PT XYZ LIFE INSURANCE COMPANY DETAILS 101 TIME DEPOSITS AND DEPOSIT CERTIFICATES

Transcription

1 PT XYZ LIFE INSURANCE COMPANY DETAILS 101 TIME DEPOSITS AND DEPOSIT CERTIFICATES Per Quarter Year No. Bank Name Rating Cluster General Ledger AYD (in million rupiah) Current General Notes Ledger (1) (2) (3) (4) (5) (6) (7) (8) 1 PT... Time Deposit Deposit Certificates Sub Total 2 PT... Time Deposit Deposit Certificates Sub Total 3 PT... Time Deposit Deposit Certificates Sub Total 4 PT... Time Deposit Deposit Certificates Sub Total 5 PT... Time Deposit Deposit Certificates Sub Total Total Time Deposit Total Deposit Certificates Total

2 No. Issuer Name PT XYZ LIFE INSURANCE COMPANY DETAILS 102 SHARES Per Quarter Year Category General Ledger AYD Current General Ledger (in million rupiah) Notes (1) (2) (3) (4) (5) (6) (7) Total

3 PT XYZ LIFE INSURANCE COMPANY DETAILS 103 CORPORATE BOND AND CORPORATE SUKUK Per Quarter Year (in million rupiah) No. Issuer Name Rating Cluster General Ledger Difference between SAP and SAK valuation AYD Current General Ledger (Less than One Year) Notes (1) (2) (3) (4) (5) (6) (7) (8) (9) 1 PT... Corporate Bond Corporate Sukuk Sub Total 2 PT... Corporate Bond Corporate Sukuk Sub Total 3 PT... Corporate Bond Corporate Sukuk Sub Total 4 PT... Corporate Bond Corporate Sukuk Sub Total 5 PT... Corporate Bond Corporate Sukuk Sub Total Total Corporate Bond Total Corporate Sukuk Total

4 PT XYZ LIFE INSURANCE COMPANY DETAILS 104 SECURITIES ISSUED BY REPUBLIC OF INDONESIA Per Quarter Year No. Securities Name General Ledger Difference between SAP and SAK valuation AYD Current General Ledger (Less Than One Year) (1) (2) (3) (4) (5) (6) T o t a l

5 No. Issuer/ Issuing Country PT XYZ LIFE INSURANCE COMPANY DETAILS 105 SECURITIES ISSUED BY COUNTRIES OTHER THAN INDONESIA Rating Cluster General Ledger Difference between SAK and SAP valuations (in millions Rupiah) AYD Current Ledger (Less than a Year) (1) (2) (3) (4) (5) (6) (7) (8) Total

6 PT XYZ LIFE INSURANCE COMPANY DETAILS 106 SECURITIES ISSUED BY BANK INDONESIA Per Quarter Year No. Securities General Ledger Difference between AYD Current General Ledger (Less Than One Year) (1) Name (2) (3) SAP and SAK valuation (4) (5) (6) Total

7 PT XYZ LIFE INSURANCE COMPANY DETAILS 107 SECURITIES ISSUED BY MULTINATIONAL ENTITIES Per Quarter Year No. Securities Name General Ledger Difference between SAP and SAK valuation AYD Current General Ledger (Less Than One Year) (1) (2) (3) (4) (5) (6) Total

8 No. Mutual Fund Name Investment Manager PT XZY LIFE INSURANCE COMPANY DETAILS 108 MUTUAL FUND. Quarter. Year. General Ledger AYD General Ledger (1) (2) (3) (4) (5) (6) (7) Notes I 100% Government Securities II Total I Private and or money market securities III Equity Total II IV Total III Mixed/d Total IV Total Mutual Funds ( I+II+III+IV )

9 PT XZY LIFE INSURANCE COMPANY DETAILS 109 ASSET-BACKED SECURITIES INVESTMENT COLLECTIVE CONTRACT. Quarter. Year. No. Issuer Name/ Investment Manager Rating Cluster General Ledger Difference between SAP and SAK valuation AYD Current General Ledger (Less Than One Year) Notes (1) (2) (3) (4) (5) (6) (7) (8) (9) T o t a l

10 PT XZY LIFE INSURANCE COMPANY DETAILS 110 REAL ESTATE INVESTMENT FUND. Quarter. Year. No. Issuer Name/ Investment Manager Rating Cluster General Ledger Difference between SAP and SAK valuation AYD Current General Ledger (Less Than One Year) Notes (1) (2) (3) (4) (5) (6) (7) (8) (9) T o t a l

