55
Form C.
Statement to be made by a Fire or Guarantee Insurance Company whose deposits are under one hundred thousand dollars, except those referred to in section four.
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$ cts.
Amount of Premiums received during the year on risks effected in Canada less twenty-five per cent. and the net amount of losses actually paid
Deposit in conformity with the second section of the said Act
Assets of the Company
Liabilities of the Company
Amount of Capital Stock
Amount paid thereon
Of what the assets of the Company consist, viz: (insert particulars)
Amount of losses paid during the year
Amount of losses due and unpaid
Losses adjusted and not due
Losses in suspense and waiting for further proof
Losses the payment of which is resisted, and for what cause
All other claims against the Company
Amount of premiums earned during the past year
Amount of premiums unearned
Amount at risk on total policies in force in Canada
Losses in Canada paid during the year
Losses in Canada adjusted and not due
Losses in suspense and waiting for further proof
Losses the payment of which is resisted and for what cause
All other claims against the Company
Premiums earned in Canada daring the year
Premiums unearned in Canada during the year
Form D.
Statement to be made by an Insurance Company referred to Section fifteen.
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$ cts.
Total premiums received during the year, in Canada
Number and amount of policies issued do. do.
Amount at risk in total policies in force in Canada
Number and amount of policies that have become claims in Canada during the year
Amount of losses in Canada paid during the year
Amount of losses in Canada in suspense and waiting further proof
Losses in Canada the payment of which is resisted and for what cause
Amount of premiums earned for the past year in Canada
Amount of premiums unearned in Canada
