AXA NA Form 9 - Insurance.pdf - Government of Anguilla

CONFIDENTIAL WHEN COMPLETED 

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SURVEY OF LIFE INSURANCE & GENERAL INSURANCE COMPANIES 

2007 

NATIONAL ACCOUNTS FORM 9 

This survey is being conducted under the Statistics Act, which makes provision of the 

information requested, a legal requirement. A copy of the Statistics Act can be viewed 

at: http://gov.ai/statistics/policies.htm/ 

Please return in enclosed addressed envelope to: STATISTICS DEPARTMENT 

P.O. BOX 60, 

THE VALLEY, ANGUILLA 

To call for collection or more information: Tel: (264) 497-5731/497-2451 EXT. 2874 

Fax: (264) 497-3986 

Email: statistics@gov.ai 

PLEASE READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING 

Please complete questionnaire in full. If there is no data to be provided, then mark with a 

0 (zero). The first page of the questionnaire will be removed once the information has 

been verified so no identification will remain with your data in the database. The 

information will be held in Strict Confidence and used only for statistical purposes. 

Please see notes for definition of various items. 

Identification of Officer responsible for completing the questionnaire 

Name………………………………… 

Position……………………………… 

Signature……………………………. 

Telephone:………………………..… 

Email address:……………………… 

Date………………………………….. 

SECTION 1 – DESCRIPTION OF ESTABLISHMENT 

1.1 Name of Establishment ……………………….………………………………. 

1.2 Physical Address………………………..………………………….…. 

1.3 Postal Address (if different from above)…………….………………………… 

1.4 Phone Number: (264)-……………….. Fax Number: (264) - ………………. 

1.5 Business Website ………………………………………………

FORM 9 –Life Insurance & General Insurance 

FOR OFFICIAL USE ONLY (Do not complete this box) 

Date Received……………………… 

Checked by………………………… 

AXABRN…………………… 

AXACEA…..……………….. 

1.6 Activity of Establishment. List activities in order of importance: 

1………………………………………. 

2………………………………….. 

1.7 Information used in the completion of this form is for the financial year: 

From …………………200_ to………………………..200_ 

1.8 Month and year operation started…………………………………………. 

1.9 Type of Ownership Structure (please indicate by a [√]) 

Individual proprietor [ ] Public Corporation [ ] 

Partnership [ ] Private Corporation [ ] 

Other specify ………………………………………………………………… 

1.10 Ownership of equity: 

……… % National 

………. % Foreign ……………….. 

(state country) 

1.11 State the number of persons on the payroll at the end of the following periods: 

Full–Time (FT): 35 hours or more per week. 

Part-Time (PT): less than 35 hours wkly 

INFORMATION IS FOR THE YEAR ENDED 2007 

Pay Period 

(A) 

Working 

Proprietors 

(B) 

Unpaid Family 

Workers 

June 2007 

December 2007 

(C) 

All Other 

Employed 

(A+B+C) 

Total 

Employed 

FT PT FT PT FT PT FT PT 

SECTION 2 - REVENUE 

Please tick [√] the currency that the financial information is provided. Please convert as 

needed by using the following rate: US$1.00 = EC$2.6882. 

. 

INFORMATION IS FOR THE FINANCIAL YEAR 2007 US $ EC $ 

REVENUE - LIFE INSURANCE $ 

2.1 Premiums Received 

2.2 Interest Earned on these reserves 

2.3 Rental/lease of machinery, buildings and equipment 

2.4 Income Earned on Dividends & Other Investments 

2.5 Other Receipts 

2.6 TOTAL LIFE INSURANCE (sum 2.1 to 2.5) 

2 

NATIONAL ACCOUNTS 2007



REVENUE - GENERAL INSURANCE $ 

2.7 Premiums Received 

2.8 Commission Received 

2.9 Reinsurance claims recovered 

2.10 Other Income 

2.11 TOTAL GENERAL INSURANCE (sum 2.7 to 2.10) 

TOTAL REVENUE (sum 2.6 and 2.11) 

SECTION 3 – CURRENT EXPENDITURE 


CURRENT EXPENDITURE $ 

3.1 Gross wages and salaries paid to employees 

3.2 Contributions by employers for employees 

3.3 Director’s Fees 

3.4 Cost of housing, medical, welfare facilities provided primarily for 

employees (excluding charities and donations). 

