Schedule 2

SECOND SCHEDULERegulation 18(1)INSURANCE ACT (CHAPTER 142)INSURANCE (APPROVED MARINE, AVIATION AND TRANSIT INSURANCE BROKERS AND APPROVED REINSURANCE BROKERS) REGULATIONSFORMNAME OF APPROVED INSURANCE BROKER _________________________PLACEMENT OF BUSINESS HANDLED FOR THE FINANCIAL YEAR ______ TO ______I.Approved MAT Insurance Broking BusinessPlacement withPremiums (S$)(a)Registered insurers(b)Approved MAT insurers(c)Other US Financial Institutions Total II.Approved General Reinsurance Broking BusinessPlacement withPremiums (S$)(a)Registered insurers(b)Authorised General Reinsurers(c)Others Total III.Approved Life Reinsurance Broking BusinessPlacement withPremiums (S$)(a)Registered insurers(b)Authorised Life Reinsurers(c)Others Total Notes:1.“Premiums” refers to premiums received or receivable during the financial year, including brokerage.2.“Authorised General Reinsurers” refers to persons who are authorised under section 8A of the Insurance Act to carry on general business.3.“Authorised Life Reinsurers” refers to persons who are authorised under section 8A of the Insurance Act to carry on life business.Names and signatures of:___________________ Director___________________ Director___________________ Chief Executive OfficerDate: ______________ ___________________ [G.N. No. S 681/2003]