11 PT XZY LIFE INSURANCE COMPANY DETAILS 111 DIRECT INVESTMENT. Quarter. Year. No. Company Name Business Type Ownership (%) General Ledger Difference between SAK and SAP valuation AYD Notes (1) (2) (3) (4) (5) (6) (7) (8) I Under OJK Supervision Sub Total I II Not Under OJK Supervision Sub Total II Total Direct Investment

12 PT XYZ LIFE INSURANCE COMPANY DETAILS 112 BUILDINGS WITH STRATA-TITLE RIGHTS OR LAND WITH BUILDINGS FOR INVESTMENT Per Quarter Year (in million rupiah) No. Address General Ledger SAP-Based Valuation (Appraisal Value/ NJOP) Difference between SAP and SAK valuation (1) (2) (3) (4) (5) I Investment Yield of > 4% per year Sub Total I II Investment Yield of 2% - 4% per year Sub Total II III Investment Yield < 2% per year Sub Total III Total (I + II + III) IV Admitted Asset (Max. 10% of total investment)

13 PT XYZ LIFE INSURANCE COMPANY DETAILS 113 PURCHASE OF RECEIVABLES FOR FINANCING COMPANY AND/OR BANK Quarter Year.. No. Financing Company/ Bank Business Permit General Ledger AYD Current General Ledger (Less Than One Year) (in million rupiah) Notes (1) (2) (3) (4) (5) (6) (7) I Lease Total I II Credit Card III Total II Consumer Financing Total III Total Mutual Fund ( I+II+III)

14 PT XYZ LIFE INSURANCE COMPANY DETAILS 114 PURE GOLD Quarter.. Year.. No. Custodian Bank Name Quantity (pcs / gr) General Ledger Difference between SAP and SAK valuation AYD Current General Ledger (Less Than One Year) (1) (2) (3) (4) (5) (6) (7) Total Gold

15 LIFE INSURANCE COMPANY DETAILS 115 MORTGAGE-BACKED LOAN No. Debtor Name Land Certificate Number Collateral Value (Appraisal or NJOP) Initial Loan Value General Ledger AYD Current General Ledger (Less Than One Year) (1) (2) (3) (4) (5) (6) (7) (8) I Residential Property a. LTV<60% b. 60%<LTV<80% II Sub Total I Other Commercial Property a. LTV<60% b. 60%<LTV<80% III Sub Total II Unused property Sub Total III Total (I + II + III)

16 LIFE INSURANCE COMPANY DETAILS 116 OTHER INVESTMENT No. Description Amount (1) (2) (3) Total Other Investment

17 PT XYZ LIFE INSURANCE COMPANY DETAILS 201 DIRECT PREMIUM WRITTEN RECEIVABLES No. Insurance Branch General Ledger AYD Current General Ledger (Less Than One Year) (1) (2) (3) (4) (5) I Life Insurance Term Insurance) Endowment and/or its Combination Whole Life Sub Total II III IV Annuity 1-Year Term Personal accident V VI Health Others Sub Total Total Details of receivables by age (in million rupiah) No. Insurance Branch Less than or equal to 2 months 2-3 months More than 3 months (1) (2) (3) (4) (5) I Life Insurance Term Insurance) Endowment and/or its Combination Whole Life Sub Total

18 III IV V VI 1-Year Term Personal accident Health Others Sub Total Total

19 LIFE INSURANCE COMPANY DETAILS 202 CO-INSURANCE CLAIM RECEIVABLES No. Debtor Rating Cluster General Ledger AYD General Ledger (Less Than One Year) (1) (2) (3) (4) (5) (6) (7) I Under OJK Supervision II Sub Total I Not Under OJK Supervision Sub Total II Total I + II Details of Receivables by age (in million rupiahs) No. Debtor Name Less than or equal to 2 months 2 to 3 months More than 3 months (1) (2) (3 ) (4) (5) I Under OJK Supervision

20 II Sub Total II Total I + II

21 LIFE INSURANCE COMPANY DETAILS 203 REINSURANCE RECEIVABLES No. Debtor Rating Cluster General Ledger AYD Current General Ledger (Less Than One Year) (1) (2) (3) (4) (5) (6) (7) A I II Inward Reinsurance Premium Receivables and Claim Recovery Under OJK Supervision Sub Total I Not Under OJK Supervision Sub Total II B III Reinsurance Asset Under OJK Supervision Sub Total III IV Not Under OJK Supervision Sub Total IV Total I + II + III + IV