________________ 

3.5 Payments in Kind (e.g. free or subsidised meals, 

accommodation and staff transport) 

3.6 Any other payment to employees (specify) …………………..…. 

3.7 TOTAL LABOUR PAYMENTS (sum 3.1 to 3.6) 

3.8 Insurance (property, machinery, vehicles) 

3.9 Depreciation 

3.10 Bad debts written off, 

3.11 Donations 

3.12 Cost of Electricity 

3.13 Cost of Water 

3.14 Office Supplies 

3.15 Telephone, postage and other communications 

3.16 Professional Fees 

3.17 Cost of Fuel 

3.18 Sub-contract work 

3.19 Rental/lease of machinery, equipment and vehicles 

3.20 Rental/lease of building and land 

3.21 Royalties & Trademarks 

3.22 Interest Payments 

3.23 Computer services and maintenance of office equipment 

3.24 Maintenance and Repairs 

3.25 Advertising and Marketing 

3.26 

All taxes, duties and levies paid to government (fees, licenses 

etc) 

3.27 Scholarships and training 

3.28 Transportation Cost - Hired 

3.29 Security 

3.30 SUBTOTAL (sum 3.7 to 3.29) 

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B/fwd 3.30 

3.31 A Claims Paid (Life insurance) 

3.32 B Claims Paid (General insurance) 

3.33 A Commissions Paid (Life insurance) 

3.33 B Commissions Paid (General insurance) 

3.34 Reinsurance Premiums Paid (General insurance) 

3.35 

Additions to Reserves (Life Assurance Annuity Funds at the end 

of the year less funds at the beginning of the year) 

3.36 Other Current Expenses (not included elsewhere) 

TOTAL CURRENT EXPENDITURE (sum 3.31 to 3.36) 


SECTION 4 – CAPITAL EXPENDITURE 

FIXED ASSETS 

$ 

4.1 Land 

4.2 Buildings Purchased 

4.3 Machinery & Equipment 

4.4 Vehicles 

4.5 Buildings Constructed 

4.6 Other constructions (roads, sewage 

etc.)________ 

4.7 Other Capital Expenditure 

(specify)_________ 

TOTAL CAPITAL EXPENDITURE (sum 4.1 to 4.7) 

ACQUISITION 

DURING 2007 

DISPOSAL/SALE 

DURING 2007 

SECTION 5 - AVERAGE INSURANCE RATES in 2007 

5.1 Commercial Property 

5.2 Private Property 

5.3 Commercial Motor Vehicles 

5.4 Private Motor Vehicles 1200 - 1500 cc 

5.5 Private Motor Vehicles 1500 - 2000 cc 

5.6 Private Motor Vehicles above 2000 cc 

5.7 Pick-up Vans 1300 - 1600 cc 

5.8 Pick-up Vans 1600 - 2000 cc 

5.9 Pick-up Vans above 2000 cc 

4 



COMMENTS AND SUGGESTIONS 

Thank you for completing this questionnaire. Your comments and suggestions are 

welcomed. Please write them below. 

Your assistance and patience is appreciated 

YOU MAY FIND IT USEFUL TO TAKE A COPY OF THIS FORM FOR FUTURE REFERENCE OR TO 

ANSWER ANY QUERIES THAT MAY ARISE. 

5 


EXPLANATORY NOTES 


2.2 Interest Earned(Received) Income receivable by the owners of certain types of financial assets 

such as deposits, loans, securities, etc. 

2.4 Dividends Income to which shareholders become entitled to as a result of placing 

funds at the disposal of corporations. 

2.7 Insurance premiums received Include premiums received for life, accident, sickness, fire or other forms 

of insurance to individuals or groups. 

2.10 Other operating income Income from other sources related to the business, e.g., rental of 

buildings and equipment, commissions, ledger fees, exchange gain/loss, 

miscellaneous income, etc. Exclude grants, donations and subventions 

received, gains or losses on the sale of fixed assets and bad debts 

recovered. 

3.2 Contributions by employer for 

employees 

Include the employer's contributions to pension, insurance, social 

security and other schemes on behalf of employees. 

3.8 Insurance Premiums paid for motor vehicle, property and marine insurance. 

3.9 Depreciation and / or 

Amortization 

3.10 

& 

3.11 

Bad debts , net of recoveries 

and Donations 

3.15 Telephone, postage and other 

communication 

Includes the amount allocated during the reporting period to amortize the 

cost of acquiring long-term assets over the useful life of the asset. 

Include financial claims that can no longer be collected because of 

bankruptcy or other factors. 

Include cellular phone charges, the cost of courier and messenger 

services, fax, telex, and internet services. 

3.16 Professional Services Include expenditure on legal, accounting, audit, architectural and 

engineering services, management and other consultancy services. 

3.23 Computer services and 

maintenance of office 

equipment 

Include maintenance and repair of office and accounting machinery and 

of computers and computer peripheral equipment. 

3.25 Advertising and Marketing Include entertainment expenses. 

3.26 Other taxes and licences Include business fees, business and professional licences, property 

taxes, vehicle licences, and other fees paid to government on behalf of 

the business. 

3.36 Other expenses Include security services, janitorial services and other expenditures such 

as subscriptions, research and development, etc. Exclude bad debts, 

extraordinary items and other non-current items of expenditure. 

4.5 Buildings Value of new and existing buildings acquired during the year, less 

disposals of existing buildings. Include the value of extensions and major 

renovations to existing buildings. 

4.3 Machinery, equipment and 

other fixed assets 

Value of all new or second hand machinery and equipment, including 

transport equipment; office, accounting and computer equipment, 

including computer software; furniture, fixtures and furnishings and other 

durable goods acquired during the year, less disposals of similar items. 

6

AXA NA Form 9 - Insurance.pdf - Government of Anguilla

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