Quarterly Reports on Selected Financial Statistics

<!--.style1 {font-size: 12pt}--> June 21, 2016 INSURANCE CIRCULAR LETTER NO. 035-16 Supersedes: None TO : All Mutual Benefit Associations Authorized to Transact Business in the Philippines SUBJECT : Quarterly Reports on Selected Financial Statistics In view of the significance of the subject reports in monitoring and assessing the state and performance of the insurance industry, all mutual benefit associations (MBAs) are hereby enjoined to submit two (2) copies of the reports within the deadline prescribed herein. The quarterly reports using the attached templates shall be duly certified to by a responsible officer with a rank of at least Vice-President. The initial report covering the second quarter is due not later than 20 July 2016 while the subsequent reports will be due every 20th day of the month following the end of every quarter. The values that shall be reflected in the report as of the end of the quarter must represent cumulative amounts. A penalty of FIVE THOUSAND PESOS (P5,000.00) for each day of delay in the submission of quarterly reports and FIVE HUNDRED PESOS (P500.00) for every wrong data entry of material information shall be imposed pursuant to Circular Letter No. 2014-15 dated May 15, 2014. For strict compliance. (SGD.) EMMANUEL F. DOOC Insurance Commissioner ATTACHMENT _______________________ Name of the Association Report on Selected Financial Statistics on Mutual Benefit Associations (MBAs) As of the Quarter ending _______________ (Indicate the applicable date) Check appropriate box: Regular MBA [ ] Microinsurance MBA [ ] I. Financial Condition Assets 1. Cash and invested assets P____________ 2. Members' Fees & Dues Receivable ____________ 3. Members' Contributions Due and Uncollected ____________ 4. Net Premiums Due and Uncollected ____________ 5. Unremitted Members' Contributions, ____________ Dues and Fees 6. Unremitted Premiums ____________ 7. Amounts Recoverable from Reinsurers ____________ 8. Other Assets ____________ Total Assets (sum of lines 1 to 8) P___________- Liabilities 9. Liability on Individual Equity Value P____________ 10. Basic Contingent Benefit Reserve ____________ 11. Optional Benefit Reserve ____________ 12. Claims Payable on Basic Contingent Benefit ____________ 13. Claims Payable on Optional Benefits ____________ 14. Amounts Due to Reinsurers ____________ 15. Other Liabilities ____________ Total Liabilities (sum of lines 9 to 15) P___________- Fund Balance 16. Assigned Fund Balance (16.1 + 16.2 + 16.3 + 16.4) P___________- 16.1 Funds Assigned for Guaranty Fund P________ 16.2 Funds Assigned for Members' Benefits ________ 16.3 Funds Assigned for Community Development ________ 16.4 Others 17. Revaluation/Fluctuation Reserve ____________ 18. Free and Unassigned Fund Balance ____________ Total Fund Balance (sum of lines 18 to 18) P___________- Total Liabilities and Fund Balance P___________- Notes: Cash and invested assets includes: Bonds, Treasury Bills, Stocks; Investment in Properties; Certificate Loans, Policy Loans & Other Loans, Other Investments, Cash and cash equivalents and Short Term investments ____________________________________ Name of the Mutual Benefit Association As of the Quarter ending ________________ (indicate the applicable date) II. Investments Invested Assets Long Term Investments P Government Bonds P____________ Corporate Bonds ____________ ___________- Short-Term Investments Government (Treasury Bills) ____________ Corporate Investments ____________ ___________- Stocks ____________ Investment in Property/ies ____________ Loans Membership Certificate Loans ____________ Policy Loans ____________ Other Loans Receivable ____________ ___________- Time Deposits/Fixed Deposits ____________ Other Investments Proprietary Shares ____________ Money Market Placements ____________ Others ____________ ___________- Total Investments P ========== ___________________________________ Name of Mutual Benefit Association As of the