22 No. Debtor s name Lessor equal to 2 months Moe than 2 months up to 3 months More than 3 months (1) (2) (3) (4) (5) A I Inward Reinsurance Premium Receivables and Claim Recovery Under OJK supervision II Sub Total I Not under OJK supervision B III Sub Total II Reinsurance Asset Under OJK supervision IV Sub Total III Not under OJK supervision Sub Total IV Total I + II + III +4

23 LIFE INSURANCE COMPANY DETAILS 204 INVESTMENT RECEIVABLES No. Investment Type General Ledger AYD Current General Ledger (Less Than One year) (1) (2) (3) (4) (5) Time Deposit & Deposit Certificate Shares Corporate Bond & Corporate Sukuk Securities issued by Republic of Indonesia Securities issued by Countries other than Republic of Indonesia Securities issued by Bank Indonesia Securities Issued by Multinational Entities Mutual Funds Asset-Backed Securities Investment Collective Contract Real Estate Investment Fund Direct Investment Building with Strata-title Right or Land with Building for Investment Purchase of Receivables Pure Gold Mortgage-backed loans Other Investments Total No. Details of Receivables by age Type of Investment Less than or equal to 1 month 1 to 3 months (in million rupiah) More than 3 months (1) (2) (3) (4) (5) Time Deposit & Deposit Certificate Shares Corporate Bond & Corporate Sukuk Securities issued by Republic of Indonesia Securities issued by Countries other than Republic of Indonesia Securities issued by Bank Indonesia Securities Issued by Multinational Entities Mutual Funds Asset-Backed Securities Investment Collective Contract Real Estate Investment Fund Direct Investment Building with Strata-title Right or Land with Building for Investment

24 LIFE INSURANCE COMPANY DETAILS 205 INVESTMENT YIELD RECEIVABLE No. Investment Type General Ledger AYD Current General Ledger (Less Than One year) (1) (2) (3) (4) (5) Time Deposit & Deposit Certificate Shares Corporate Bond & Corporate Sukuk Securities issued by Republic of Indonesia Securities issued by Countries other than Republic of Indonesia Securities issued by Bank Indonesia Securities Issued by Multinational Entities Mutual Funds Asset-Backed Securities Investment Collective Contract Real Estate Investment Fund Direct Investment Building with Strata-title Right or Land with Building for Investment Purchase of Receivables Pure Gold Mortgage-backed loans Other Investments Total No. Details of Receivables by age Type of Investment Less than or equal to 1 month 1 to 3 months (in million rupiah) More than 3 months (1) (2) (3) (4) (5)

25 Shares Corporate Bond & Corporate Sukuk Securities issued by Republic of Indonesia Securities issued by Countries other than Republic of Indonesia Securities issued by Bank Indonesia Securities Issued by Multinational Entities Mutual Funds Asset-Backed Securities Investment Collective Contract Real Estate Investment Fund Direct Investment Building with Strata-title Right or Land with Building for Investment Purchase of Receivables Pure Gold Collateral-backed loans Other Investments Total

26 LIFE INSURANCE COMPANY DETAILS 206 POLICY LOAN No. Description Cash Value of the Insured Policy General Ledger AYD Current General Ledger (Less Than One Year) (1) (2) (3) (4) (5) (6) I. Loan Opening : a. APL (Automatic Policy Loan) b. Non APL II. Current Period Loan : a. APL (Automatic Policy Loan) b. Non APL b. Non APL Total

27 LIFE INSURANCE COMPANY DETAILS 207 BUILDING WITH STRATA-TITLE RIGHTS OR LAND WITH BUILDING FOR OWN-USE No. Location Address General Ledger SAP-Based Valuation (Appraisal/NJ OP) Difference between SAK and SAP valuation (1) (2) (3) (4) (5) I II Admitted Asset Total (Maximum 15% Own-Capital in the Current Year)

28 LIFE INSURANCE COMPANY DETAILS 208 OTHER FIXED ASSETS No. Description Amount (1) (2) (3) Total Other Fixed Assets

29 LIFE INSURANCE COMPANY DETAILS 209 OTHER ASSETS No. Description Amount (1) (2) (3) Total Other Assets

30 LIFE INSURANCE COMPANY DETAILS 301 CLAIM PAYABLE No. Insurance Branch Claim Settled Date Own-Retention Reassurance Expense Total Current General Ledger (Less Than one Year) (1) (2) (3) (4) (5) (6) (7) I Life Insurance Term Life Endowment and/or its combination Whole Life S II III IV V VI Annuity 1-year term Personal accident Health Others Sub Total II+III+IV+V+VI Grand total Notes: Of the total Own-Retention Claim Payable, those that are more than 30 days is.

