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					                               Prudential Returns for Authorised Firms conducting Insurance Mediation Business.
                                                                                          Reporting Frequency
                   Authorised Firm Name
                                                                                               Quarterly         Bi-Annually         Annually
                   QFC Number
                                                                                          Solo vs Consolidated
                   Accounting standards
                   applied by the firm                                                        Solo                             Consolidated

                   Reporting currency                                                     Reporting Period
                   (see General Note 3)
                                                                                          Start Date                            End Date



         General notes for completing Q300 to Q309 Forms
            1      Figures must be typed and the declaration below signed by the person or persons authorised to sign the return.
                   Note: Annual prudential returns must be signed by two officers of an Authorised Firm who are either Directors or Persons previously approved
                   in writing by the Regulatory Authority for this purpose. All other prudential returns must be signed by one officer of an Authorised Firm who is
                   either a Director, Partner or Person previously approved in writing by the Regulatory Authority for this purpose. Please note that an approval to
                   perform the Finance Function does not automatically approve the individual to sign prudential returns.
            2      The Authorised Firm’s name, QFC Number and reporting period must be identified above.
            3      Unless otherwise agreed with the Regulatory Authority, the Authorised Firm or Group’s reporting currency must be in US Dollars.
            4      Within the forms ‘N’ represents the reports for the current period and ‘N-1’ should contain figures provided in the previous year’s reporting
                   statements. For example, for the 2nd quarter 2009 report, ‘N-1’ will be the 2nd quarter 2008. Whereas for an annual return, ‘N-1’ will be the
                   prior year's annual numbers.
            5      Quarterly statements should use standard 3-month periods. For example, if a company has a December 31 year end, the second-quarter
                   statements should be for the period April 1 - June 30.
            6      Forms must be completed in the English language.
            7      When completed, submit the forms in line with the GENE Rulebook chapter 5.
            8      Instructions for completing each form are provided as a stand alone document and must be complied with.
         Forms attached
         The following forms are attached to this declaration:
         Form No.                 Appendices
         Q300
         Q301
         Q302
         Q303                         303A

         Q304
         Q305
         Q306
         Q307
         Q308
         Q309


         Declaration
         I declare that, to the best of my knowledge and belief, having made due enquiry, the information given in this form is complete and correct. I understand
         that it is an offence under Article 84 of the Financial Services Regulations to knowingly or recklessly provide to the QFC Regulatory Authority any
         information, which is false, misleading or deceptive, or to conceal information where the concealment of such information is likely to mislead or
         deceive the QFC Regulatory Authority .
         I confirm that I have the authority to make this application, to declare as specified above and sign this form for the Firm.
         I declare these forms have been prepared in accordance with the Rules in PIIB and the relevant accounting standards.


         Print name of person authorised to sign the return per Note 1 above


         Signature of person authorised to sign the return per Note 1 above                                  Date


         Print name of person authorised to sign the return per Note 1 above


         Signature of person authorised to sign the return per Note 1 above                                  Date


         Please submit this form to:
         QFC Regulatory Authority
         Regulatory Services                                                                                                                  For Regulatory Authority Use
         Level 14, QFC Tower
                                                                                                             Reference No:
         PO Box 22989
         Doha, Qatar
                                                                                                             Date received:
         Tel:    +974 44956888
         Fax:    +974 44835031
                                                                                                             Received by:
         Email: rs@qfcra.com


Q300s-VER3-Jul10                                                                                                                                                         Page 1 of 15
                                                       This form is to be completed by Authorized Firms conducting only insurance mediation business,
                                                                             insurance companies should fill out the Q200 forms.

                               Which Forms Must be Completed?
                               The table below provides general guidance over the prudential returns that are required to be prepared and the frequency of reporting.

                               The forms mentioned in the table are identified by their version number. The version number of this set of forms is Q300-Ver2-Dec08 and this
                               can be found at the lower left hand corner on the cover sheet to the forms.

                               The prudential returns that are required to be prepared, the frequency of reporting and the version of the forms are likely to change from time
                               to time. Before preparing prudential returns, please check the Regulatory Authority’s website www.qfcra.com to ensure that you are
                               complying with the latest requirements (including the latest Prudential Returns Notice) and that you are using the latest version of the forms.




