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					                      Додаток 13
до Політики розкриття інформації
     страховиками-членами УФУ
A1
Coversheet for reporting                                                                                            General note;
Note: It is currently envisaged that this information would only be provided quarterly                              CEIOPS has not yet considered which of those solo forms will also apply for Group rep




Static data
        Name of institution
        Type of company (life / non-life / composite)
        Reference number
        Data reported as at
        Contact details
        Is it a member of a group?
        Reporting currency
        Internal model approval date
        Unit of reporting eg thousands

Capital requirements
  1    Minimum capital requirement (MCR)                                                           (value)

  2    Own funds eligible to meet the MCR                                                          (value)
  3    Own funds in excess of the MCR                                                              (value)

  4    Solvency capital requirement (SCR)                                                          (value)

       How SCR is calculated
  5    Standard Formula                                                                            (yes/no)
  6    Partial model                                                                               (yes/no)
  7    Full internal model                                                                         (yes/no)

  8    Own funds eligible to meet the SCR                                                          (value)
  9    Own funds in excess of the SCR                                                              (value)

Profit and Loss data
                                                                                                Gross
                                                                                         Life           Non-life          Total
  10   Premiums written in financial year to date - Direct business                                                 formula
  11   Premiums written in financial year to date - Reinsurance accepted                                            formula
  12   Premiums written in financial year to date - Reinsurance ceded                                               formula
  13   Premiums written in financial year to date - Net                        formula             formula          formula

       Non-life premiums - top 5 lines of business
                                                                                          Latest quarter                        Year to date            Previous year
                                                                                Line of business      Amount         Line of business      Amount          Amount
  14
  15
  16
  17
  18


       Life premiums - top 5 lines of business
                                                                                          Latest quarter                        Year to date            Previous year
                                                                                Line of business      Amount         Line of business      Amount          Amount
  19
  20
  21
  22
  23

                                                                                         Life           Non-life          Total
  24   Claims paid in financial year to date - Net                                                                  formula

                                                                                         Life                     Non-life                    Total
                                                                                                    Attributable to Relating to claims
                                                                                                    new business        management

  25   Expenses in the financial year to date                                                                                            formula

Regulatory Balance Sheet (all Solvency II values)
                                                                                         Life           Non-life          Total
  26   Investments - total                                                                                          formula

                                                                                         Life           Non-life          Total
  27   Technical provisions - best estimate - Direct business                                                       formula
  28   Technical provisions - best estimate - Reinsurance accepted                                                  formula
  29   Technical provisions - best estimate - Reinsurance ceded                                                     formula
  30   Technical provisions - best estimate - Net                              formula             formula          formula
  31   Technical provisions - risk margin                                                                           formula
  32   Technical provisions - best estimate plus risk margin                   formula             formula          formula




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                 Page 2                                                                           7/26/2011
                                                                        B1



B1
Own funds
Note    Ancillary own funds should only be reported if they have supervisory approval at the reporting date.
                                                                                             A           B         C            D
                                                                                           Tier 1      Tier 2    Tier 3
        Basic own funds
  1     Paid-up and called-up share capital (net of own shares)                         sum         sum         sum
  2          Paid-up share capital
  3          Called up share capital
  4          Less: Own shares held
  5     Paid-up and called-up initial fund
  6     Reserves                                                                        sum         sum         sum
  7          Retained earnings (excluding current year)
  8          Share premium account
  9          Other reserves
  10    Current year profit/loss (net of any announced dividends)
  11    Budgeted supplementary calls
  12    Subordinated mutual member accounts
  13    Undated preference shares
  14    Dated preference shares
  15    Undated hybrid capital instruments / subordinated liabilities
  16    Dated hybrid capital instruments / subordinated liabilities
  17    Surplus funds (as defined in article 90(2) of the Directive)
  18    Total basic own funds                                                           sum         sum         sum
  19    Of which: Provided by other group entities

        Ancillary own funds
  20    Unpaid share capital
  21    Unpaid initial funds
  22    Unpaid, undated preference shares
  23    Unpaid, dated preference shares
  24    Unpaid, undated hybrid capital instruments / subordinated liabilities
  25    Unpaid, dated hybrid capital instruments / subordinated liabilities
  26    Letters of credit
  27    Guarantees
  28    Unbudgeted supplementary calls
  29    Other legal commitments
  30    Total ancillary own funds                                                                   sum         sum
  31    Of which: Provided by other group entities

  32    Own funds eligible to meet the MCR                                                                                sum
  33    Own funds in excess of the MCR                                                                                    sum

  34    Own funds eligible to meet the SCR                                                                                sum
  35    Own funds in excess of the SCR                                                                                    sum




541560c5-6aef-44aa-82a5-6802c775f942.xls                              Page 3                                                        7/26/2011
                                                           B2A


B2A
Solvency Capital Requirement - for firms on Standard Formula or Partial Internal Models
Note    Also for firms on internal models following approval of the Internal Model, subject to Article 110(7)
        Firms on partial internal models will only have to fill in those modules for which they use the standard formula



                                                                              Overall SCR
                                                                                  A
        Basic SCR
   1    Market risk after Future Profit Sharing                                                                 (a)
   2    Counterparty default risk after Future Profit Sharing                                                   (a)
   3    Life underwriting risk after Future Profit Sharing                                                      (a)
   4    Health underwriting risk after Future Profit Sharing                                                    (a)
   5    Non-life underwriting risk after Future Profit Sharing                                                  (a)
   6    Aggregation (diversification effect)

   7    Remaining part of the SCR calculated using partial internal
        model

        Final SCR calculation
   8    Basic SCR                                                                 formula
   9    Operational risk SCR                                                                                    (a)
  10    Adjustment for Future Discretionary benefits
  11    Adjustment for deferred taxation
  12    Diversified SCR, excluding capital add-on
  13    Capital add-ons already set
  14    SCR (as disclosed)                                                        formula                       (b)


  (a)   As reported in specific sheets
  (b)   As reported on Cover Sheet




541560c5-6aef-44aa-82a5-6802c775f942.xls                  Page 4                                                 7/26/2011
                                                                 B2B



B2B

Solvency Capital Requirement - for firms on Full Internal Models
      (Following approval of the full Internal Model, firms may also have to complete B2A, if requested by the supervisory authority)

                                                                Overall SCR                        Notes
      Final SCR calculation
  1   Diversified SCR, excluding capital add-on
  2   Capital add-ons already imposed
  3   SCR (as disclosed)                                             formula                         (a)

  4   Date of formal approval of internal model

 (a) As reported on Cover Sheet




541560c5-6aef-44aa-82a5-6802c775f942.xls                        Page 5                                                        7/26/2011
                                                                                 B3A




B3A
Solvency Capital Requirement
Further information on Basic SCR
Note Only completed by firms on full internal models if required under Art 110(7). Firms on partial internal models will only fill in Columns A-C for risk
      module results modelled using the standard formula.
                                                                                  A                B               C                             D
      Market risk - Basic information                                      Net after profit Gross capital Mitigating                           How
                                                                           sharing capital     charge           effect                     calculated (a)
                                                                               charge

  1   Interest rate up risk
  2   Interest rate down risk
  3   Interest rate risk
  4   Equity risk
  5   Duration based equity risk (art. 305 b)
  6   Property risk
  7   Spread risk
  8   Risk concentration
  9   Currency risk up
 10   Currency risk down
 11   Currency risk
 12   Diversification within module

 (a) Standard formula/Partial internal model/Simplification




541560c5-6aef-44aa-82a5-6802c775f942.xls                                        Page 6                                                                       7/26/2011
                                                                                  B3B




B3B

Solvency Capital Requirement
Further information on Basic SCR
Note Only completed by firms on full internal models if required under Art 110(7). Firms on partial internal models will only fill in column A for risk
      module results modelled using the standard formula.
                                                                        A                                       B
                                                                   Net capital                                How
                                                                     charge                                calculated
      Counterparty default risk (b)                                                                            (a)
      Type 1 exposures
  1 Reinsurance
  2 Derivatives
  3 Intermediaries
  4 Other credit exposures