31 LIFE INSURANCE COMPANY DETAILS 302 CO-INSURANCE PAYABLE No. Creditor Name Rating Total (1) (2) (3) (4) (5) I Under OJK Supervision Current General Ledger (Less Than One Year) II Sub Total I Not under OJK Supervision Sub Total II Total I + II

32 LIFE INSURANCE COMPANY DETAILS 303 REINSURACE PAYABLE No. Creditor Name Rating Total (1) (2) (3) (4) (5) I Under OJK Supervision Current (Less Than One Year) II Sub Total I Not Under OJK Supervision Sub Total II Total I + II

33 LIFE INSURANCE COMPANY DETAILS 304 COMMISSION PAYABLE No. Insurance Branch Total Current General Ledger (less than one year) (1) (2) (3) (4) I Life Insurance Term Life Endowment and/or its combination Whole Life Sub Total I II III IV V VI Annuity 1-year term Personal accident Health Others Sub Total II+III+IV+V+VI Total

34 LIFE INSURANCE COMPANY DETAILS 305 ACCCRUED EXPENSES No. Description Amount (1) (2) (3) Total

35 No. Description PT XYZ LIFE INSURANCE COMPANY DETAILS 306 OTHER PAYABLES Amount (1) (2) (3) Total Other Payables

36 LIFE INSURANCE COMPANY DETAILS 401 PREMIUM RESERVE No. Insurance Branch Single Premium Policies Premium Reserve Paid-up policies Premium Reserve Regular Policy Premium Reserve (Installment) Total Policy (3) + (4) + (5) Premium Reserve - policies due in less than 1 year Quarter Year (Previous Period) Risk Reserve Accumulated Fund Reserve Risk Reserve Accumulated Fund Reserve Risk Reser ve Accumulated Fund Reserve (1) (2) (3) (4) (5) (6) (7) (8) A B Life Insurance 1. Term Life 2. Endowment and/or its combination 3. Whole Life Sub 4. others Total A Annuity Sub Total B Total Premium Reserve

37 LIFE INSURANCE COMPANY DETAILS 402 UNEARNED PREMIUM RESERVE No. Insurance Branch Single Premium Policies Premium Reserve Paid-up policies Premium Reserve Regular Policy Premium Reserve (Installment) Total (3) + (4) + (5) Year.../Quarter Policy Premium Reserve - policies due in less than 1 year Quarter Year (Previous Period) (1) (2) (3) (4) (5) (6) (7) (8) I Unearned Premium Reserve Tem Life Personal accident Health 4 Total CAPYBMP II Reserve for Risk Not Yet Undertaken Term Life Multiple Personal accident Health 8 Total CARYBD Max (CAPYBMP,CARYBD)

38 LIFE INSURANCE COMPANY DETAILS 403 CLAIM RESERVE No. Insurance Branch Total Claim On Process Claim Reserve IBNR Claim Reserve Quarter / Year Own- Expense Claim Total IBNR Claims Own-Expense IBNR Claim Total Claim Reserve Claim Reserve < 1 year Quarter / Year (Previous Period) (1) (2) (3) (4) (5) (6) (7) (8) (9) Term Life Personal accident Health Total

39 PT XYZ LIFE INSURANCE COMPANY DETAILS 501 PREMIUM INCOME (in Term Insurance Endowment and/its combination Whole Life Annuity 1-year term Personal accident Health t Premium nal Insurance Premium ment Premium (Annual, Semester, etc) Total sonal Product Premium up Insurance Total New Product Premium Premium Insurance b. surance Total Follow Up Premium Total Premium Income (2) (3) (4) (5) (6) (7) (8) (9) e Premium ncrease) of CAPYBMP (Increase) of CAPYBMP (Gross) ium Reserve in current year/quarter ium reserve in previous year/quarter (Increase) of Reassurance Asset over CAPYBMP surance Asset over CAPYBMP in current year/quarter ssurance Asset over CAPYBMP in previous year/quarter otal Increase (Decrease) CAPYBMP Net Premium Revenue ( )