                               Authorised firm incorporated in the QFC (if a branch see the table on the next page)
                                Return                     Return form name                       PIIB category 3     PIIB category 4
                                                                                                     Frequency          Frequency
                                 Q300                   General firm information                        A                   A


                                 Q301                         Balance sheet                          A and Q             A and Q



                                 Q302                   Profit and loss statement                    A and Q             A and Q



                                 Q303                 Calculation of eligible capital                A and Q             A and Q



                                Q303A      Calculation of expenditure based capital requirement      A and Q             A and Q


                                 Q304                Schedule of income information                     A                   A

                                 Q305                       Client information                          A                   A

                                 Q306              Aging of premiums owed to insurers                   B                   B


                                 Q307                  Client and insurance money                    A and Q               N/A


                                 Q308               Professional indemnity Insurance                    B                   B

                                 Q309                 Guarantees and contingencies                      A                   A



                               Authorised firm conducting insurance mediation business through branch
                               File the following information at branch level
                                Return                     Return form name                       PIIB category 3     PIIB category 4
                                                                                                     Frequency          Frequency

                                 Q302                   Profit and loss statement                    A and Q             A and Q


                                 Q304                Schedule of income information                     A                   A

                                 Q305                       Client information                          A                   A

                                 Q306              Aging of premiums owed to insurers                   B                   B


                                 Q307                  Client and insurance money                    A and Q               N/A



                               File the following information at company level
                                 Q300                   General firm information                        A                   A


                                 Q301                         Balance sheet                          A and Q             A and Q


                                 Q308               Professional indemnity Insurance                    B                   B

                                 Q309                 Guarantees and contingencies                      A                   A


                               Index
                               Letters in the 'Frequency column have the following meaning:

                               Q indicates that the relevant form must be prepared and submitted on a quarterly basis;
                               A indicates that the relevant form must be prepared and submitted on an annual basis;
                               A and Q together indicate that the relevant form must be prepared and sumbitted on both a quarterly and annual basis;
                               B indicates that the relevant form must be prepared and submitted on a six-monthly basis; and
                               N/A indicate that the form is not applicable to the particular PIIB Category of Authorised Firm

                                Annual filings are due within four months after the financial year-end for the Authorised Firm. Quarterly filings are due within one month after
                                                                                        the end of each standard quarter.




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                                                                                           Page 2 of 15
                                                                                        Instructions for Completing Prudential Returns

                                                                                         FORM Q300: GENERAL FIRM INFORMATION
                               No.         Item                                                                    Instruction


                               0.4         List of Individuals                                                              ● Refer to INDI section 2.1 for descriptions of the various Executive Functions


                  FORM Q301: BALANCE SHEET
                               No.         Item                                                                    Instruction
                               1.1         Goodwill                                                                Include amounts relating to any purchased goodwill.
                               1.1.2       Other intangible assets                                                 Items to be included:
                                                                                                                   ● capitalised development costs;
                                                                                                                   ● brand names, trademarks and similar rights; and

                               1.2         Tangible assets                                                         Include, for example, the value of the following:
                                                                                                                   ● plant and equipment, the residual value of items leased out under an operating lease.

                                                                                                                   ● own premises being occupied or developed for occupation by the Authorised Firm.
                                                                                                                   The amounts reported here should be net of accumulated depreciation and amortisation.


                               1.3         Investments                                                             Investment securities held with intent to trade. Do not include, for example:
                                                                                                                   ● investments in subsidiaries and associated companies;

                                                                                                                   ● real estate/buildings used by the firm instead of for investment purposes

                                                                                                                   ● holdings in non financial firms of which the Authorised Firm is a controller (i.e. Qualifying
                                                                                                                   Holdings).
                                                                                                                   Note investments held as current assets should be included under item 1.6.

                               1.7         Cash at bank and in hand                                                Include, for example, the following amounts:
                                                                                                                   ● notes and coins;
                                                                                                                   ● deposits at call;



                                                                                                                   Balances on client or insurance bank accounts and related client or insurance accounts
                                                                                                                   must not form part of the firm's own balance sheet. Instead these items should be included
                                                                                                                   in Form 307.


                               1.7.1       Other assets                                                            Assets that have not been included in any of the items above. In particular deferred tax assets,
                                                                                                                   sundry debtors, prepayments and accrued income not identified elsewhere.

                               2.3         Elligible subordinated debt, hybrid securities and other loan capital   Report all items not included in any of the above, such as proposed dividends payable, sundry
                                                                                                                   accruals and deferred income etc.