        Type 2 exposures
  5     Reinsurance
  6     Derivatives
  7     Intermediaries
  8     Other credit exposures




        Large life reinsurance exposures (c)
                             Counterparty                              Product           Share of gross     Premiums          Deposits
                                 (d)                                     (e)          technical provisions ceded to the         from
                                                                                          ceded to the      reinsurer        reinsurers
                                                                                     reinsurer at year end during year




        Large non-life reinsurance exposures (f)
                             Counterparty                              Product           Share of gross     Premiums          Deposits
                                 (d)                                     (g)          technical provisions ceded to the         from
                                                                                          ceded to the      reinsurer        reinsurers
                                                                                     reinsurer at year end during year




 (a)    Standard formula/partial internal model
 (c)    Any counterparty with more than x% (to be defined) of gross life technical provisions at the year end
 (d)    There would be a list of codes to identify all the main reinsurers
 (e)    For life the analysis would identify at the level of protection / annuity / linked / other.
  (f)   Any counterparty with more than x% (to be defined) of gross non-life technical provisions at the year end
 (g)    For non-life, the analysis would identify proportional/non-proportional




541560c5-6aef-44aa-82a5-6802c775f942.xls                                         Page 7                                                                   7/26/2011
                                                                                            B3C




B3C

Solvency Capital Requirement
Further information on Basic SCR
Note Only completed by firms on full internal models if required under Art 110(7). Firms on partial internal models will only fill in columns A-C for risk module
      results modelled using the standard formula.
      Will need to define 'Products'
                                                                                                  A                B                 C                           D
      Life underwriting risk - Basic information                                            Net of profit Gross capital Mitigating                             How
                                                                                          sharing capital       charge             effect                   calculated
                                                                                              charge                                                            (a)

 1    Mortality risk
 2    Longevity risk
 3    Disability risk
 4    Lapse up risk
 5    Lapse down risk
 6    Lapse risk
 7    Expense risk
 8    Revision risk
 9    Catastrophe risk
 10   Diversification within module

                                                                                                                                  Products
      Life underwriting risk - Aditional information
                                                                                               TOTAL              P1              P2            P3             P4        ….
      Mortality risk
 11      Capital at risk
 12      Average age of exposed population
 13      Duration
      Longevity risk
 14      Technical provisions (best estimate)
 15      Average age of exposed population
 16      Duration
      Disability risk
 17      Capital at risk
 18      Average age of exposed population
 19      Duration
      Lapse risk
 20      Sum of positive diferences between the surrender value and the best estimate
 21      Sum of negative diferences between the surrender value and the best estimate
 22      Duration of liability portfolio for policies with positive surrender strain
 23      Duration of liability portfolio for policies with negative surrender strain
      Expense
 24      Technical provisions (best estimate)
 25      Duration

 26   Revision risk - Technical provisions
      CAT Life
 27     Capital at risk for death
 28     Capital at risk for disability

 (a) Standard formula/With specific parameters/Partial internal model




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                   Page 8                                                                             7/26/2011
                                                                                 B3D




B3D

Solvency Capital Requirement
Further information on Basic SCR
Note Only completed by firms on full internal models if required under Art 110(7). Firms on partial internal models will only fill in columns A-C for risk
     module results modelled using the standard formula.
     May need more information on Health liabilities
                                                                                             A                 B                   C                D
     Health underwriting risk - Basic information                                       Net of profit     Gross capital Mitigating                How
                                                                                       sharing capital       charge       effect               calculated
                                                                                          charge                                                   (a)

  1   SLT Health underwriting risk
  2   Non-SLT Health underwriting risk

      SLT Health underwriting risk - Basic information
 3    Mortality risk
 4    Longevity risk
 5    Disability/morbidity risk
 6      Medical insurance risk
 7      Income insurance risk
 8    Lapse risk
 9      Lapse up risk
 10     Lapse down risk
 11     Lapse risk
 12   Expense risk
 13   Revision risk
 14   Catastrophe risk

 15   Diversification between risks

      Non-SLT Health underwriting risk - Basic information
 16   Premium risk
 17   Reserve risk
 18   Catastrophe risk

 19   Diversification between risks

      SLT Health underwriting risk - Additional information

 20   Technical provisions
 21    Best Estimate
 22    Risk margin

      Non-SLT Health underwriting risk - Additional information

 23   Technical provisions
 24    Best Estimate
 25    Risk margin

 (a) Standard formula/With specific parameters/Partial internal model




541560c5-6aef-44aa-82a5-6802c775f942.xls                                        Page 9                                                                       7/26/2011
                                                                                                                         B3E




B3E

Solvency Capital Requirement
Further information on Basic SCR
Note CAT risk will be derived following CEIOPS consultation

      Non-life underwriting risk - Basic information                         Motor vehicle   Motor,     Marine, Fire and Third-party Credit and  Legal    Assistanc Miscellaneous     Non-          Non-           Non-     Diversification
                                                                               liability      other     aviation  other   liability suretyship expenses       e        non-life   proportional proportional porportional between Lines
                                                                                             classes      and    damage                                               insurance   reinsurance - reinsurance - reinsurance -  of Business
                                                                                                       transport                                                                    property      casualty       marine,
                                                                                                                                                                                                               aviation and
                                                                                                                                                                                                                transport
  1   Premium risk
  2   Reserve risk
  3   Catastrophe risk
  4   Diversification between risks

      Non-life underwriting risk - Additional information
  5   Premium risk derived parameter (specific calculated with loss ratio)
  6   Premium risk weighted parameter
  7   Premium risk entity specific parameter

  8   Reserve risk entity specific parameter

 9    Earned premiums, net of reinsurance
 10   Claims provision, net of reinsurance


 11   How calculated




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                                               Page 10                                                                                                      7/26/2011
                                                                 B3F



B3F
Solvency Capital Requirement - Operational risk SCR
Note    Firms on partial internal models will only fill in column A for risk module results modelled using the standard formula.

                                                                                   A                            B
                                                                           Net capital charge             How calculated
                                                                                                               (a)
        Operational risk SCR - Additional information
  1     Life gross technical provisions
  2     Life gross technical provisions unit-linked
  3     SLT Health gross technical provisions
  4     Non-SLT Health gross technical provisions
  5     Non-life gross technical provisions
  6     Result based on technical provisions                                       calc
  7     Life gross earned premiums
  8     Life gross earned premiums unit-linked
  9     SLT Health gross earned premiums
  10    Non-SLT Health gross earned premiums
  11    Non-life gross earned premiums
  12    Result based on earned premiums
  13    Operational risk SCR pre capping
  14    Operational risk capping adjustment
  15    Operational risk unit linked annual expenditure                            calc

  (a)   Standard formula/Partial internal model




541560c5-6aef-44aa-82a5-6802c775f942.xls                       Page 11                                                        7/26/2011
B4A
MCR Calculation
                                                              MCR components                                              Background information
       Non-Life MCR
  1    Non-life MCR Result
                                                                                                           Net (of           Net (of
                                                                                                     reinsurance) best   reinsurance)
                                                                                                          estimate     written premiums
                                                                                                         provisions
   2   Motor vehicle liability
   3   Motor, other classes
   4   Marine, aviation and transport
   5   Fire and other damage to property
   6   Third-party liability
   7   Credit and suretyship
   8   Legal expenses
   9   Assistance
  10   Miscellaneous non-life insurance
  11   NP reins property
  12   NP reins casualty
  13   NP reins MAT

  14   Accident and health (segmentation pending)

       Non-life MCR* (non-life activities similar to life)
  15   Non-life MCR* Result
                                                                                                         Amount
  16   Technical provisions for SLT health insurance
  17   Technical provisions for non-life liabilities valued according to life principles


