General instructions: The notification form must be completed with reference to the applicable Legal and Policy Framework that appears at the end of the notification form. Part 1: general information




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NOTIFICATION FORM: GENERAL NOTIFICATIONS UNDER PART 3 (COMPOSITION, GOVERNANCE AND STRUCTURE OF THE BOARD OF DIRECTORS) AND PART 4 (RISK MANAGEMENT SYSTEM) OF BOARD NOTICE 158 OF 2014



General instructions:

The notification form must be completed with reference to the applicable Legal and Policy Framework that appears at the end of the notification form.




PART 1: GENERAL INFORMATION




Insurer Name






Insurer Number




Type of notification (please indicate with “x” for all the questions in the spaces provided below):

1. Notification under the -




Long-term Insurance Act Short-term Insurance Act

2. Notification in respect of –





Non-compliance with prescribed board composition (section 3(2)(b))

Chairperson who is not independent (section 3(3)(b)(ii))

Inadequacy and/or ineffectiveness of the insurer's governance framework (section 4(2)(j))

Non-establishment of risk committee (section 7(5)(a))

Non-establishment of remuneration committee (section 7(5)(a))

Assessment of a responsible person as not being fit and proper (section 12(d))


PART 2: NOTIFICATIONS



2.1 Notification and Motivation in terms of section 3(2)(b) of Board Notice 158 of 2014 – Non-compliance with prescribed board composition:

(indicate if not applicable)


<2.1>

2.1.1 Indicate the composition of the board of directors and highlight how the composition does not comply with section 3(2)(a) of Board Notice 158 of 2014:




<2.1.1>

2.1.2 Motivate why the composition of the board of directors does not undermine the effectiveness of the insurer’s governance framework:




<2.1.2>



2.2 Notification and Motivation in terms of section 3(3)(b)(ii) of Board Notice 158 of 2014 - Chairperson of the board of directors is not an independent director:

(indicate if not applicable)


<2.2>

2.2.1 Provide reasons why the chairperson of the board of directors is not an independent director and explain how this does not undermine the effectiveness of the insurer’s governance framework




<2.2.1>

2.2.2 Has a lead independent director been appointed?



Yes No N/A

2.2.3 If the answer to 2.2.2 is “Yes”, provide the name of lead independent director (full names and surname)




<2.2.3>

2.2.4 If the answer to 2.2.2 is “No”, provide reasons for the non-compliance




<2.2.4>



2.3 Notification in terms of section 4(2)(j) of Board Notice 158 of 2014 - Shortcomings pertaining to the adequacy and effectiveness of the insurer’s governance framework:

(indicate if not applicable)


<2.3>

2.3.1 Provide details of the shortcomings pertaining to the adequacy and effectiveness of the insurer’s governance framework




<2.3.1>

2.3.2 Provide details of any actions taken or to be taken to address the shortcomings listed under 2.3.1, including timelines in brackets in which these actions will be completed.





<2.3.2>

  • Action 1 (mmm yy)

  • Action 2 (mmm yy)

  • etc





2.4 Notification and Motivation in terms of section 7(5)(a) of Board Notice 158 of 2014 - Non-establishment of a risk committee:

(indicate if not applicable)


<2.4>

2.4.1 Provide reasons why a risk committee has not been established and motivate the non-compliance




<2.4.1>

2.4.2 Will the functions of a risk committee as set out in section 8 of Board Notice 158 of 2014 be performed by the audit committee?



Yes No N/A

2.4.3 If the answer to 2.4.2 is “No”, provide details of the committee that is to perform these functions (please note that the use of this committee to perform the functions of the risk committee is subject to the approval of the Registrar)




<2.4.3>



2.5 Notification and Motivation in terms of section 7(5)(a) of Board Notice 158 of 2014 - Non-establishment of a remuneration committee:

(indicate if not applicable)


<2.5>

2.5.1 Provide reasons why a remuneration committee has not been established and motivate the non-compliance




<2.5.1>

2.5.2 Will the functions of a remuneration committee as set out in section 9 of Board Notice 158 of 2014 be performed by the audit committee?



