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orm IRDA- Assets- AA
(See Regulation 3)

INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY (ASSETS, LIABILITIES, AND SOLVENCY MARGIN OF INSURERS) REGULATIONS, 2000.

Statement of Assets as at 31st March,20___.

Form Code: [ ][ ][ ][ ][ ][ ][ ][ ][ ]

Name of Insurer: Registration Number: Date of registration: ____________

Classification: Business Within India/ Total Business

Item No.(1) Category of Asset (2) Policyholders' funds:Amount ( in rupees lakhs) as per (a) below (3) Shareholders' funds: Amount ( in rupees lakhs) as per (a) below (4)

01 Approved Securities
02 Approved Investments
03 Deposits
04 Non-Mandated Investments
05 Other Assets, specify
06 Total
07 Fair Value Change Account
08 Adjusted Value of Assets6) - (7)

I certify that the statement has been prepared in accordance with Schedule I.


Place Name and Signature of Appointed Actuary.
(in case of a life insurer)
Date
/ Name and Signature of Auditor
(in case of a general insurer)

Form IRDA- Assets- AA