       Life MCR
  18   Result relating to with profits contracts
                                                                                                       Guaranteed       Discretionary
                                                                                                        benefits       future bonuses
  19   Net technical provisions relating to with profits contracts

  20   Result relating to risk drivers
                                                                                                          Death            Saving         Survivorship   Morbidity
  21   Net technical provisions relating to unit-linked
  22   Net technical provisions relating to non-profit




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                   Page 12                                                            7/26/2011
  23   Result relating to administrative expenses
                                                                              Amount
  24   Last year net administrative expenses

  25   Result of capital at risk
                                                                          5 years or more     3 to 5 years     Under 3 years
  26   Capital at risk net by outstanding term

  27   Life MCR result                                calc

       Life MCR* (supplementary non-life insurance)
  28   Life MCR* Result
                                                                            Net technical      Premiums
                                                                             provisions
  29   Motor vehicle liability
  30   Motor, other classes
  31   Marine, aviation and transport
  32   Fire and other damage to property
  33   Third-party liability
  34   Credit and suretyship
  35   Legal expenses
  36   Assistance
  37   Miscellaneous non-life insurance
  38   NP reins property
  39   NP reins casualty
  40   NP reins MAT

  41   Accident and health (segmentation pending)



       Final MCR calculation
  42   Linear MCR                                     calc
  43   SCR without add-on                                                 Method used to calculate SCR reference value (a)
  44   Capital add-on
  45   MCR cap                                        calc
  46   MCR floor                                      calc
  47   Combined MCR                                   calc
  48   Absolute floor
  49   Final MCR                                      calc

       Notional Life and Non-life MCR calculation     Life     Non-life



541560c5-6aef-44aa-82a5-6802c775f942.xls                     Page 13                                                           7/26/2011
  50   Linear MCR                                                    calc       calc
  51   Notional SCR without add-on                                   calc       calc
  52   Capital add-on
  53   Notional MCR cap                                              calc       calc
  54   Notional MCR floor                                            calc       calc
  55   Notional Combined MCR                                         calc       calc
  56   Absolute floor
  57   Notional MCR                                                  calc       calc


(a)    Standard formula/Full internal model/Partial internal model




541560c5-6aef-44aa-82a5-6802c775f942.xls                                    Page 14    7/26/2011
                                                     B4Q


B4Q
MCR Calculation
                                                           MCR components
       Non-Life MCR
  1    Non-life MCR Result

       Non-life MCR*
  2    Non-life MCR* Result


  3    Notional non-life MCR                                     calc

       Life MCR
  4    Result relating to with profits contracts

  5    Result relating to risk drivers

  6    Result relating to administrative expenses

  7    Result of capital at risk

  8    Life MCR result                                           calc

       Life MCR*
  9    Life MCR* Result

  10   Notional life MCR                                         calc


       Final MCR calculation
  11   Linear MCR                                                calc
  12   Notional SCR without add-on
  13   Capital add-on
  14   Notional MCR cap                                          calc
  15   Notional MCR floor                                        calc
  16   Notional Combined MCR                                     calc
  17   Absolute MCR
  18   Notional MCR                                              calc




541560c5-6aef-44aa-82a5-6802c775f942.xls            Page 15                 7/26/2011
                                                                                                 C1




C1
Balance sheet

                                                                                              A                  B
                                                                                         Solvency II         Statutory   Notes
                                                                                         value (total        accounts
                                                                                        balance sheet)       valuation
Assets                                                                                                       basis (e)
1    Cash and cash equivalents
2    Trade and other receivables
3    Mortgages and loans made
4    Investments other than property
5    Derivatives
6    Financial assets (other than cash or debtors)
7    Property and other tangible assets held for investment
8    Property (for own use), plant and equipment
9    Reinsurance recoverables
10   SPV recoverables
11   Insurance recoverables (incl. intermediaries)
12   Current tax assets
13   Deferred tax assets
14   Interest receivable but not yet due
15   Deferred acquisition costs                                                                                           (h)
16   Other regularisation accounts                                                                                        (h)
17   Net staff pension scheme surplus                                                                                     (h)
18   Intangible assets                                                                                                    (h)
19   Any other accounting assets, not elsewhere shown                                                                     (h)
20   Total assets                                                                       sum                sum


Liabilities and own funds                                                                     A                  B
                                                                                         Solvency II         Statutory
                                                                                         value (total        accounts
                                                                                        balance sheet)       valuation
      Liabilities                                                                                            basis (e)
21    Gross technical provisions – non-life
22    Gross technical provisions – life
23    Investment contracts                                                                                                (x)
24    Derivatives
25    Deposits from reinsurers (outside of EEA)
26    Deposits from reinsurers (EEA)
27    Assumed (re)insurance accounts payable
28    Amounts owed to credit institutions
29    Contingent loans (where provided)
30    Current tax liabilities
31    Deferred tax liabilities
32    Net staff pension scheme deficit
33    Other provisions
34    Trade and other payables
35    Other financial liabilities
36    Regularisation accounts                                                                                             (h)
37    Subordinated liabilities/hybrid capital
38    Subordinated debt and other capital
39    Any other accounting liabilities, not elsewhere shown                                                               (h)
40    Total liabilites                                                                  sum                sum
      Own funds
41    Surplus funds (as referred in article 90 of the Directive)
42    Subordinated liabilities/hybrid capital
43    Subordinated debt and other capital
44    Fund for future appropriations                                                                                      (h)
45    Issued capital and reserves
46    Total own funds (eligible and ineligible)                                         sum                sum
47    Total                                                                             sum                sum

                                                                                              A                  B
                                                                                         Solvency II         Statutory
                                                                                         value (total        accounts
                                                                                        balance sheet)       valuation
Memorandum items / off-balance sheet                                                                         basis (e)
48  Contingent liabilities - not provided for
49  Contingent assets
50  Off balance sheet assets
51  Repos and reverse repos?
52  Guarantees provided by the undertaking
53  Undrawn committed borrowing facilities provided to the undertaking

Issues still open
Detail for memo items/off balance sheet items
Check if all SII assets are there
Decision on health split for TPs waiting on TP sub group consideration
Notes
(e)    Should agree with the undertaking's statutory accounts, whether prepared under IFRS or local GAAP
(h)    Does not exist as a Solvency II value, but may appear in some companies' statutory accounts
(x)    For undertakings applying IFRS4 contract classification




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                      Page 16                            7/26/2011
                                                                  C2



C2
Profit & loss account
                                                                         A         B               C
                                                                       Gross   Reinsurers'        Net
Technical account (life)                                                         share
1    Premiums                                                                                formula
2    Investment income (non-linked assets)
3    Investment income (linked assets)
4    Increase (decrease) in value (non-linked allocated assets)
5    Increase (decrease) in value (linked allocated assets)
6    Unwinding of discount
7    Change of discount rates/risk-free rates
8    Other income
9    Transfers of business in
10   Claims incurred                                                                         formula
11   Expenses (detailed in F9)                                                               formula
12   Interest payable
13   Tax attributable                                                                        formula
14   Change in technical provisions                                                          formula
15   Transfers of portfolio out
16   Transfers to fund for future appropriations
17   Balance on technical account (life)

Technical account (non-life)
18   Premiums receivable                                                                     formula
19   Unwinding of discount                                                                   formula
20   Change of discount rates/risk-free rates                                                formula
21   Inwards transfers of portfolio                                                          formula
22   Investment income                                                                       formula
23   Other income                                                                            formula
24   Expenses attributable to new business                                                   formula
25   Claims paid                                                                             formula
26   Expenses payable relating to claims management                                          formula
27   Increase (decrease) in premium provision                                                formula
28   Increase (decrease) in claims provision                                                 formula
29   Increase (decrease) in value of allocated assets                                        formula
30   Outwards transfer of portfolio                                                          formula
31   Other outgoings                                                                         formula
32   Balance on technical account (non-life)                                                 formula

