SIXTH SCHEDULE.

FORM APPLICABLE TO MECHANICALLY PROPELLED VEHICLE INSURANCE BUSINESS.

STATEMENT of the estimated liability in respect of outstanding claims arising in the year of account, and in the preceding year or years; computed as at the end of the year in which the claims arose, and as at the end of the year of account; with particulars as to the number and amount of the claims actually paid in the intervening period.

I. Claims arising during the year of account ending _________ 19_________

(a) Particulars as to claims arising and settled during the year of account.

Notes.—1. All claims arising under one policy and out of a single occurrence shall be treated as one claim for the purposes of this Schedule.

2. Under the headings “By costs and expenses” (column (4) of the above Form) and “Total of columns (3) and (4)” (column (5) of the above Form) the amounts need not be segregated in each of the said headings in the said columns (4) and (5) as between—(i) third party claims, and (ii) all other claims.

(b) Particulars as to claims arising during and outstanding at the end of the year of account.

Notes.—1. All claims arising under one policy and out of a single occurrence shall be treated as one claim for the purposes of this Schedule.

2. Under the headings “By costs and expenses” (columns (4) and (6) of the above Form) and “Total of columns (3) to (6)” (column (7) of the above Form) the amounts need not be segregated under each of the said headings in the said columns (4), (6) and (7) as between—(i) third party claims, and (ii) all other claims.

II. Outstanding claims arising during the first year preceding the year of account, ending ______________ 19______

Notes.—1. If there are claims outstanding which arose during the second year preceding the year of account, or earlier, particulars are to be furnished on a form similar to this Form II.

2. All claims arising under one policy and out of a single occurrence shall be treated as one claim for the purposes of this Schedule.

3. Under the headings “By costs and expenses” (columns (4), (7), (10), and (13) of the above Form) and “Total of columns (6), (7), (9), (10), (12),. and (13)” (column (14) of the above Form) the amounts need not be segregated under each of the said headings in the said columns (4), (7), (10), and (13) as between—(i) third party claims, and (ii) all other claims.

III. Summary of estimated liability in respect of claims outstanding as at the end of the year of account.