Ref: Apply – Time
APPLICATION FORM
FINANCIAL SERVICES BOARD
REPUBLIC OF SOUTH AFRICA
LONG-TERM INSURANCE ACT, 1998 (ACT 52 OF 1998)
SHORT-TERM INSURANCE ACT, 1998 (ACT 53 OF 1998)
APPLICATION FOR APPROVAL OF EXTENSION OF TIME IN TERMS OF SECTION
4(1) OF THE LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE
ACT (“ACT”)
A.
Instructions for completion and submission
1.
This form must be properly completed and signed. Questions must be answered
either in full or not applicable (“n/a”). The signer(s) must be duly authorised to
make the application.
2.
The format of this form or the wording of questions may not be changed.
However, this form may be reproduced.
3.
Answers may be in writing or may be typed.
3.1
If the form is completed on a computer, (a)
delete the solid lines in those areas provided for answers before the
answers are typed or use the overtype mode whilst the answers are
typed.
Date: 23/04/2010
Page 1
APPLICATION FOR APPROVAL OF EXTENSION OF TIME IN TERMS OF SECTION 4(1) OF THE
LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT
(b)
rows may be inserted where insufficient space is provided for
answers.
3.2
If the form is completed by hand, should the space provided not be
sufficient, the detail can be provided on a separate page, duly crossreferenced to the relevant question.
3.3
If the form that is submitted contains any changes to typed or written
information, those changes must be signed.
4.
The completed form does not need to be accompanied by any number of copies.
5.
The application must be submitted sufficiently long before the approval is needed
to allow the Registrar to consider it and seek information or clarification, where
necessary.
B.
General information
1.
This form is required in terms of section 3(2)(a) of the Act read with section 4(1) of
the Act. The form must be accompanied by the fees prescribed by the Registrar
in terms of section 3(2)(b)(i) and, where indicated, by the documents required in
terms of section 3(2)(b)(ii) of the Act.
2.
The Registrar, in terms of section 4(2) of the Act, may by notice direct a long-term
or short-term insurer (“insurer”) to furnish the Registrar, within a specified period,
with specified additional information or documents.
3.
The application will not be considered favourably if it is not supported by a
compelling reason(s).
Date: 23/04/2010
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APPLICATION FOR APPROVAL OF EXTENSION OF TIME IN TERMS OF SECTION 4(1) OF THE
LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT
C.
Legal and policy framework
1.
In terms of section 4(1) of the Act a person may apply for approval of extension of
time in which to perform anything that is required or permitted to be done under
the Act. The application must set out all the reasons for, and information relevant
to, the request.
2.
In the past it has been experienced that certain persons merely indicate that “due
to circumstances beyond our control” or “illness of certain officials” an act cannot
be performed within the prescribed period. Other reasons frequently put forward
for the inability to perform such acts timely are:
3.
2.1
Pressure of work at the insurer’s, auditors’ or statutory actuary’s office.
2.2
Holiday arrangements.
2.3
Absence from office of the chairman, director or public officer, etc.
Extensions will only be granted in cases where the Registrar is satisfied that the
delay cannot be avoided by means of alternative arrangements.
4.
If the Registrar is satisfied that steps could be taken to avoid a delay it will not
grant approval and will not hesitate to enforce the penalty provisions of section 68
of the Long-term Insurance Act or section 66 of the Short-term Insurance Act.
D.
Specific information
I, the undersigned, being the Public Officer1 ___________________________________
of ____________________________________________________________________
hereby apply for approval of extension of time.
Date: 23/04/2010
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APPLICATION FOR APPROVAL OF EXTENSION OF TIME IN TERMS OF SECTION 4(1) OF THE
LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT
1.
Delete public officer and insert other title if the application is not in respect of an insurer.
The following information is provided in support of the application.
1.
Describe the act in respect of which the request for extension of time is made.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
2.
Furnish the date by which the act has to be completed and submitted to the
Registrar.
_________________________________________________________________
3.
Furnish the extended date for which approval is applied for.
_________________________________________________________________
4.
The reason(s) set out below in support of the extension is as a result of the insurer (possibly) not maintaining a financially
sound condition as required by section 29 of the Long-term
Insurance Act or section 28 of the Short-term Insurance Act 2
as a result of factors that will not endanger the financially sound
condition of the insurer2
2.
Leave blank if the application is not in respect of an insurer.
_________________________________________________________________
_________________________________________________________________
Date: 23/04/2010
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APPLICATION FOR APPROVAL OF EXTENSION OF TIME IN TERMS OF SECTION 4(1) OF THE
LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
5.
Is the date in answer to question 3 already an extended date?
Yes3
No
3.
If the answer is “Yes” kindly -
5.1
give the date and reference number of the Registrar’s previous approval.
____________________________________________________________
5.2
state the reason(s) that supported that application for extension of time.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
6.
If the reasons in answer to questions 4 and 5 of Part D are the same, the following
measure(s) will be taken to address the problem and prevent it from occurring
again4:
4.
If the measure(s) include a reference to the auditor or statutory actuary, the insurer
should discuss the measure(s) with the auditor or statutory actuary.
Date: 23/04/2010
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APPLICATION FOR APPROVAL OF EXTENSION OF TIME IN TERMS OF SECTION 4(1) OF THE
LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
7.
Furnish the date on which the next financial year/quarter of the insurer ends.
Period
Date
Financial year5
Quarter5
5.
8.
Leave blank if not applicable to the application.
Did the insurer inform its auditor(s) and statutory actuary (where one is appointed)
of this application?
Yes
No6
6.
If the answer is “No” kindly explain.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
9.
Are there any other information or documents that are relevant to this application?
Yes7
No
7.
If the answer is “Yes” kindly specify the information or documents.
Date: 23/04/2010
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APPLICATION FOR APPROVAL OF EXTENSION OF TIME IN TERMS OF SECTION 4(1) OF THE
LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
10.
I hereby enclose 10.1
Proof of payment of the fee prescribed by the Registrar by notice in the
Government Gazette (the latest fee schedule as prescribed is available on
the FSB’s website).
10.2
The documents, if any, mentioned in the Part D of this form in support of
the application.
11.
I certify, to the best of my knowledge, that the information given in the answers to
the above questions are complete, accurate and true and not misleading in any
respect.
Full forename(s) and surname of the public officer/person.
______________________________________________________________________
______________________________
___________________________
SIGNATURE OF PUBLIC OFFICER8
DATE
______________________________
8.
Delete public officer and insert other title if the application is not in respect of an insurer.
Date: 23/04/2010
Page 7