Non-technical account
33   Balance on technical account (life)
34   Tax credit (life)
35   Balance on technical account (non-life)
36   Tax credit (non-life)
37   Investment income
38   Increase (decrease) in value of assets
39   Other income
40   Investment expenses
41   Interest payable
42   Contra for unwinding of discount
43   Contra for change in discount rates
44   Other expenses
45   Profit before tax                                                                       formula
46   Tax
47   Profit after tax                                                                        formula
48   Dividends
49   Current year profit/loss                                                                formula

50    Statutory accounts - Current year profit/loss




541560c5-6aef-44aa-82a5-6802c775f942.xls                    Page 17                                     7/26/2011
                                                                                                                               D1




D1
Investments Data - Portfolio list
Note   See annotations below

       Unit:

       Portfolio    Fund       ID Code        CIC        Name      Currency    Quantity    Nominal     Maturity   Frequency Unit cost   Internal   Custodian Unit price    Total   Accrued    Investment Valuation   Group    Income in
                   number                     (a)                                          value (c)   date (c)   of interest            rating                           amount   interest      return   method     code    the current
                                                                                                                  payments                                                                                            (b)        year
                                                                                                                      (c)



(a)   The CIC is built up as a three digit number based on types of instrument
(b)   Groups of connected counterparties are identified by the template Group (attached)
(c)   Only required for unquoted corporate bonds etc
The data would be used in conjunction with information such as this from Bloombergs
      Data                                   Data
      Type of security                       Coupon and coupon frequency
      Stock exchange                         Maturity
      Stock related index                    Duration
      Market and industry sector             Rating
      Issuer                                 Price volatility
      Parent company                         Structured notes risk factors
      Country                                Investment funds focus and UCITS
      Currency                               Security price




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                                                     Page 18                                                                                                       7/26/2011
                                                        D2


      D2
       Investments data - Groups of connected counterparties
      Note Linked with template D1

                Group code                        Group name
                     1          (always undertakings connected to the reporter)
                     2
                    etc




541560c5-6aef-44aa-82a5-6802c775f942.xls             Page 19                      7/26/2011
                                                                    D3


D3
Properties held for investment
Note   Detail and coverage still to be determined

       Unique         Address of property           Solvency II     Purchased     Expense in   Fund number Yield from   Acquisition
       identifier                                   value of        during year   property                 property     cost
                                                    property        (yes/no)




541560c5-6aef-44aa-82a5-6802c775f942.xls                          Page 20                                                             7/26/2011
                                                                                                                      D4




D4
Derivatives data (a)
Note Further discussion of how hedges are dealt with
     Coverage of derivatives to agree with CP33

      Unit:

      Portfolio    Fund     ID Code       CIC    Counterp Contract    Risk     Notional   Net     Profit  Number    Contract Unit price IRS paid       IRS     Swap      Swap Swap paid       Swap       FRA           FRA       Market
                  number                          arty ID  name      covered   amount exposure and loss     of     dimension             interest   received delivered received   interest  received   effective   termination   value
                                                                                        (buyer / to date contracts                         rate      interest currency currency frequency interest       date         date
                                                                                         seller)                                                       rate                                frequency




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                                                                        D5



D5
Values of Collective Investment Schemes on balance sheet
Note Allocation based on stated asset distrubution of each CIS fund
                                                                                     A             B             C
                                                                                Underlying    Underlying     Underlying
                                                                                Solvency II   Solvency II    Solvency II
                                                                                  asset          asset         asset
                                                                                exposure -    exposure -     exposure -
                                                                                 unlinked      property     index linked
Assets                                                                                          linked
1    Cash and cash equivalents
2    Fixed interest rate                                                     sum              sum           sum
3       Listed
4       Non-listed
5    Variable interest rate                                                  sum              sum           sum
6       Listed
7       Non-listed
8    Equities                                                                sum              sum           sum
9       Listed
10      Non-listed
11   Property
12   Hedge funds
13   Others
14   Collective investment schemes                                           sum              sum           sum




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                                                                                        E1



E1
Life Technical Provisions

                                    Contracts with profit     Contracts where the        Other contracts without         Accepted reinsurance             Total
                                    participation clauses    policyholder bears the     profit participation clauses
                                                                 investment risk
                                     New                       New                         New                            New                      New
                                                  Total                     Total                         Total                       Total                       Total
                                   Business                  Business                    Business                       Business                 Business
Best Estimate
1      Gross Business                                                                                                                           formula     formula
2      Reinsurance Ceded                                                                                                                        formula     formula
3      Net                       formula      formula       formula     formula        formula        formula          formula     formula      formula     formula

Risk Margin
4      Net                                                                                                                                      formula     formula

Best estimate plus risk margin
5      Total                   formula        formula       formula     formula        formula        formula          formula     formula      formula     formula

Pure reinsurers record under accepted reinsurance
Lines of business accord with 4 high level segments per CP-27/09




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                                                                                                                      E2




E2
Non-Life Technical Provisions



                                                                                                                                                                                                                Non-
                                                                                                                                                                                                            proportional
                                                                                                                                                                                       Non-         Non-    reinsurance
                                                              Motor                     Marine,        Fire and                                                      Miscellaneous proportional proportional - marine,
                                   Workers     Accident      vehicle     Motor, other aviation and      other     Third-party    Credit and      Legal                   non-life  reinsurance reinsurance aviation and
                                 compensation and Health     liability    classes      transport       damage       liability    suretyship    expenses   Assistance   insurance    - property   - casualty   transport     TOTAL
Best Estimate
 1 Direct business                                                                                                                                                                                                         formula
 2 Reinsurance Accepted                                                                                                                                                                                                    formula
 3 Reinsurance Ceded                                                                                                                                                                                                       formula
 4 Net                           formula     formula       formula       formula     formula         formula      formula       formula       formula     formula    formula        formula     formula     formula        formula

Risk Margin
  5 Net                                                                                                                                                                                                                    formula

Best estimate plus risk margin
 6 Total                         formula     formula       formula       formula     formula         formula      formula       formula       formula     formula    formula        formula     formula     formula        formula

  7   Gross claims provisions                                                                                                                                                                                              formula
  8   Net claims provisions                                                                                                                                                                                                formula

 9 Gross premium provisions                                                                                                                                                                                                formula
 10
    Of which: Gross discounted
    value of future premiums
 11 Net premium provisions
 12 Of which: Net discounted
    value of future premiums                                                                                                                                                                                               formula


LoB agree with CEIOPS-CP-27/09




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                                                        E3


E3
Life - changes in own funds


     1   Changes in own funds over the financial year         sum

     2   Of which: Due to new business
     3             Changed economic assumptions
     4             Changed mortality assumptions
     5             Changed persistency assumptions
     6             Changed expenses assumptions
     7             Other changes in assumptions
     8             Returns on capital
     9             Other




541560c5-6aef-44aa-82a5-6802c775f942.xls            Page 25         7/26/2011
                                                                     E4



E4
Valuation basis - Non-life
                                                                              For technical              For
                                                                              provisions                 premiums
                                                                              purposes                   (if
                                                                                                         different)
         Economic assumptions                                                         A
     1   Gross interest rate                                                                   (a)
     2   Net interest rate                                                                     (a)
     3   Expense inflation
     4   Service charge inflation
     5   Claims inflation

Notes
a   Discount rate for liabilities valued net of tax. Since insurers are required to use the whole term structure,
    interest rates should be presented for the whole structure or for relevant (harmonized) terms.