                               2.3.1       Provision for liabilities and charges                                   Items to be included for example: Provision for Errors and Ommissions and other claims;
                                                                                                                   provisions for foreign exchange losses.


                               2.5.1       Ordinary Shares                                                         Include in respect of this item the amount of ordinary share capital issued, reported at nominal
                                                                                                                   paid up value. Do not report the unpaid element of partly paid shares or authorised but unissued
                                                                                                                   share capital. Authorised Firms should exclude holdings in their own shares.


                               2.5.2       Preference Shares                                                       Fixed dividend share capital that ranks above ordinary shares in the event of liquidation. Report
                                                                                                                   the value of the preference shares issued.
                               2.5.4       Share premium account                                                   Any amounts received by the authorised institution in excess of the nominal paid up value.

                               2.5.5                                                                               Report all amounts

        FORM Q302: PROFIT AND LOSS STATEMENT
                               Item No.    Item                                                                    Instruction




                               2.12        Depreciation & Amortisation                                             Charges relating, for example, to depreciation / amortisation of property, plant and equipment
                                                                                                                   and other amounts written off in respect of tangible and intangible fixed assets.


                               2.13        General and administrative expenses                                     Include, for example:
                                                                                                                   ● Salary costs;
                                                                                                                   ● Employer’s contribution to any pension scheme;
                                                                                                                   ● Costs of staff benefits paid on a per capita basis such as private medical insurance.

                               2.14        Other operating expenses                                                Examples of expenses can be as follows:
                                                                                                                   ● Occupancy expenses – for example, rates, rent, insurance of building, lighting, maintenance
                                                                                                                   costs and subsidised restaurants;
                                                                                                                   ● Other overhead expenses;
                                                                                                                   ● All other expenditure not falling into one of the other specific categories.

                               2.19        Other income/expenses                                                   Include under this heading income such as:
                                                                                                                   ● Revaluations of foreign exchange positions;
                                                                                                                   ● Dividends from other group companies (if reporting on an unconsolidated basis);
                                                                                                                   ● Revaluation of any investment in subsidiaries or associates (if equity accounting);
                                                                                                                   ● Profit / losses received from subsidiaries, joints ventures and other associated undertakings.


                                                                                                                   ● Profit or loss on the sale of non-trading assets – e.g. premises, equipment, subsidiary and
                                                                                                                   associated companies and trade investments;
                                                                                                                   ● Revaluation surpluses/deficits - following normal accounting practice.


                               2.24        Net profit / (loss)                                                     The amount of profit / loss that could be distributed to shareholders (or partners) or retained for
                                                                                                                   future use within the firm.

                               2.25        Dividends and other distributions, declared or paid                     The amount to be distributed in the current year to shareholders out of the profits of a firm.


                               2.26        Other adjustments                                                       Any other adjustments that affect the retained profits.

                               2.27        Retained profits for the reporting period                               Profits that have not been paid out as dividends to shareholders or withdrawn by partners but
                                                                                                                   retained for further investment by the firm.




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                                                                                                                                 Page 3 of 15
                                                                                    FORM Q303: CALCULATION OF ELIGIBLE CAPITAL
                               ● Authorised Firms are referred to PIIB section 2.7 for more detail on the particular line items. If an Authorised Firm is uncertain as to where to classify a particular item, it should
                               contact the Regulatory Authority to obtain this clarity.

                               ● PIIB section 2.8 notes the limits of Total Tier Two Capital and Lower Tier Two Capital that can be used as part of Eligible Capital.

                               Item No.                                      Item                                         Instruction

                               3.2         Deductions from Tier One Capital                                           Enter deductions as positive numbers. Refer to PIB 2.6 calculation of capital resources and the
                               3.4         Tier Two Capital                                                           Refer to PIB 2.6 for calculation of capital resources and the provisions in sections 2.7 to 2.10.


                               3.6.1       Subordinated Debt                                                          Under PIIB rule 2.10.1(1)(K) the Insurer must have notified the Regulatory Authority in writing
                                                                                                                      of its intention to include the subordinated debt as part of its Eligible Capital.



                               3.9         Deductions from Tier One and Tier Two Capital                              Enter deductions as positive numbers. Refer to PIB 2.6 calculation of capital resources and the
                                                                                                                      provisions in sections 2.7 to 2.10.