40 No. Type of Investment After Tax Revenue PT XYZ LIFE INSURANCE COMPANY DETAILS 502 INVESTMENT YIELD Unrealized Gain (Loss) Total Investment Result Notes (Type of Result) Cash Receipt Receivable (1) (2) (3) (4) (5) (6) (7 ) I II Investment Placement on Non-Affiliated Entity Time Deposits and Certificates of Deposits Shares Corporate Bonds and Corporate Sukuk Securities Issued by Republic of Indonesia Securities Issued by Countries other than Republic of Indonesia Securities Issued by Bank Indonesia Securities Issued by Multinational Entities Mutual Funds Asset-Backed Securities Collective Investment Contract Real Estate Investment Fund Direct Investment Building with Strata-title Right or Land & Building for investment Purchase of Receivables for Financing Companies and/or Banks Pure Gold Mortgage-Backed Loan Other Investments Sub Total Investment Placement on Affiliated Entity Time Deposits and Certificates of Deposits Shares Corporate Bonds and Corporate Sukuk Securities Issued by Republic of Indonesia Securities Issued by Countries other than Republic of Indonesia Securities Issued by Bank Indonesia Securities Issued by Multinational Entities Mutual Funds Collective Investment Contract Asset-Backed Securities Real Estate Investment Fund Direct Investment Building with Strata-title Right or Land & Building for investment Purchase of Receivables for Financing Companies and/or Banks Pure Gold Mortgage-Backed Loan Other Investments Subtotal Gross investment return (17+34) Investment cost Net investment return (35-36)

41 LIFE INSURANCE COMPANY DETAILS 503 OTHER INCOME No. Description Total (1) (2) (3) Total Other Investment

42 PT XYZ LIFE INSURANCE COMPANY DETAILS 504 INSURANCE EXPENSE (in m Description Term Insurance Endowment and/or its Combination Whole Life Branch of Life Insurance Annuity 1-year term Health Personal accident Benefit Paid f Contract (Due Date) Death Value s aim and Benefit Paid ( ) (2) (3) (4) (5) (6) (7) 8 ) (9) ce Claim Decrease) Premium Reserve (Decrease) Premium Reserve (Gross) um Reserve of current year/quarter m Reserve of previous year/quarter (Decrease) Reassurance Assets on Premium Reserve ssurance Assets on Premium Reserve of current year/quarter ssurance Assets on Premium Reserve of previous year/quarter ase (Decrease) Premium Reserve (9-12) Decrease) of Claim Reserve (Decrease) Claim Reserve (Gross ) Reserve of current year/quarter Reserve previous year/quarter (Decrease) Reassurance Assets on Claim Reserve ance Assets on Claim Reserve current year/quarter rance Assets on Claim Reserve previous year/quarter Total Increase (Decrease) Claim Reserve (17-20) aim and Benefit Expense ( ) n Expense sion Expense FirstYear sionexpense Subsequent Year sion Expense Overriding pense uisition Expense Total Insurance Expense ( )

43 PT XYZ LIFE INSURANCE COMPANY DETAILS 505 OTHER INCOME (EXPENSE) No. Description Amount (1) (2) (3) I. Other Income Sub Total I II. Other Expense Sub Total II Total I - II -

44 PT XYZ LIFE INSURANCE COMPANY DETAILS 506 OTHER COMPREHENSIVE INCOME No. Description Amount (1) (2) (3) Difference in financial statement due to exchange rate of foreign currency Financial Assets Available For Sale Gain from Reevaluation of Fixed Assets Other comprehensive income from associated entities Total Comprehensive Income -

45 PT XYZ LIFE INSURANCE COMPANY DETAILS 601 CURRENT ASSETS AND LIABILITIES Quarter Quarter No. Description Year Year (1) (2) (3) (4) ASSETS Investment Time Deposits and Certificates of Deposits Shares Corporate Bonds and Corporate Sukuk Securities Issued by Republic of Indonesia Securities Issued by Countries other than Republic of Indonesia Securities Issued by Bank Indonesia Securities Issued by Multinational Entities Mutual Funds Asset-Backed Securities Collective Investment Contract Real Estate Direct Investment Fund Building with Strata-title Right or Land & Building for investment Purchase of Receivables for Financing Companies and/or Banks Pure Gold Mortgage-Backed Loan Other Investments Non-Investment Cash and Bank Direct Premium Written Receivable Co-insurance Claim Receivable Reassurance Receivable Investment Receivable Total Investment Policy Loan Investment Yield Receivable Other Current Assets Total TOTAL Non-Investment CURRENT ASSETS LIABILITIES Liabilities Technical Reserve Premium Reserve Unearned Premium Reserve Claim Reserve Total Technical Reserve

46 Payable Claim Payable Co-insurance Payable Reinsurance Payable Commission Payable Tax Payable Accrued Expenses Other Payables Total Payable TOTAL CURRENT LIABILITIES