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                                                                                                  E5




E5
Valuation assumptions - Life
                                                                                                                                                             For
                                                                                       For technical provisions purposes                                     premiums
                                                                                                                                                             (if
                                                                                                                                                             different)
         Economic assumptions                                                           A                B                 C
     1   Gross interest rate                                                                                                                      (a)
     2   Net interest rate
     3   Gross unit growth rate                                                                                                                   (b)
     4   Net unit growth rate                                                                                                                     (c)
     5   Expense inflation
     6   Service charge inflation
     7   Claims inflation

         Mortality assumptions
         Endowment mortality rates for key ages                                       Male             Female
     8                                                                 25
     9                                                                 35
    10                                                                 45
    11                                                                 55

         Term assurance mortality for key ages                                        Male             Female         Aggregate
    12                                                                25
    13                                                                35
    14                                                                45
    15                                                                55
    16                                                              Smoker
    17                                                            Non-smoker

         Expectation of life for pension annuities in payment                         Male             Female
    18                                                                 65
    19                                                                 75

         Expectation of life for deferred pension annuities                           Male             Female
    20                                                                 45
    21                                                                 55


         Lapse assumptions (percentages)                                                         Average for the policy years
                                                                                      1 to 5         6 to 10         11 to 15          16 to 20
    22   Savings endowment
    23   Target cash endowment
    24   Level term
    25   Decreasing term
    26   With-profits bond surrender
    27   With-profits bond automatic withdrawals
    28   Unit-linked bond surrender
    29   Unit-linked bond automatic withdrawals
    30   Regular premium individual pension surrender
    31   Regular premium individual pension paid-up
    32   Single premium individual pension surrender
    33   Regular premium group pension surrender
    34   Regular premium group pension paid-up
    35   Single premium group pension surrender

         Expense assumptions (per annum)
    36   Savings endowment
    37   Target cash endowment
    38   Term assurance
    39   Pension annuity in payment
    40   With-profits bond
    41   Unit-linked bond
    42   Regular premium individual pension
    43   Single premium individual pension
    44   Regular premium group pension
    45   Single premium group pension

a        Discount rate for liabilities valued net of tax. Since insurers are required to use the whole term structure, interest rates should be presented for the whole
         structure or for relevant (harmonized) terms.
b        Units where no tax is deducted.
c        Units where tax is deducted from income and capital gains.




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                       Page 27                                                                    7/26/2011
                                                                 F1



F1
Life revenue analysis
                                                             A                 B              C              D
                                                                          Reinsurance    Reinsurance
                                                       Direct business                                      Net   Notes
                                                                           Accepted        Ceded
Premiums
1        Regular premiums                                                                              formula
2        Single premiums                                                                               formula
3        Total premiums                                formula           formula        formula        formula

Claims
4          Death or disability lump sums                                                               formula
5          Annuity or disability periodic payments                                                     formula
6          Lump sums on maturity                                                                       formula
7          Lump sums on retirement                                                                     formula
8          Individual surrender or partial surrender                                                   formula
9          Group surrender or partial surrender                                                        formula
10         Individual pre retirement transfer                                                          formula
11         Individual post retirement transfer                                                         formula
12         Conversion to annuity at retirement                                                         formula
13         Total claims                                formula           formula        formula        formula

Expenses
14         Acquisition commission                                                                      formula
15         Acquisition management expenses                                                             formula
16         Renewal commission                                                                          formula
17         Renewal management expenses                                                                 formula
18         Investment expenses                                                                         formula
19         Other management expenses                                                                   formula
20         Total expenses                              formula           formula        formula        formula




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                                                                                                  F2




F2
Life premiums
                                                                          A              C            D              E          F               H           J              K
                                                                            Regular Premium Business                               Single Premium Business
                                                                                                              Number of                                             Number of
                                                                                    Reinsurance                                            Reinsurance
                                                                       Business                      Net      contracts      Business                      Net      contracts
                                                                                       Ceded                                                  Ceded
Premiums
New business
1        Contracts with profit participation clauses                                            formula                                                formula
2        Contracts where policyholders bear the investment risk                                 formula                                                formula
3        Other contracts without profit participations clauses                                  formula                                                formula
4        Accepted reinsurance                                                                   formula                                                formula
5        Total                                                      formula       formula       formula    formula        formula       formula        formula   formula

Existing business with changed characteristics of contracts
6          Contracts with profit participation clauses                                          formula                                                formula
7          Contracts where policyholders bear the investment risk                               formula                                                formula
8          Other contracts without profit participations clauses                                formula                                                formula
9          Accepted reinsurance                                                                 formula                                                formula
10         Total                                                    formula       formula       formula    formula        formula       formula        formula   formula

Existing business with unchanged characteristics
11         Contracts with profit participation clauses                                          formula                                                formula
12         Contracts where policyholders bear the investment risk                               formula                                                formula
13         Other contracts without profit participations clauses                                formula                                                formula
14         Accepted reinsurance                                                                 formula                                                formula
15         Total                                                    formula       formula       formula    formula        formula       formula        formula   formula
Total of premiums                                                   formula       formula       formula                   formula       formula        formula


Lines of business aligned with CEIOPS-CP-27/09




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                                                                                                                                                      F3




F3
Non-life technical account per line of business
Note Presented on a Solvency II basis
                                                                                                                                                                                                                                                                                Non-
                                                                                                                                                                                                                                                                            porportional
                                                                                                                                                                                                                                                Non-           Non-        reinsurance -
                                                                                           Accident     Motor                         Marine,                                                                                Miscellaneous proportional     proportional      marine,
                                                                              Workers        and       vehilcle     Motor, other    aviation and   Fire and other    Third-party     Credit and       Legal                     non-life   reinsurance -   reinsurance -    aviation and
                                                                            compensation    Heatlh     liability     classes         transport        damage          liability      suretyship     expenses    Assistance     insurance      property        casualty       transport        TOTAL
1    Premiums written: Gross amount                                                                                                                                                                                                                                                        formula
2        of which : single premium                                                                                                                                                                                                                                                         formula
3    Premiums written: Reinsurers' share                                                                                                                                                                                                                                                   formula
4        of which : single premium                                                                                                                                                                                                                                                         formula
5    Premiums written: Net (1-2)                                            formula        formula    formula      formula         formula         formula          formula        formula        formula      formula       formula       formula         formula         formula         formula
6    Claims paid: Gross amount                                                                                                                                                                                                                                                             formula
7    Claims paid: Reinsurers' share                                                                                                                                                                                                                                                        formula
8    Claims paid: Net (4-5)                                                 formula        formula    formula      formula         formula         formula          formula        formula        formula      formula       formula       formula         formula         formula         formula
9    Net operating expenses: Commissions                                                                                                                                                                                                                                                   formula
10   Net operating expenses: Other acquisition expenses                                                                                                                                                                                                                                    formula
11   Net operating expenses: Administrative expenses                                                                                                                                                                                                                                       formula
12   Net operating expenses: Reinsurance commissions                                                                                                                                                                                                                                       formula
13   Net operating expenses: Profit participations                                                                                                                                                                                                                                         formula
14   Net operating expenses: Payable net (7+8+9-10-11)                      formula        formula    formula      formula         formula         formula          formula        formula        formula      formula       formula       formula         formula         formula         formula
15   Best estimate inc/decr financial yr: Undiscounted: Gross amount                                                                                                                                                                                                                       formula
16   Best estimate inc/decr financial yr: Discounted: Gross amount                                                                                                                                                                                                                         formula
17   Best estimate inc/decr financial yr: Undiscounted: Reinsurance share                                                                                                                                                                                                                  formula
18   Best estimate inc/decr financial yr: Discounted: Reinsurance share                                                                                                                                                                                                                    formula
19   Best estimate inc/decr financial yr: Undiscounted: net (13-15)                                                                                                                                                                                                                        formula
20   Best estimate inc/decr financial yr: Discounted: net (14-16)           formula        formula    formula      formula         formula         formula          formula        formula        formula      formula       formula       formula         formula         formula         formula
21   Market Value Margin inc/decr financial yr

LoBs based on CEIOPS-CP-27/09




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                                                                  F4



F4
Distribution of profits for with profits funds                                         One column
                                                                                       per (sub)fund
                                                                                       where
                                                                                       applicable
                                                                             TOTAL
Composition of surplus
  1  Profit brought forward
  2  Profit in year
  3  Total available for distribution
  4  Less profit carried forward
  5  Distributable surplus