                               3.9.3       Illiquid Assets                                                            Refer to PIIB 2.7.8 for a listing of illiquid assets;
                                                                                                                      Intangible assets are deducted in item 3.2.2 so should not be included here.


                                                             FORM Q303A: CALCULATION OF EXPENDITURE BASED CAPITAL REQUIREMENT
                               Item No.    Item                                                                       Instruction

                               3.A.1       Type of License                                                            Use the drop down menu to select the type of licence.

                               3.A.2       Base Capital Requirement                                                   Calculated automatically in accordance with PIIB 2.4.1

                               3.A.3       Expenditure Based Capital Minimum                                          Refer to PIIB section 2.5 for more details as to how this is calculated.

                               3.A.3.1     Insurance Money                                                            As per ASET Rule 7.3.1(A), treat all money received from, or on behalf of, a Client (including
                                                                                                                      a customer of an Insurance Manager) in respect of its Insurance Mediation Business as
                                                                                                                      Insurance Money.

                               3.A.3.2     Total expenses                                                             Forwarded from line 2.16 of form Q302
                               3.A.3.13    Expenditure Based Capital Minimum Factor                                   This factor is based on PIIB 2.5.1 (e.g 18/52, 13/52, or 6/52 depending on category)


                                                                                    FORM Q304: SCHEDULE OF INCOME INFORMATION

                                                                                                          No additional instructions

                                                                                               FORM Q305: CLIENT INFORMATION
                               Item No.    Item                                                                       Instruction


                               5.1         significant Commerical Customers                                           Refer to INAP for the definition of a Commercial Customer . For the purposes of this line item
                                                                                                                      please provide details of your top 12 Commercial Customers .

                               5.2         top 5 insurers according to income                                         For the purposes of this line please provide details of your top 5 insurers according to the firm's
                                                                                                                      income (from highest to lowest).



                                                                                FORM Q306: AGEING OF PREMIUMS OWED TO INSURERS

                                                                                                          No additional instructions

                                                                                       FORM Q307: CLIENT AND INSURANCE MONEY

                               7.1         Client Money and Insurance Money                                           Refer to ASET 2 for Client Money definition and ASET 7 for Insurance Money definition.



                               7.2         If applicable has the firm's external auditor produced an Client Money Refer to GENE 9.5 Auditors Report and in particular 9.5.1D where the Authorised Firm holds
                                           report and/or Insurance Money report                                   Client Money and 9.5.1E where the Authorised Firm holds Insurance Money.


                               7.3         Have any notifiable issues been raised in relation to client or            Refer to GENE 9.5 Auditors Report and in particular 9.5.1D where the Authorised Firm holds
                                           insurance money either by the firm's Auditor or elsewehere that have       Client Money and 9.5.1E where the Authorised Firm holds Insurance Money. If the answer is
                                           not previously been notified to the QFCRA?                                 'yes' here, you should ensure that the relevant issues are notified to us. Refer to ASET 7 for
                                                                                                                      Insurance Money definition and ASET 2 for Client Money definition.


                               7.4.1       Client Money credit total as at reporting date                             This should be the total of credits on the firm's client money account(s) over the period. These
                                                                                                                      should be taken from the firm's ledgers.

                               7.4.2       Client Money debit total as at reporting date                              This should be the total of debits on the firm's insurance money account(s) over the period.
                                                                                                                      These should be taken from the firm's ledgers.

                               7.4.3       Net client money balance as at reporting date                              This should be the aggregate balance on the firm's insurance money account(s).

                               7.5.1       Insurance Money credit total as at reporting date                          This should be the total of credits on the firm's insurance money account(s) over the period.
                                                                                                                      These should be taken from the firm's ledgers.

                               7.5.2       Insurance Money debit total as at reporting date                           This should be the total of debits on the firm's insurance money account(s) over the period.
                                                                                                                      These should be taken from the firm's ledgers.

                               7.5.3       Net insurance money balance as at reporting date                           This should be the aggregate balance on the firm's client money account(s).


                                                                              FORM Q308: PROFESSIONAL INDEMNITY INSURANCE (PII)
                               8.1         Does the Firm hold a compliant PII policy or a guarantee in                Refer to CTRL 4.10 for PII requirements and rules governing the provision of guarantees in leiu
                                           accordance with CTRL 4.10 for its regulated activities?                    of PII.

