THE INSURANCE LAW, 1979.
(Law 24 of 1979)

THE INSURANCE (FORMS) REGULATIONS, 1980.
APPLICATION FOR A CLASS "B" INSURER'S LICENCE
(Section 4(2))
Please complete all sections as fully as possible, giving reasons for non-compliance if any, and attaching appendices where appropriate.
PLEASE PRINT CLEARLY
1. NAME OF APPLICANT  
2. WHETHER LICENCE APPLIED FOR IS RESTRICTED OR UNRESTRICTED Unrestricted
3. DATE ON WHICH APPLICANT COMMENCED, OR INTENDS TO COMMENCE, CARRYING ON BUSINESS IN OR FROM WITHIN THE ISLANDS. As soon as possible
4. WHETHER BUSINESS BEING, OR PROPOSED TO BE, TRANSACTED IS "GENERAL" OR "LONG-TERM" OR BOTH (AS DEFINED IN SECTION 2 OF THE LAW).  

 

5. ADDRESS OF
a) PRINCIPAL OFFICE

b) REGISTERED OFFICE

Britannia Insurance Management (Cayman) Ltd.
P. O. Box 10139-APO
Piccadilly Centre, Elgin Avenue,
Grand Cayman, Cayman Islands, B.W.I.

either as "a)" above, or a law firm in Grand Cayman.

6. IF THE APPLICANT IS TO DEPEND UPON AGENT OR SERVICE COMPANIES FOR THE PROVISION OF UNDERWRITING, MANAGEMENT, FINANCIAL OR ACCOUNTING SERVICES, PLEASE GIVE DETAILS OF SUCH COMPANIES INCLUDING EVIDENCE OF THEIR AGREEMENT TO PROVIDE THE SERVICES MENTIONED. Britannia Insurance Management (Cayman) Ltd.
P. O. Box 10139APO
Piccadilly Centre, Elgin Avenue,
Grand Cayman, Cayman Islands, B.W.I.

Letter of confirmation attached.
7. ATTACH EVIDENCE OF THE PROPER INCORPORATION OF THE APPLICANT PURSUANT TO SECTION 4 OF THE COMPANIES LAW, AND A COPY OF THE MEMORANDUM OF ASSOCIATION AND ARTICLES OF ASSOCIATION, OR OTHER INSTRUMENT OF CONSTITUTION OF THE APPLICANT, AS MAY BE APPROPRIATE, OR IN THE CASE OF COMPANIES NOT YET INCORPORATED, THE PROPOSED DOCUMENTATION. See attached Exhibits A & B.
8. LIST ALL NAMES (INCLUDING ANY PREVIOUS NAMES,) ADDRESSES AND NATIONALITIES OF ALL SHAREHOLDERS. IN THOSE INSTANCES WHERE SHARES ARE HELD BY A CORPORATE BODY OR BODIES THE CHAIN OF CONNECTION TO THE ULTIMATE OWNER MUST BE SHOWN.  
9. ATTACH PERSONAL QUESTIONAIRE COMPLETED BY SHAREHOLDERS, DIRECTORS, MANAGERS AND CONTROLLERS.  

 

10. ATTACH THREE REFERENCES INCLUDING ONE FROM AN INSURER (OR RE-INSURER) AND ONE FROM A BANK.  
11. a) NAME AND ADDRESS OF THE PRINCIPAL AGENT OR REPRESENTATIVE RESIDENT IN THE CAYMAN ISLANDS


b) ADDRESS OF DESIGNATED PRINCIPAL OFFICE IN THE ISLANDS WHERE FULL BUSINESS RECORDS WILL BE KEPT.

Britannia Insurance Management (Cayman) Ltd.
P. O. Box 10139APO
Piccadilly Centre, Elgin Avenue,
Grand Cayman, Cayman Islands, B.W.I.

Britannia Insurance Management (Cayman) Ltd.
P. O. Box 10139APO
Piccadilly Centre, Elgin Avenue,
Grand Cayman, Cayman Islands, B.W.I.

12. NAME, ADDRESS AND PROFESSIONAL QUALIFICATION OF AUDITORS AND THE COUNTRY WHOSE GENERALLY ACCEPTED ACCOUNTING PRINCIPLES ARE TO APPLY. ATTACH EVIDENCE THAT SAID AUDITORS HAVE AGREED TO ACCEPT APPOINTMENT. See attached letter. (Exhibit )
 

13.

NAME AND ADDRESS OF PERSON RESIDENT IN THE CAYMAN ISLANDS WHO IS AUTHORISED TO ACCEPT SERVICE OF PROCESS IN LEGAL PROCEEDINGS AND NOTICE ON BEHALF OF THE APPLICANT AND WHO IS APPROVED OR PROPOSED FOR APPROVAL UNDER SECTION 7(1)(c)(ii) OF THE LAW.  
14. a) (FOR AN EXISTING INSURER.) ATTACH ANNUAL ACCOUNTS FOR THREE YEARS PRECEDING THE DATE OF THIS APPLICATION.

b) (FOR AN APPLICANT FOR A NEW UNRESTRICTED CLASS "B" INSURER'S LICENCE.) ATTACH A WRITTEN UNDERTAKING TO PROVIDE AT LEAST THE MINIMUM NET WORTH REQUIREMENTS SET OUT IN SECTION 4(8) OF THE LAW, TOGETHER WITH A STATEMENT AS TO HOW SAID NET WORTH IS TO BE CALCULATED.

See attached 3-year pro-forma financial statements,

(Exhibits & ) and letter (Exhibit ).

15. ATTACH A BUSINESS PLAN. THE HEAD OF INSURANCE MAY INDICATE THAT ANY PART OF THE INFORMATION INCLUDED IN THE BUSINESS PLAN SHALL NOT FORM PART OF THIS APPLICATION FOR THE PURPOSE OF SECTIONS 4(3) AND 7(2) OF THE LAW.  

See attached Exhibit .

16. HAVE ANY OF THE PARTIES CONNECTED WITH THIS APPLICATION EVER APPLIED, EITHER INDIVIDUALLY OR IN CONJUNCTION WITH OTHERS, FOR AUTHORITY TO TRANSACT INSURANCE BUSINESS IN ANY OTHER JURISDICTION? IF SO PLEASE GIVE DETAILS.  

 

APPLICATION IS ACCORDINGLY HEREBY MADE FOR THE LICENCE SPECIFIED ABOVE AND IT IS CERTIFIED THAT ALL THE PARTICULARS CONTAINED IN THIS APPLICATION AND IN THE DOCUMENTS ACCOMPANYING IT OR OTHERWISE FURNISHED IN SUPPORT HEREOF ARE TRUE AND CORRECT.

DATED THIS _________________ DAY OF ________________________ 1998.

 

______________________________________________________________________________________

(Name of Applicant)

 

BY ITS* DIRECTORS/*SECRETARY/* OR OTHER PERSON DULY AUTHORISED.

 

____________________________________________________________

Signed.

 

WITNESS: NAME:
OCCUPATION:
ADDRESS:

 

*Delete words which are not applicable.