Distribution of surplus
   6    Cash payment on termination
   7    Cash payment on continuing policies
   8    Reversionary bonuses (increase sum assured / technical provisions)
   9    Premium reductions
  10 Total allocated to policyholders of the fund                            formula       formula
  11 Transfer to non-technical account (shareholders)
  12 Transfer to other funds / parts of fund                                    (b)
  13 Total surplus distributed                                               formula       formula

  14   Proportion for policyholders                                          formula       formula

(a)    The analysis is required for the total business and each subfund
(b)    Expected to be zero




541560c5-6aef-44aa-82a5-6802c775f942.xls                       Page 31                                 7/26/2011
                                                      F5



F5
Non-life Insurance Premium Information
Note         Solvency II basis

Line of Business
Currency

Latest Year            2012

Gross Premiums Earned (Incremental)                                              Premiums Written
                                                                                  In Calendar Year
                1       2        3   4      5   6     7       8   9   10                Gross
     Prior                                                                            formula
     2003                                                                             formula
     2004                                                                             formula
     2005                                                                             formula
     2006                                                                             formula
     2007                                                                             formula
     2008                                                                             formula
     2009                                                                             formula
     2010                                                                             formula
     2011                                                                             formula
     2012                                                                             formula
                                                                           Total      formala

Reinsurance Premiums Earned (Incremental)

                1       2        3   4      5   6     7       8   9   10           Reinsurance
     Prior                                                                          formula
     2003                                                                           formula
     2004                                                                           formula
     2005                                                                           formula
     2006                                                                           formula
     2007                                                                           formula
     2008                                                                           formula
     2009                                                                           formula
     2010                                                                           formula
     2011                                                                           formula
     2012                                                                           formula
                                                                           Total    formula

Net Premiums Earned (Incremental)

                1       2        3   4      5   6     7       8   9   10               Net
     Prior                                                                          formula
     2003                                                                           formula
     2004                                                                           formula
     2005                                                                           formula
     2006                                                                           formula
     2007                                                                           formula
     2008                                                                           formula
     2009                                                                           formula
     2010                                                                           formula
     2011                                                                           formula
     2012                                                                           formula
                                                                           Total    formula




541560c5-6aef-44aa-82a5-6802c775f942.xls            Page 32                                          7/26/2011
                                                          F6


F6
Non-life Insurance Gross Expense Information
Note     Solvency II basis

Line of Business
Currency

Latest Year   2012
REINSURANCE COMMISSIONS AND PROFIT PARTICIPATIONS

Commissions                                          Reinsurance Commissions

          Prior                                                         Prior
          2003                                                          2003
          2004                                                          2004
          2005                                                          2005
          2006                                                          2006
          2007                                                          2007
          2008                                                          2008
          2009                                                          2009
          2010                                                          2010
          2011                                                          2011
          2012                                                          2012
         Total

Other Acquisition Expenses                           Profit Participations from Reinsurance

          Prior                                                         Prior
          2003                                                          2003
          2004                                                          2004
          2005                                                          2005
          2006                                                          2006
          2007                                                          2007
          2008                                                          2008
          2009                                                          2009
          2010                                                          2010
          2011                                                          2011
          2012                                                          2012
         Total


Administration Expenses

          Prior          0
          2012           0
         Total           0

Proportionality principle may apply in 4 different areas - period to be used (annual/quarter); different granularity of
Lines of business; some undertakings exempt; and currency detail if relevant




541560c5-6aef-44aa-82a5-6802c775f942.xls               Page 33                                                7/26/2011
                                                                                                                                      G1




G1
Life liability analysis

      A                B               C               D                E               F               G                 H               I              J             K                 L                M             N                O              P
                                                                                                                      Amount of
                                                                                                                     benefit (sum                                 Discounted                                       Provision for
 DB / RA / RC     Product ID                        Product        Number of                                                                         Amount of                    Other liabilities   Technical                    Cost of options   PV Future
                                 Fund number                                      Average age        Duration         assured or   Surrender value               value of units                                    Discretionary
      (a)            (b)                           description   insured person                                                                      premiums                      (unit linked)      provisions                   and guarantees    Premiums
                                                                                                                    annual amount                                 (unit linked)                                      benefits
                                                                                                                     of annuities)




(a)             Either DB = direct business, RA = reassurance accepted, or RC = reassurance ceded, as appropriate
(b)             In column B: "European" code related to the type of product - to be developed




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                                                                       G2


G2
New life business analysis

      A                B               C               D               E              F                 G               H           I
                                                                     Regular premium business        Single premium business
                                                    Product         Number of       Amount of        Number of      Amount of   Technical
 DB / RA / RC      New / incr      Product ID
                                                   description   insured persons    premiums      insured persons   premiums    provisions




(a)             In column A, either: DB = direct business, RA = reassurance accepted, RC = reassurance ceded
(b)             In column B, either: new = new policies, incr = increments.




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                                                         G3


G3
Non-life Insurance Premium Information
Note    Only required for major lines of business
        Future cashflow assumptions from existing business

        Line of business

                                    1       2      3          4   5+
       1 Future gross premiums
       2 Future net premiums
       3 Future premium expenses

       4 Discounted Gross Future Premium Reserve
       5 Discounted Net Future Premium Reserve




541560c5-6aef-44aa-82a5-6802c775f942.xls               Page 36         7/26/2011
                                                          G4


G4
Projection of future cash flows

                                                                               Non-life insurance
                                     Life insurance obligations
                                                                                  obligations
                                  Cash out-flows
          Year (projection
                               Future         Future                        Cash out-
          of undiscounted                             Cash in-flows                     Cash in-flows
                             Guaranteed Discretionary                         flows
             cash-flows)
                              Benefits       Benefits
                   0
                   1
                   2
                   3
                   4
                   5
                   6
                   7
                   8
                   9
                  10
                  11
                  12
                  13
                  14
                  15
                  16
                  17
                  18
                  19
                  20
                  21
                  22
                  23
                  24
                  25
                  26
                  27
                  28
                  29
                 30<
           Value of future
                               formula        formula             formula    formula        formula
          cash-flows (sum)
          Expected present
           value of future
             cash-flows




541560c5-6aef-44aa-82a5-6802c775f942.xls                Page 37                                         7/26/2011
                                                                                                          H1




H1
Non-life IBNR

     Line of business:

     Gross IBNR (amount)                                                                                          Gross IBNR (number)


                           A             B                C              D           E = A - (B+C+D)                                        F                G                    H                I
                    Gross IBNR                      Gross claims
                      provision                     provision (at
                                    Amount of      the end of the
                     (amount at                                                                                                                      Number of claims
                                 gross payments year) referred Gross IBNR                                                         Number of IBNR                            Number of
                          the                                                                                                                        reported in 2012                     Number of IBNR
                                    in 2012 for       to claims      provision                                                       claims (as                            RBNS claims
                    beginning of                                                   Profit/Loss (IBNR)                                              (with accident year <                     claims (as
     Accident Year               claims reported     reported in    (amount at                                    Accident Year   estimated at the                       reported in each
                     the year as                                                                                                                    2012) (net of those                   estimated at the
                                   in 2012 with      2012 (with   the end of the                                                     end of the                            calendar year
                    estimated at                                                                                                                      settled without                     end of the year)
                                  accident year < accident year <      year)                                                       previous year)                         (accident year)
                      the end of                                                                                                                     payment in 2012)
                                       2012         2012) but not
                    the previous
                        year)                      settled during
                                                       the year
         2003                                                                      formula                            2003
         2004                                                                      formula                            2004
         2005                                                                      formula                            2005
         2006                                                                      formula                            2006
         2007                                                                      formula                            2007
         2008                                                                      formula                            2008
         2009                                                                      formula                            2009
         2010                                                                      formula                            2010
         2011                                                                      formula                            2011
         2012                                                                      formula                            2012
         Total     formula       formula          formula         formula          formula                            Total       formula          formula              formula          formula