                               8.2         Limit of Indemnity                                                         You should record here the indemnity limits on the firm's PII policy, both in relation to single
                                                                                                                      claims and in aggregate.

                               8.2.2       Excess                                                                     Refer to CTRL 4.10.9 and 4.10.10.


                                                                              FORM Q309: GUARANTEES AND CONTINGENT LIABILITES
                                                                                            No additional instructions




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                                                                                                                                    Page 4 of 15
                                   FORM Q300: GENERAL FIRM INFORMATION
         Item No.
         0.1        Mailing address




         0.2        Primary Contact Person,
                    Title
                    phone # and email address

                                                                                                      Executive/
         0.3        List all members of the Board of Directors                                        Non-Executive




         0.4        List all individuals with Senior Executive Functions and Executive Governance Functions in the firm

                    Chairman
                    CEO
                    CFO
                    COO




         0.5        Please attach an up-to-date Group structure chart for the Firm's Corporate Group showing controlling interests
                    and voting power




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                                             Page 5 of 15
                                                                                        FORM Q301: BALANCE SHEET

                                     Balances on client accounts must not form part of the firm's own balance sheet. Instead these items should be included in Form 307.


                  Item No.                                                                                                 Amount ('000)                     Amount ('000)
                                                                                                                                  N                               N-1
                               FIXED ASSETS
                  1.0          Intangible assets
                  1.1                              Goodwill
                  1.1.2                            Other
                  1.2          Tangible assets


                  1.3          Investments:
                  1.3.1                            Real estate held for investment/sale
                  1.3.2                            Other invested assets


                               TOTAL FIXED ASSETS                                                                                          0                                 0


                               CURRENT ASSETS
                  1.4          Debtors - amounts owed by group undertakings
                  1.5          Other debtors
                  1.6          Investments held as current assets
                  1.7          Cash at bank and in hand
                  1.7.1        Other assets


                  1.8          TOTAL CURRENT ASSETS                                                                                        0                                 0


                               TOTAL ASSETS                                                                                                0                                 0


                  1.9          CURRENT LIABILITIES: Amounts falling due within one year
                  1.9.1        Bank Loans and Overdrafts
                               Creditors - amounts owed to group undertakings
                  1.9.2        Other Liabilities (see above)


                               TOTAL AMOUNTS FALLING DUE WITHIN ONE YEAR                                                                   0                                 0


                  2.0          Net current assets                                                                                          0                                 0


                  2.1          Total assets less current liabilities                                                                       0                                 0


                               LONG TERM LIABILITIES: Amounts falling due after more than one year
                  2.3          Subordinated debt, hybrid securities and other loan capital
                  2.3.1        Other liabilities


                  2.4          TOTAL AMOUNTS FALLING DUE AFTER MORE THAN ONE YEAR                                                          0                                 0


                               Provision for liabilities and charges


                               NET ASSETS                                                                                                  0                                 0



                               SHAREHOLDERS' EQUITY


                  2.5          Share capital:
                  2.5.1                            Ordinary shares
                  2.5.2                            Preference shares
                  2.5.3        Total share capital                                                                                         0                                 0


                  2.5.4        Share Premium account


                  2.5.5        Retained profits / losses


                  2.5.6        Other items affecting shareholders' equity



                  2.5.8        TOTAL SHAREHOLDERS' EQUITY                                                                                  0                                 0



                  Memo:        Overdraft facility Limit


                  Memo:        Utilisation of overdraft facility as at reporting date


                  Memo:        Maximum utilisation of overdraft facility during the period
                                                                                                                              YES/NO
                  Memo:        Was the firm's last annual audit accounts audit report qualified?                                 No


                                                              Please use this box if you have any clarifications to the data in this form




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                                                                                         Page 6 of 15
                                       FORM Q302: PROFIT AND LOSS STATEMENT

Item No.                                                                   Amount ('000)        Amount ('000)

                                                                                N                   N-1
           INCOME
2.1        Income from fees
2.2        Income from commissions
2.3        Investment income
2.8        Other operating income

2.9        TOTAL INCOME                                                                    0                    0

           EXPENSES
2.10       Interest paid and payable
2.11       Commission and brokerage expenses
2.12       Depreciation & Amortization
2.13       General and administrative expenses
2.14       Other operating expenses

2.15       TOTAL OPERATING EXPENSES                                                        0                    0

2.16       Operating profit from ordinary activities                                       0                    0

2.17       Profit (loss) from extraordinary items
2.18       Changes to profit & loss due to effects of accounting changes
2.19       Other income/expenses

