To be filled by insurance company Activity code Registration number Name: Registered office: Type of insurance: TIN PROFIT AND LOSS ACCOUNT for the period from __________ to __________ 20____ - in 000 RSD Group of accounts , account ITEM 1 2 Amount ADP 3 А. OPERATING INCOME AND EXPENSES I OPERATING (FUNCTIONAL) INCOME (1002+1009+1014+1015) 1001 1. Income from insurance and coinsurance premiums (0003+00040024+1004-1005-1006-1007+1008) 1002 600, part 1.1. Calculated premium in life insurance and coinsurance 602 1003 610 and 1.2. Calculated premium in non-life insurance and coinsurance 613 1004 part 512, 1.3. Outward reinsurance premium – passive part 523 1005 part 512, 1.4. Outward reinsurance premium part 523 1006 part 60, 1.5. Increase of unearned premiums reserves and unexpired part 61 insurance and reinsurance risk reserves 1007 part 60, 1.6. Decrease of unearned premiums reserves and unexpired part 61 insurance and reinsurance risk reserves 1008 2. Income from reinsurance premiums and retrocessions (10101009 1011-1012+1013) part 602, 2.1. Calculated reinsurance premium and retrocession 614, 615 1010 part 512, 2.3. Outward premium through reinsurance retrocession and part 523 retrocession 1011 part 60, 2.4. Increase of unearned premium reserves and reserves for part 61 unexpired insurance and reinsurance risks and retrocession 1012 part 60, part 61 606, part 609, 650 and part 659 part 609, 639, 64, part 653, 655, part 659 2.5. Decrease of reserves for unearned premium, and reserves for unexpired insurance and reinsurance risk and retrocession 1013 3. Income from transactions directly related to insurance activities 1014 4. Other operating income 1015 III OPERATING (FUNCTIONAL) EXPENSES (1017+1026+1034-1035-1044+1045-1046+1047+1048) 1016 1. Expenses for long-term provisions and functional contributions 1017 (1018+1019+1020+1021+1022+1023+1024+1025) 500 1.1. Mathematical reserves in life insurance - increase 1018 506 1.2. Mathematical reserves in non-life insurance - increase 1019 502 1.3. Prevention contribution 1020 503 1.4. Contributions stipulated by special laws 1021 Note number 4 Current year Previous year 5 6 Amount Group of accounts, account ITEM 1 2 ADP 3 504 1.5. Contributions to Guarantee Fund 1022 505 1.6. Risk equalization reserves 1023 507 509 1.7. Provisions for insurances where the insured agreed to share the investment risk, provisions for bonuses and discounts and 1024 increase other technical reserves 1.8. Other expenses for long-term provisions and functional 1025 contributions 2. Expenses for payment for claims and agreed amounts (1027+1028+1029+1030+1031-1032-1033) 1026 510 2.1. Settled claims and agreed amounts in life insurance 1027 520 2.2. Settled claims in non-life insurance 1028 part 513, 2.3. Settled claims– share of claims in insurance part 524 1029 part 513, part 524 part 53, part 54 and part 55 part 603, 620, 621 2.4. Settled claims – share of claims in reinsurance and retrocession 1030 2.5. Expenses for reserches, assessment, settlement and payment of claims and agreed amounts 1031 2.6. Income from insurance participation in payment of claims 1032 part 603, 2.7. Income from insurance and retrocession participation in 622, 623, payment claims 624, 625 515 1033 3. Outstanding claims – increase (1036-1037+1038-1039+1040-1041+1042-1043) › 0 1034 3. Outstanding claims – decrease (1036-1037+1038-1039+1040-1041+1042-1043) ‹ 0 1035 3.1. Outstanding claims in life insurance– increase 1036 part 604 3.2. Outstanding claims in life insurance – decrease 1037 526 3.3. Outstanding claims in non-life insurance– increase 1038 630 3.4. Outstanding claims in non-life insurance – decrease 1039 516 and 3.5. Outstanding claims in coinsurance, reinsurance and 527 retrocession– increase 1040 part 604, 3.6. Outstanding claims in coinsurance, reinsurance and 632 retrocession – decrease 1041 part 513 3.7. Increase in outstanding claims – share of coinsurer, reinsurer and retrocessionaire 1042 635 3.8. Decrease in outstanding claims – share of coinsurer, reinsurer and retrocessionaire 1043 4. Income from recourse receivables and sale of insured damaged items 1044 5. Increase of other technical reserves – net 1045 6. Decrease of other technical reserves – net 1046 7. Expenses for bonuses and redebates 1047 8. Other unmentioned expenses 1048 III PROFIT– GROSS OPERATING RESULT (1001-1016) 1049 IV LOSS– GROSS OPERATING RESULT (1016-1001) 1050 607, 652, 654 and part 673 517 and 529 part 604, 631, 633, 638 518 and 528 part 51, part 52 B. INCOME AND EXPENSES FROM INVESTING ACTIVITIES Note number 4 Current year Previous year 5 6 Group of accounts, account ITEM ADP Note number 1 2 3 4 Amount I INCOME