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                                                                                                                                        H2




H2
Gross Claims Outstanding (RBNS)

     Line of business:
     Currency


                               A                   B                    C               D = (C-B)                E                 F                    G            H = E - (F+G)         I = A - (C+E)             L        M=L-I     N=D+H-M
                                                                                                                                                                     Gross claims     Gross claims
                                                                                                                                                                       provision        provision         Increase
                                                                                                                                                                      referred to      referred to    (decrease) of the
                                                   Gross claims                                      Gross claims Amount of                          Profit/Loss        claims           claims         gross claims
                                     Amount of                                                                                  Amount of gross
                   Gross claims                     provision (at                                       provision      gross                        (from claims    outstanding at   outstanding at provision referred
                                 gross payments                                    Profit/Loss (from                             claim provision
                     provision                     the beginning                                       referred to  payments in                    settled without the beginning of the beginning of      to claims
                                     in 2012 for                                      payment of                                (at the end of the
     Accident Year (amount at                       of the year)                                     claims settled   2012 for                      payment and      the year that    the year that  outstanding at the Total Profit/Loss
                                   claims settled                                       claims)                                  year) for claims
                  the beginning                      referred to                                         in 2012     claims re-                       claims re-     aren't settled   aren't settled  beginning of the
                                    (partially or                                                                                 re-opened in
                    of the year)                   claims settled                                     without any    opened in                         opened)     (with or without (with or without   year that aren't
                                  totally) in 2012                                                                                     2012
                                                     in 2012 (a)                                        payment         2012                                       payment) in 2012    payment) in     settled (with or
                                                                                                                                                                    (amount at the 2012 (amount at without payment)
                                                                                                                                                                   beginning of the the end of the         in 2012
                                                                                                                                                                         year)            year)
          2003                                                                     formula                                                                          formula             formula                          formula      formula
          2004                                                                     formula                                                                          formula             formula                          formula      formula
          2005                                                                     formula                                                                          formula             formula                          formula      formula
          2006                                                                     formula                                                                          formula             formula                          formula      formula
          2007                                                                     formula                                                                          formula             formula                          formula      formula
          2008                                                                     formula                                                                          formula             formula                          formula      formula
          2009                                                                     formula                                                                          formula             formula                          formula      formula
          2010                                                                     formula                                                                          formula             formula                          formula      formula
          2011                                                                     formula                                                                          formula             formula                          formula      formula
          Total        formula           formula              formula              formula               formula            formula           formula               formula             formula            formula       formula      formula

(a) For claims partially settled in 2012 it has to be reported only the part of the claim provision that the undertaking deem to be not necessary for the payment of the remaining part of the claims




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                                                                                                                                                                                                                        H3




H3
Non-life Insurance Claims Information (including allocated claims management expenses)
Note          CEIOPS will consider later whether the number of periods may differ depending on tail of business
              Solvency II basis

Line of Business                                                                                                                Methodology used
Currency                                                                                                                        Tail factor used

Latest Year               2012
                                                                                                                                       UNDISCOUNTED Notified Outstanding Claims                                                                                      UNDISCOUNTED Incurred But Not Reported (IBNR & IBNER)                                                                   Best estimate
                                                                                                                                                                                                                                                                                                                                                                                                relating to
Gross Claims Paid (Incremental)                                                                                                        Gross Claims Outstanding                                                                                                      Gross IBNR (including claims arising from unexpired exposure)                                                              unexpired
                                                                                                                                                                                                                                                                                                                                                                                                      risks
                 1        2         3         4         5         6          7      8       9       10        In Current year                        1         2         3         4         5         6          7      8       9       10               Year end               1         2         3         4         5         6          7      8       9       10               Year end   Year end
  Prior                                                                                                            formula               Prior                                                                                                           formula       Prior                                                                                                         formula
  2003                                                                                                             formula               2003                                                                                                            formula       2003                                                                                                          formula
  2004                                                                                                             formula               2004                                                                                                            formula       2004                                                                                                          formula
  2005                                                                                                             formula               2005                                                                                                            formula       2005                                                                                                          formula
  2006                                                                                                             formula               2006                                                                                                            formula       2006                                                                                                          formula
  2007                                                                                                             formula               2007                                                                                                            formula       2007                                                                                                          formula
  2008                                                                                                             formula               2008                                                                                                            formula       2008                                                                                                          formula
  2009                                                                                                             formula               2009                                                                                                            formula       2009                                                                                                          formula
  2010                                                                                                             formula               2010                                                                                                            formula       2010                                                                                                          formula
  2011                                                                                                             formula               2011                                                                                                            formula       2011                                                                                                          formula
  2012                                                                                                             formula               2012                                                                                                            formula       2012                                                                                                          formula
                                                                                                            Total  formula                                                                                                                       Total   formula                                                                                                             Total   formula

Salvage and subrogation (included within Gross Claims Paid)                                                                            Salvage and subrogation (included within Gross Claims Outstanding)                                                            Salvage and subrogation (included within Gross IBNR)

                 1        2         3         4         5         6          7      8       9       10        In Current year                        1         2         3         4         5         6          7      8       9       10               Year end               1         2         3         4         5         6          7      8       9       10               Year end
  Prior                                                                                                            formula               Prior                                                                                                           formula       Prior                                                                                                         formula
   -9                                                                                                              formula                -9                                                                                                             formula        -9                                                                                                           formula
   -8                                                                                                              formula                -8                                                                                                             formula        -8                                                                                                           formula
   -7                                                                                                              formula                -7                                                                                                             formula        -7                                                                                                           formula
   -6                                                                                                              formula                -6                                                                                                             formula        -6                                                                                                           formula
   -5                                                                                                              formula                -5                                                                                                             formula        -5                                                                                                           formula
   -4                                                                                                              formula                -4                                                                                                             formula        -4                                                                                                           formula
   -3                                                                                                              formula                -3                                                                                                             formula        -3                                                                                                           formula
   -2                                                                                                              formula                -2                                                                                                             formula        -2                                                                                                           formula
   -1                                                                                                              formula                -1                                                                                                             formula        -1                                                                                                           formula
    0                                                                                                              formula                 0                                                                                                             formula         0                                                                                                           formula
                                                                                                            Total  formula                                                                                                                       Total   formula                                                                                                             Total   formula


                                                                                                                                                                                                                                                                                                                                                                                             Best estimate
                                                                                                                                                                                                                                                                                                                                                                                                relating to
Reinsurance Recoveries Paid (Incremental)                                                                                              Reinsurance Claims Outstanding                                                                                                Reinsurance IBNR (including claims arising from unexpired exposure)                                                        unexpired
                                                                                                                                                                                                                                                                                                                                                                                                      risks
                 1        2         3         4         5         6          7      8       9       10                  In CY                        1         2         3         4         5         6          7      8       9       10               Year end               1         2         3         4         5         6          7      8       9       10               Year end   Year end
  Prior                                                                                                             formula              Prior                                                                                                           formula       Prior                                                                                                         formula
  2003                                                                                                              formula              2003                                                                                                            formula       2003                                                                                                          formula
  2004                                                                                                              formula              2004                                                                                                            formula       2004                                                                                                          formula
  2005                                                                                                              formula              2005                                                                                                            formula       2005                                                                                                          formula
  2006                                                                                                              formula              2006                                                                                                            formula       2006                                                                                                          formula
  2007                                                                                                              formula              2007                                                                                                            formula       2007                                                                                                          formula
  2008                                                                                                              formula              2008                                                                                                            formula       2008                                                                                                          formula
  2009                                                                                                              formula              2009                                                                                                            formula       2009                                                                                                          formula
  2010                                                                                                              formula              2010                                                                                                            formula       2010                                                                                                          formula
  2011                                                                                                              formula              2011                                                                                                            formula       2011                                                                                                          formula
  2012                                                                                                              formula              2012                                                                                                            formula       2012                                                                                                          formula
                                                                                                            Total   formula                                                                                                                      Total   formula                                                                                                             Total   formula