2.20       Profit (loss) before taxation and minority interest                             0                    0

2.21       Tax on (profit) / loss

2.22       Profit (loss) before minority interest                                          0                    0

2.23       Minority interests

2.24       NET PROFIT (LOSS)                                                               0                    0


2.25       Dividends, and other distributions, declared or paid
2.26       Other adjustments: increases/(decreases) to retained profits


2.27       RETAINED PROFITS FOR THE REPORTING PERIOD                                       0                    0


                  Please use this box if you have any clarifications to the data in this form




 cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                 Page 7 of 15
                               FORM Q303: CALCULATION OF ELIGIBLE CAPITAL
  Item No.   Item

  3.1        Tier One Capital                                              ('000)

  3.1.1      Permanent Share Capital                                            -
  3.1.2      Partnership Capital                                                -
  3.1.3      Audited Reserves                                                   -
  3.1.4      Share Premium Account
  3.1.5      Externally verified interim net profits                            -
  3.1.6         Tier One Capital                                                            -

  3.2        Deductions from Tier One capital:
  3.2.1      Investments in own shares                                          -
  3.2.2      Intangible assets                                                  -
  3.2.3      Interim net losses                                                 -
  3.2.4      Excess of drawings over profits (partnerships only)                -
  3.2.5         Total Deductions from Tier One Capital                                      -

  3.3        Tier One Capital After Deductions                                                           -

  3.4        Tier Two Capital

  3.5        Upper Tier Two Capital:
  3.5.1      Perpetual qualifying hybrid capital instruments                    -
  3.5.2      Fixed dividend ordinary shares                                     -
  3.5.3        Total Upper Tier Two Capital                                                 -

  3.6        Lower Tier Two Capital:
  3.6.1      Subordinated Debt                                                  -
  3.6.2      Fixed term preference shares                                       -
  3.6.3        Total Lower Tier Two Capital (cannot exceed 50% of 3.1.6)                    -

  3.7        Total Tier Two Capital (cannot exceed 2/3 of 3.3)                                           -

  3.8        Total Tier One Capital plus Tier Two Capital                                                          -

  3.9        Deductions from Tier One and Tier Two Capital:
  3.9.1      Investments in subsidiaries and associates                         -
  3.9.2      Connected lending of a capital nature                              -
  3.9.3      Illiquid assets                                                    -
  3.9.4          Total deductions from Tier One and Tier Two Capital                                               -

  3.10       Total Eligible Capital                                                                                -




                                Please use this box if you have any clarifications to the data in this form




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                      Page 8 of 15
                    FORM Q303A: CALCULATION OF EXPENDITURE BASED CAPITAL REQUIREMENT

 Item No.
 3.A.1      Select the PIIB Category of the Firm from the drop-down menu on the right:
             -- PIIB Category 3: Dealing in Investments, Managing Investments,                          Category 3
                     Arranging Deals in Investments, Advising on Investments
             -- PIIB Category 4: Arranging Deals in Investments, Advising on Investments

                                                                                                 (thousands of US dollars)
 3.A.2      BASE CAPITAL REQUIREMENT                                                                                  500



 3.A.3      Expediture Based Capital Minimum

            Select the category that applies to the firm from the drop-down menu on the right:
 3.A.3.1     A) The firm holds Insurance Money                                                              A
             B) The firm is a PIIB Category 3 Firm that does not hold Insurance Money
             C) The firm is a PIIB Category 4 Firm that does not hold Insurance Money

                                                                                                 (thousands of US dollars)
 3.A.3.2    Total expenses, per the annual audited accounts (excluding exceptional items)                              -

 3.A.3.3    less:               staff bonuses                                                                          -
 3.A.3.4                        employee's and directors share of profits                                              -
 3.A.3.5                        other appropriations of profits                                                        -
 3.A.3.6                        shared commissions payable                                                             -
 3.A.3.7                        interest paid to clients on Insurance Money                                            -
 3.A.3.8                        fees, brokerage and other charges paid to intermediate brokers                         -
 3.A.3.9                           for the purposes of executing transactions                                          -
 3.A.3.10                       foreign exchange losses                                                                -
 3.A.3.11                       contributions to charities                                                             -

 3.A.3.12   Total expenses for calculating expediture based capital minimum                                            -

 3.A.3.13   Expenditure Based Capital Minumum Factor                                                                 0.346

 3.A.4      EXPENDITURE BASED CAPITAL MINIMUM                                                                          -



 3.A.7      MINIMUM CAPITAL REQUIREMENT (greater of A&B)                                                              500

 3.A.8      Total Eligible Capital (from form 303)                                                                     -

 3.A.9      Excess of Eligible Capital over the Minimum Capital Requirement                                           (500)




                        Please use this box if you have any clarifications to the data in this form




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                                      Page 9 of 15
                          FORM Q304: SCHEDULE OF INCOME INFORMATION

          Item no.