Yes No N/A

2.5.3 If the answer to 2.5.2 is “No”, provide details of the committee that is to perform these functions (please note that the use of this committee to perform the functions of the remuneration committee is subject to the approval of the Registrar)




<2.5.3>



2.6 Notification of assessment and actions to be taken in terms of section 12(d) of Board Notice 158 of 2014 - A responsible person as not being fit and proper:

(indicate if not applicable)


<2.6>

2.6.1 Provide the detail of the responsible person



<2.6.1.1>




<2.6.1.2>
Surname


<2.6.1.3>
First Name(s)


<2.6.1.4>
Position held

ID or Passport no


2.6.2 Provide details of the assessment and the outcomes thereof


<2.6.2>


2.6.3 Describe the actions taken and any actions still to be taken




<2.6.3>



PART 3: CONTACT DETAILS & CONFIRMATION

Instructions:

Please provide the details of the responsible person / public officer to whom the Registrar must direct all correspondence.





Full name and surname






Telephone number






E-mail address

I, ……………………………………………………………………………………………….. [full name of responsible person / public officer], identity / passport number hereby certify, to the best of my knowledge, that the answers and information are complete, accurate, true and not misleading in any respect.

…………………………………………………………. …………………….



Signature of responsible person / public officer Date
We hereby confirm that this notification and all information contained herein represent the views and express intentions of the board and audit committee.

………………………………………………………….. …………………….



Signature of chairperson of the board Date

………………………………………………………….. …………………….



Signature of CEO Date

………………………………………………………….. …………………….



Signature of chairperson of the audit committee Date

………………………………………………………….. …………………….



Signature of chairperson of the risk committee Date

INFORMATION RELATING TO A NOTIFICATION UNDER PART 3 (COMPOSITION, GOVERNANCE AND STRUCTURE OF THE BOARD OF DIRECTORS) AND PART 4 (RISK MANAGEMENT SYSTEM) OF BOARD NOTICE 158 OF 2014



A. Introduction
This notification form relates to a notification under Part 3 (Composition, Governance and Structure of the Board of directors) and Part 4 (Risk Management System) of Board Notice 158 of 2014.
B. Interpretation/Legal framework


  1. In the notification form any word or expression defined in the Long-term Insurance Act, the Short-term Insurance Act or Board Notice 158 of 2015 (published in Government Gazette No. 38357 on 19 December 2014 in terms of section 12(1)(bD) of the Short-term Insurance Act No. 53 of 1998 and Long-term Insurance Act No. 52 of 1998), as the case may be, including any measure referred to in the definitions of “this Act” in sections 1(1) of the Acts, have, unless the context otherwise indicates, the meaning so defined.

  2. Note that, if there is any discrepancy between the notification form and the provisions of the Long-term Insurance Act, the Short-term Insurance Act or Board Notice 158 of 2015, as the case may be, the provisions in the Act or the Board Notice will be deemed correct.

  3. In terms of Part 3 (Composition, Governance and Structure of the Board of Directors) of Board Notice 158 of 2014 the insurer shall notify the Registrar of certain non-compliance and shortcomings.

  4. In terms of Part 4 (Risk Management System) of Board Notice 158 of 2014 the insurer shall notify the Registrar of an assessment of a responsible person as not being fit and proper and the actions taken.


C. Instructions


  1. The notification must be submitted directly to the Registrar of Long-term Insurance or Short-term Insurance at the Financial Services Board.

  2. Notifications will only be processed if submitted via the FSB Insurance Upload Facility on the web site and both the typed word version as well as a scanned, signed copy are submitted.

  3. The notification form must be completed in full by the responsible person and be signed by the person duly authorised to sign this form.

  4. The notification form must be completed with reference to the instructions provided in the notification form and this information document in respect of each part of this form.

  5. The format of the notification form or the wording of questions may not be changed.


D. Additional Information
The Registrar, in accordance with section 4(2) of the Long-term Insurance Act and Short-term Insurance Act, may request additional information relating to the notification.


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