FROM INVESTING INSURANCE ASSETS (1052+1053+1057+1058+1059+1060+1061) 660, 661, 665 and 1. Income from associated companies and joint ventures part 672 1051 1052 2. Income from investments in immovables (1054+1055+1056) 1053 part 608, 2.1. Income from rental of investment immovables part 653 1054 part 681 2.2. Income from value adjustment of investment properties 1055 part 670 2.3. Income from sale of immovables (disinvestment) 1056 part 662 3. Income from interests 1057 part 683, part 686 4. Income from alignment of financial assets designed at fair and part value through profit and loss account 687 1058 part 672 5. Profits from sale of securities 1059 part 663 6. Positive course effects from investing activities 1060 part 671, part 679, part 682, 7. Other income from investing activities part 686, part 689 1061 II EXPENSES FROM INSURANCE ASSETS INVESTMENTS (1063+1064+1067+1068+1069+1070) 560, 561, 1. Expenses related to subsidiaries, associated legal entities 565, part and joint ventures 572 2. Expenses from investments in immovables (1065+1066) 1062 1063 1064 part 581 2.1. Expenses from impairment of investment immovables 1065 part 570 2.2. Expenses from sale of immovables (disinvestment) 1066 part 583, part 586 4. Expenses from alignment of financial assets designed at fair 1067 and part value through profit and loss account 587 part 572 5. Losses from sale of securities 1068 part 563 6. Negative course effects from investing activities 1069 part 571, part 579, part 582, 7. Other expenses from investing activities part 586, part 589 1070 III PROFIT FROM INVESTING ACTIVITIES (1051-1062) 1071 IV LOSS FROM INVESTING ACTIVITIES (1062-1051) 1072 C. INSURANCE MANAGEMENT COSTS (1074+1079+1084-1085) 1073 1. Policy acquisition costs (1075+1076-1077+1078) 1074 part 542 1.1. Commissions 1075 part 53, part 54 1.2. Other policy acquisition costs part 55 1076 274 1.3. Increase in deferred policy acquisition costs 1077 274 1.4. Decrease in deferred policy acquisition costs 1078 2. Management costs (1080+1081+1082+1083) 1079 Current year Previous year 5 6 Group of account s, account 1 530 ITEM ADP Note number 2 3 4 2.1. Depreciation 1080 part 54 2.2. Materials, energy, services and intangible costs 1081 part 55 2.3. Salaries, wages and other personal indemnities 1082 part 53, part 54 2.4. Other management costs part 55 part 53, part 54 3. Other underwriting expenses part 55 605, 651 4. Commission from reinsurance and retrocession 1083 1084 1085 I OPERATING PROFIT – NET OPERATING RESULT (1049+1071-1050-1072-1073 ) ≥ 0 1086 II OPERATING LOSS – NET OPERATING RESULT (1049+1071-1050-1072-1073 ) ≤ 0 1087 part 66 III FINANCE INCOME, EXCEPT FOR FINANCE INCOME FROM INVESTING ACTIVITIY 1088 part 56 III FINANCE EXPENSES, EXCEPT FOR FINANCE EXPENSES FROM INVESTING ACTIVITIY 1089 part 68 V INCOME FROM REVALUATION OF RECEIVABLES AND OTHER OPERATING ASSETS 1090 part 58 V EXPENSES FROM IMPAIRMENT OF RECEIVABLES AND OTHER OPERATING ASSETS 1091 part 67 VII OTHER INCOME 1092 part 57 VIII OTHER EXPENSES 1093 IX PROFIT FROM OPERATIONS BEFORE TAX (1086 + 1088 + 1090 + 1092 – 1087 – 1089 – 1091 – 1093) ≥ 0 1094 X LOSS FROM OPERATIONS BEFORE TAX (1086 + 1088 + 1095 1090 + 1092 – 1087 – 1089 – 1091 – 1093) ≤ 0 XI NET PROFIT FROM DISCONTIUNED OPERATIONS IN BUSINESS, POSITIVE EFFECTS OF CHANGES IN 69 – 59 ACCOUNTING POLICIES AND CORRECTIONS OF ERRORS FROM PREVIOUS PERIODS 1096 XII NET PROFIT FROM DISCONTIUNED OPERATIONS IN BUSINESS, NEGATIVE EFFECTS OF CHANGES IN ACCOUNTING POLICIES AND CORRECTIONS OF ERRORS FROM PREVIOUS PERIODS 1097 D. PROFIT BEFORE TAX (1094+1096-1095-1097) 1098 E. LOSS BEFORE TAX (1095+1097-1094-1096) 1099 59 – 69 F. TAX ON PROFIT 721 1. Tax on profit 1100 342 2. Profit from created deferred tax assets and decrease tax liabilities 1101 352 3. Loss from created deferred tax assets and decrease tax liabilities 1102 G. NET PROFIT (1098-1099-1100+1101-1102) 1103 1. Net profit which belogns to minority investors 1104 2. Net profit which belogns majority owner 1105 Amount Current year 5 Previous year 6 Group of account s, account 1 ITEM ADP Note number 2 3 4 H. NET LOSS (1099-1098+1100-1101+1102) 1106 1. Net loss attributed to minority investors 1107 2. Net loss attributed to majority owner 1108 Amount Current year 5 Previous year 6 I. EARNING PER SHARE 1. Basic earning per share (in dinars no para) 1109 2. Diluted earning per share (in dinars no para) 1110 In _____________________ on ___________________ S.P. Legal representative ______________________ This form is mandatory pursuant to the Decision on the content and layout of financial statement forms of insurance companies (RS Official Gazette No 135/2014 and 141/2014).