          4.1                                                             Income earned by the firm from
                               Line of business                     Retail                        Commercial




          4.2                         TOTAL:                          0                                0



                          Please use this box if you have any clarifications to the data in this form




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                       Page 10 of 15
                                        FORM Q305: CLIENT INFORMATION

                      Item no.

                                  Please list information the firm's largest commercial customers based
                      5.1                              on amount of income to firm

                                                  Name                       Amount of income earned
                      1
                      2
                      3
                      4
                      5
                      6
                      7
                      8
                      9
                      10




                      5.2         Please list the firm's 5 largest insurers based on income earned by firm

                                                  Insurer                    Amount of income earned
                      1
                      2
                      3
                      4
                      5



                            Please use this box if you have any clarifications to the data in this form




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                     Page 11 of 15
                                  FORM Q306: AGEING OF PREMIUMS OWED TO INSURERS

                   Outstanding Period                            Number of Policies             Amounts of premiums owed to insurers

1) Up to 90 days                                                         0                                       0
2) Above 90 days but not exceeding 6 months                              0                                       0
3) Above 6 months but not exceeding 12 months                            0                                       0
4) Above 12 months                                                       0                                       0

Total                                                                    0                                       0

M emo:   outstanding period commences from the inception date of the insurance contract


                                Please use this box if you have any clarifications to the data in this form




        cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                        Page 12 of 15
                                                      FORM Q307: CLIENT AND INSURANCE MONEY
Item no.
                                                                                                                                  Insurance Money           Client Money
7.1          Do you hold Insurance Money or Client Money (answer as appropriate)
                                                                                                                                           No                     No



                                                                                                                                  Yes/No/Not Applicable
7.2          If applicable has the firm's external auditor's prepared a Client Money report and/or an
             Insurance Money report?                                                                                                       No



                                                                                                                                        YES/NO
7.3          If yes to 6.1 have any notifiable issues been raised in relation to client or insurance money either by the firm's
                                                                                                                                           No
             Auditor or elsewehere that have not previously been notified to the QFCRA?




7.4          If Client Money:
7.4.1        Client Money credit total as at reporting date
7.4.2        Client Money debit total as at reporting date
7.4.3        Net Client Money balance as at reporting date

7.5          If Insurance Money:
7.5.1        Insurance Money credit total as at reporting date
7.5.2        Insurance Money debit total as at reporting date
7.5.3        Net Insurance Money balance as at reporting date

                                                                                                                                        YES/NO
7.6          Is any Client Money or Insurance Money invested (other than on deposit)                                                       No



             Please use this box if you have any clarifications to the data in this form




        cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                                                          Page 13 of 15
                       FORM Q308: PROFESSIONAL INDEMNITY INSURANCE (PII)
                                                                                                         YES/NO
8.1         Does your Firm hold a compliant PII policy or a guarantee in accordance with CTRL 4.10 for      No
            its regulated activities?

8.1.1       Renewal date




8.1.2       Annual Premium (in US$)

8.2         Limit of Indemnity - single claim (in US$). Firms with unlimited indemnity should enter
            "unlimited."


8.2.1       Limit of Indemnity - aggregate (in US$). Firms with unlimited indemnity should enter
            "unlimited."

8.2.2       Excess (in US$)




            Please use this box if you have any clarifications to the data in this form




 cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                                Page 14 of 15
                             FORM Q309: GUARANTEES AND CONTINGENCIES

    Guarantees provided by the firm (quantify in US$ 000)


    Detail contingent liabilities:




                    Please use this box if you have any clarifications to the data in this form




cade111d-afa2-4dc2-967f-e5310c1d0490.xls                                                          Page 15 of 15

				
DOCUMENT INFO
Description: Commerical Real Estate Brokerage Firms document sample