                                                                                                                                                                                                                                                                                                                                                                                             Best estimate
                                                                                                                                                                                                                                                                                                                                                                                                relating to
Net Claims Paid (Incremental)                                                                                                          Net Claims Outstanding                                                                                                        Net Reinsurance IBNR (including claims arising from unexpired exposure)                                                    unexpired
                                                                                                                                                                                                                                                                                                                                                                                                      risks
                 1        2         3         4         5         6          7       8       9       10                 In CY                        1         2         3         4         5         6          7       8       9       10              Year end               1         2         3         4         5         6          7       8       9       10              Year end    Year end
  Prior                                                                                           formula           formula              Prior                                                                                         formula           formula       Prior                                                                                       formula           formula     formula
  2003        formula   formula   formula   formula   formula   formula   formula formula formula formula           formula              2003      formula   formula   formula   formula   formula   formula   formula formula formula formula           formula       2003    formula   formula   formula   formula   formula   formula   formula formula formula formula                       formula
  2004        formula   formula   formula   formula   formula   formula   formula formula formula                   formula              2004      formula   formula   formula   formula   formula   formula   formula formula formula                   formula       2004    formula   formula   formula   formula   formula   formula   formula formula formula                   formula     formula
  2005        formula   formula   formula   formula   formula   formula   formula formula                           formula              2005      formula   formula   formula   formula   formula   formula   formula formula                           formula       2005    formula   formula   formula   formula   formula   formula   formula formula                           formula     formula
  2006        formula   formula   formula   formula   formula   formula   formula                                   formula              2006      formula   formula   formula   formula   formula   formula   formula                                   formula       2006    formula   formula   formula   formula   formula   formula   formula                                   formula     formula
  2007        formula   formula   formula   formula   formula   formula                                             formula              2007      formula   formula   formula   formula   formula   formula                                             formula       2007    formula   formula   formula   formula   formula   formula                                             formula     formula
  2008        formula   formula   formula   formula   formula                                                       formula              2008      formula   formula   formula   formula   formula                                                       formula       2008    formula   formula   formula   formula   formula                                                       formula     formula
  2009        formula   formula   formula   formula                                                                 formula              2009      formula   formula   formula   formula                                                                 formula       2009    formula   formula   formula   formula                                                                 formula     formula
  2010        formula   formula   formula                                                                           formula              2010      formula   formula   formula                                                                           formula       2010    formula   formula   formula                                                                           formula     formula
  2011        formula   formula                                                                                     formula              2011      formula   formula                                                                                     formula       2011    formula   formula                                                                                     formula     formula
  2012        formula                                                                                               formula              2012      formula                                                                                               formula       2012    formula                                                                                               formula     formula
                                                                                                            Total   formula                                                                                                                      Total   formula                                                                                                             Total   formula     formula


Salvage and subrogation - completed only where significant
Proportionality principle may apply in 5 different areas - period to be used (annual/quarter); number of periods to report; different granularity of Lines of business; some undertakings exempt; and currency detail if relevant




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                                                                                                                                              Page 40                                                                                                                                                                                 7/26/2011
                                                                                  H4


H4
Information on annuities and life-like liabilities stemming from Non-Life Insurance Claims
Note    Dependent on segmentation re health

               A                 B                 C                 D                 E               F                  G                H
            Line of                            Number of                                         Annual amount        Amount of        Technical
                          Type of liability                    Average age         Duration
           business                           beneficiaries                                       of annuities         claims          provisions




In column A: Relevant types set by the home state (e.g. annuities, life assistance, split by: type of pension, incapacity levels and/or legal state
of pension, etc...)




541560c5-6aef-44aa-82a5-6802c775f942.xls                                       Page 41                                                                7/26/2011
                                                                              H5


H5
Non-life Insurance Exposure & Claim Numbers
Note      Solvency II basis

Line of Business
Currency

Latest Year         2012

Number of claims settled (Incremental)                                                               Total Claims            Total Claims
                                                                                                           Settled           Outstanding
              1      2        3      4       5       6       7        8       9         10                 to date                 to date
  2003                                                                                                 formula
  2004                                                                                                 formula
  2005                                                                                                 formula
  2006                                                                                                 formula
  2007                                                                                                 formula
  2008                                                                                                 formula
  2009                                                                                                 formula
  2010                                                                                                 formula
  2011                                                                                                 formula
  2012                                                                                                 formula
                                                                                             Total     formula     formula

Exposure Data

              1                   Appropriate Exposure will vary by class of business
  2003                            Motor:         Vehicle Years
  2004                            Property:      Sum Insured
  2005                            Liability:
  2006
  2007
  2008
  2009
  2010
  2011
  2012




541560c5-6aef-44aa-82a5-6802c775f942.xls                                    Page 42                                                          7/26/2011
                                                                                J1



J1
Risk profile
Note   Graduation of data ranges (columns B and C) to be determined

            A                B                     C                      D                       E                  F                  G
         Line of                                                                                                               Total gross written
        business     Start sum insured     End sum insured        Number of risks         Total exposure    Average exposure        premium




       Total                                                    formula                 formula            formula             formula




541560c5-6aef-44aa-82a5-6802c775f942.xls                                      Page 43                                                                7/26/2011
                                                                                                      J2




J2
Loss profile
Note Graduation of data ranges (columns B and C) to be determined

           A             B             C             D               E             F              G             H              J             K              L             M              N
        Line of    Start losses   End losses     Number of     Total losses    Number of    Total losses    Number of    Total losses    Number of    Total losses    Number of    Total losses
       business     incurred       incurred       losses T      incurred T     losses T-1   incurred T-1    losses T-2   incurred T-2    losses T-3   incurred T-3    losses T-4   incurred T-4




      Total                                     formula       formula         formula       formula        formula       formula        formula       formula        formula       formula




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                          Page 44                                                                                         7/26/2011
                                                                                   J3



J3
Facultative risks non-life (10 biggest)

               A                   B                C                  D                  E               F               G               H
                                                                                                                                      Facultative
                                                                                      Probable                                       reinsurance
       Line of business        Insured       Description risk    Sum insured        maximum loss     Share insurer   Sum reinsured     premium




       Facultative risks life (10 biggest)
               A                    B               C                  D                  E               F
                                                                                                      Facultative
                                                                Share insurer in    Reinsured risk   reinsurance
       Line of business        insured         Risk capital       risk capital          capital        premium




541560c5-6aef-44aa-82a5-6802c775f942.xls                                       Page 45                                                              7/26/2011
                                                                                                                                       J4




J4
Share reinsurers

                                                                                                                 Technical provisions                    Current account                               Earned outgoing reinsurance premium




                              Type of re-
          Legal name           insurer                                                                                                                                            Deposits
           reinsurer             (a)               Domicile            Rating          Rating agency   Ceded premiums        Ceded losses        Receivables          Debts       received       Property           Casualty          Health




       Total                                                                                           formula             formula             formula          formula       formula        formula            formula          formula

(a)    Either insurance company, internal reinsurer, external reinsurer or reinsurance captive




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                                                             Page 46                                                                                                   7/26/2011
                                                                                                                  J5




J5
Outgoing Reinsurance Program in the coming accounting year
             A                     B                      C                       D                   E                 F            G             H                J              K                 L
                                                                                                                                                                                                  Earned
                          Type of reinsurance                           Validity period (start   Retention or                  Maximum cover Maximum cover                                     reinsurance
      Line of business           treaty          Name of reinsurer(s)    date & expiry date)       priority            Limit   per risk or event per treaty   Specification   Share placed       premium
                         Quota Share
                         Surplus
                         Working XL
                         Catastrophe XL
                         Stop-Loss
                         Financial Reinsurance
     Total                                                                                                                                                                                   formula




541560c5-6aef-44aa-82a5-6802c775f942.xls                                                                        Page 47                                                                                      7/26/2011

				
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