Quarter ending _______________ (Indicate the applicable date) III. Operating Results 1 Members' Fees/Dues P____________ 2 Members' Contributions 2a. Members' Contributions collected P____________ 2b. Members' Contributions ceded to (re)/insurers ____________ 3 Net Members' Contributions collected (2a - 2b) P___________- 4 Premiums Collected 4a. Premiums collected-micro P____________ 4b. Premiums collected-regular ____________ 4c. Premiums Ceded, micro ____________ 4d. Premiums Ceded, regular ____________ 5 Net Premiums collected (4a + 4b - 4c - 4d) P___________- 6 Reinsurance Commission P____________ 7 Other Income 7a. Experience Refund P____________ 7b. Penalties and Surcharges ____________ 7c. Donations and Contributions Received ____________ 7d. Others 8 TOTAL (7a + 7b + 7c + 7d) P___________- ____________ 9 GROSS REVENUES (1 + 3 + 5 + 6 + 8) P___________- 10 Less: BENEFIT EXPENSES ____________ 11 Net Surplus Before Operating Expenses (9 - 10) P___________- 12 Less: Operating Expenses ____________ 13 NET SURPLUS (DEFICIT) BEFORE INVESTMENT INCOME (11 - 12) P___________- 14 Investment Income 14a) Dividends Earned P____________ 14b) Real Estate Income Earned ____________ 14c) Interests Income Earned ____________ 14d) Other Income ____________ P 15 Gross Investment Income (14a + 14b + 14c + 14d) P___________- 16 Investment expense ____________ 17 Final Tax ____________ 18 Net Returns from Investment (15 - 16 - 17) ___________- 19 NET SURPLUS (DEFICIT) BEFORE OTHER REVENUE (EXPENSES) (13 + 18) P___________- 20 Add/(Less): Other Non-Operating Revenues (Expenses) ____________ 21 NET SURPLUS (DEFICIT) (19 + 20) P___________- 22 ADD: OTHER COMPREHENSIVE REVENUES ____________ 23 NET COMPREHENSIVE SURPLUS (DEFICIT) (21 + 22) P___________- Note: Cummulative amounts should be reported ___________________________________ Name of Mutual Benefit Association As of the Quarter ending _______________ (Indicate the applicable date) IV. Business Done A. Basic Fund Number of Total Amount of Insurance Total Lives Certificates Members Dependents Insured Members Dependents ( 1) ( 2) ( 3) (4) = (2) + (3) ( 5) ( 6) 1) Beginning Balance - P 2) New Business a. New Issues - P b Reinstated - c Others - Total New Business - - - - P - - 3) Terminations a. Deaths - P b. Surrenders - c. Lapsed - d. Matured - e. Others - Total terminations - - - - P - - 4) Total of Basic In-force policies as of the end of the quarter (line 1 + line 2 - line 3) - - - - P - - B. Optional Fund B1. For Micro products Individual Group Insurance Total Lives Total Amount Policies No. of No. of Insured of Insurance policies certificates (1+3) ( 1) ( 2) ( 3) ( 4) ( 5) 1) Beginning Balance P 2) New Business a. New issues P b. Reinstated c. Others Total New Business - - - - P - 3) Terminations a. Deaths P b. Surrenders c. Lapsed d. Matured e. Others Total terminations - - - - P - 4) Total Optional Policies In-force as of the end of the quarter (line 1 + line 2 - line 3) - - - - P - B2. For Other than Micro Individual Group Insurance Total Lives Total Amount product Policies No. of No. of Insured of Insurance policies certificates (1 + 3) ( 1) ( 2) ( 3) ( 4) ( 5) 1) Beginning Balance P 2) New Business a. New Issues P b. Reinstated c. Others Total New Business - - - - P - 3) Terminations a. Deaths P b. Surrenders c. Lapsed d. Matured e. Others Total terminations - - - - P - 4) Total Optional In-force policies as of the end of the quarter (line 1 + line 2 - line 3) - - - - P - ___________________________________ Name of Mutual Benefit Association As of the Quarter ending _______________ (Indicate the applicable date) Basic Members' Benefits Optional Insurance Number of claims field for Amounts Paid (Php) Death Disability Hospitalization Surrender Others Death Disability Hospitalization Equity Others Number of Amount of Benefit Benefit Value claims claims paid filed Members P P P P P For non- P micro business Dependents NA P P P P NA P For micro P business TOTAL - - - - - P - P - P P - P - - -