
25. Surrenders
26.
Maturities
27. Annuities
28. Accident and Health Benefits
29.
Commissions
30. Other
31.
32. OPERATING EXPENSES
33.
34.
INCREASE (DECREASE) IN POLICY RESERVES (Actuarial Liabilities)
a) Life
b) Annuities
c)
Accident and Health
d) Total Increase (Decrease) in policy reserves
35.
INCOME BEFORE THE UNDERNOTED ITEMS
COMBINED INCOME AND UNALLOCATED ITEMS
INCOME
BEFORE UNALLOCATED ITEMS
18. GENERAL BUSINESS
35. LONG-TERM BUSINESS
36.
COMBINED INCOME
37. OTHER INCOME (DEDUCTIONS)
38. INCOME BEFORE TAXES
39.
INCOME TAXES (IF APPLICABLE)
a) Current
b) Deferred
c) Total
40.
INCOME BEFORE REALIZED GAINS (LOSSES)
41. REALIZED GAINS (LOSSES)
42.
NET INCOME
Form 8 - Statutory Statement of Capital and Surplus
1. STATUTORY CAPITAL:
a) Capital Stock
authorized _______ shares of par
value ______ each issued
and fully paid _______ shares
b) Contributed surplus
c)
Any other fixed capital
d) Total Statutory Capital
2. STATUTORY SURPLUS:
a)
Statutory Surplus - Beginning of Year
b) Add: Income for the year
c) Less:
Dividends paid and payable
d) Add (Deduct) change in unrealized appreciation
(depreciation) in investments
e) Add (Deduct) change in non-admitted assets
f)
Add (Deduct) change in appraisal of real estate
g) Add (Deduct) change in any
other statutory surplus
h) Statutory Surplus - End of Year
3. TOTAL STATUTORY
CAPITAL AND SURPLUS