Page:Statutes of Canada, Victoria 31, Part 2.djvu/140

Brunswick, so long as it shall not carry on business in the Dominion beyond the limits of that Province by the Legislature or Government of which it was incorporated, but it shall be lawful for any such company to avail itself of the provisions of this Act.

 

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SCHEDULE—FORMS.

Form A.

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

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

Form B.

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

	$ cts.
Assets of the Company.
Liabilities of the Company.
Amount of Capital Stock.
Amount paid thereon.
Of what the assets of the Company consist, viz: {insert particulars)
Amount of losses paid during the year.
Amount of losses due and unpaid Losses adjusted and not due.
Losses in suspense and waiting further proof.