Form 4
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Form 4 Name: .............................................................................................. Registered office: ............................................................................ Profit and loss account .................................................................. for the period from ......................................... to .......................... Items ______________________________________________________________________ € I. Technical account for direct accident insurance business1) 1. Earned premiums, net of reinsurance a) Gross premiums written b) Outward reinsurance premiums c) Change in gross unearned premiums d) Change in reinsurers' share in gross unearned premiums € …… …… …… …… € € …… …… …… 2. Allocated investment return transferred from the non-technical account, net of reinsurance …… 3. Other technical income, net of reinsurance …… 4. Charges for claims incurred, net of reinsurance a) Payments for claims aa) Gross amount bb) Reinsurers' share b) Change in provision for claims outstanding aa) Gross amount bb) Reinsurers' share 5. Change in other technical provisions, net of reinsurance a) Net premium reserve b) Other technical provisions, net of reinsurance …… …… …… …… …… …… …… …… …… …… 2) …… 6. Charges for bonuses and rebates, net of reinsurance 7. Operating expenses, net of reinsurance a) Gross operating expenses b) of which minus: outward reinsurance commissions and profit commissions received …… …… …… 8. Other technical expenses, net of reinsurance …… 9. Sub-total …… 10. Change in the equalisation provision and similar provisions …… 11. Balance on the technical account, net of reinsurance, for direct accident insurance business3) …… II. Technical account for life insurance business 4) 1. Earned premiums, net of reinsurance a) Gross premiums written b) Outward reinsurance premiums c) Change in net unearned premiums …… …… …… …… …… 2. Premiums from gross provision for bonuses and rebates 3. Investment income a) Income from participations of which: from affiliated undertakings €………….. b) Income from other investments of which: from affiliated undertakings €………….. aa) Income from land, land rights and buildings including buildings on third-party land bb) Income from other investments c) Income from write-ups d) Profit from the disposal of investments e) Income from profit pools, profit transfer agreements or partial profit transfer agreements …… …… …… …… …… …… …… …… …… 4. Unrealised gains on investments …… 5. Other technical income, net of reinsurance …… 6. Charges for claims incurred, net of reinsurance a) Payments for claims aa) Gross amount bb) Reinsurers' share b) Change in provision for claims outstanding aa) Gross amount bb) Reinsurers' share 7. Change in other technical provisions, net of reinsurance a) Premium reserve aa) Gross amount bb) Reinsurers' share b) Other technical provisions, net of reinsurance …… …… …… …… …… …… …… …… …… …… …… …… …… 8. Charges for bonuses and rebates, net of reinsurance 9. Operating expenses, net of reinsurance a) Acquisition costs b) Administration expenses b) of which minus: outward reinsurance commissions and profit commissions received …… …… 10. Investment expenses a) Charges for the management of investments, interest and other investment expenses b) Write-downs on investments c) Losses from the disposal of investments d) Charges from transfer of losses …… …… …… …… …… …… …… …… 11. Unrealised losses on investments …… 12. Other technical expenses, net of reinsurance …… 13. Balance on the technical account, net of reinsurance, for life insurance business5) …… III. Non-technical account 1. Balance on the technical account, net of reinsurance a) for direct accident insurance b) for life insurance 2. Investment income where not included under II 36) a) Income from participating interests of which: from affiliated undertakings €………….. b) Income from other investments of which: from affiliated undertakings €………….. aa) Income from land, land rights and buildings including buildings on third-party land bb) Income from other investments c) Income from write-ups d) Profit from the disposal of investments e) Income from profit pools, profit transfer agreements or partial profit transfer agreements 3. Investment expenses where not included under II 107) a) Charges for the management of investments, interest and other investment expenses b) Write-downs on investments c) Losses from the disposal of investments d) Charges from transfer of losses …… …… …… …… …… …… …… …… …… …… …… …… …… …… …… …… 4. Allocated investment return transferred from the technical account 8) …… 5. Other income …… 6. Other expenses …… …… …… …… 7. Profit or loss on ordinary activities 8. Extraordinary income …… 9. Extraordinary expenses …… …… 10. Extraordinary profit or loss 11. Taxes on income …… 12. Other taxes …… …… 13. Income from transfer of losses …… 14. Profits transferred on the basis of a profit pool, profit transfer agreements or partial profit transfer agreements …… …… …… 15. Profit/loss for the financial year9) Footnotes to Form 4: 1) In the case of consolidated financial statements pursuant to section 58 and of property and casualty insurance companies which also engage in direct health insurance conducted according to the technical principles of life insurance, the following heading shall be used: "Technical account for property and casualty insurance". 2) If there is no premium reserve item on the balance sheet, sub-items a and b shall not apply under item I 5 in the technical account, and the item shall simply be called: “5. Change in other technical provisions, net of reinsurance ….”. 3) In the case of consolidated financial statements pursuant to section 58 and of property and casualty insurance companies which also engage in direct health insurance conducted according to the technical principles of life insurance, the words "for direct accident insurance business" shall be replaced by the words "for property and casualty insurance business". 4) Property and casualty insurance companies which also engage in direct health insurance conducted according to the technical principles of life insurance shall replace the words "life insurance business" with the words "direct health insurance conducted according to the technical principles of life insurance“. 5) Property and casualty insurance companies which also engage in direct health insurance conducted according to the technical principles of life insurance shall replace the words "life insurance business" with the words "direct health insurance conducted according to the technical principles of life insurance“. 6) If, in consolidated financial statements pursuant to section 58, all investment income and all investment expenses are shown in the non-technical account, this item shall be called "Investment income". 7) If, in consolidated financial statements pursuant to section 58, all investment income and all investment expenses are shown in the non-technical account, this item shall be called "Investment expenses". 8) If, in consolidated financial statements pursuant to section 58, all investment income and all investment expenses are shown in the non-technical account, item III 4 "Allocated investment return transferred from the technical account" shall be replaced by the following items: “4. Interest allocated to the technical account for property and casualty insurance business 4a. Interest allocated to the technical account for life and health insurance business 9) …… …… …… …“. If changes in capital reserves and retained earnings and in capital represented by participation rights are included in the non-technical account, the following items shall be added to the non-technical account, continuing with the same numbering: “16. Profit/loss carried forward from previous year …… …… …… …… 17. Withdrawals from capital reserve 18. Withdrawals from retained earnings a) from statutory reserve b) from reserve for shares in a controlling undertaking or one with a majority interest c) from reserves required by the articles of association d) from other retained earnings …… …… …… …… 19. Withdrawals from capital represented by participation rights 20. Additions to retained earnings a) to statutory reserve b) to reserve for shares in a controlling undertaking or one with a majority interest c) to reserves required by the articles of association d) to other retained earnings 21. Replenishment of capital represented by participation rights 22. Net income/Net loss The information from item III 16 onwards may be set out in the notes instead of in the non-technical account. …… …… …… …… …… …… …… …… …… …… …… ……“.
