FORM NL-28-STATEMENT OF ASSETS - 3B

Company Name & Code:

Statement as on: 31.12.2015

Statement of Investment Assets (General Insurer, Re-insurers)

(Business within India)

Periodicity of Submission: Quarterly

No. Particulars SCH ` in Crs.
1 Investments 8 55891.72
2 Loans 9 365.94
3 Fixed Assets 10 135.19
4 Current Assets
a. Cash & Bank Balance 11 8413.75
b. Advances & Other Assets 12 7177.86
5 Current Liabilities
a. Current Liabilities 13 -23411.92
b. Provisions 14 -6773.53
c. Misc. Exp. Not written off 15
d. Debit Balance of P & L A/c
Application of Funds as per Balance Sheet (A) TOTAL (A) 41799.01
Less : Other Assets SCH ` in Crs.
1 Loans (if any) 9 0.44
2 Fixed Assets (if any) 10 135.19
3 Cash & Bank Balance (if any) 11 6106.7
4 Advances & Other Assets (if any) 12 7113.7
5 Current Liabilities 13 -23411.92
6 Provisions 14 -6773.53
7 Misc. Exp. Not written off 15
8 Debit Balance of P & L A/c
TOTAL (B) -16829.42
'Investment Assets' As per FORM 3B ( A - B ) 58628.43

NL28-Part A -Section II

Statement as on: 31.12.2015

No 'Investment' represented as Reg. % SH PH Book Value (SH + PH) % Actual FVC Amount
Balance FRSM+
(a) (b) (c) d = (b+c) (e)
1 G. Sec. Not less than 20% 2509.34 5214.09 7723.43 23.09 0
2 G. Sec or Other Apporved Sec. (incl. (1) above) Not less than 30% 3999.2 8309.82 12309.03 36.79 0
3 Investment subject to Exposure Norms 0 0 0 0 0
a. Housing & Loans to SG for Housing and FFE Not less than 5% 0 0 0 0 0
1. Approved Investments 681.95 1417.01 2098.97 6.27 0
2. Other Investments 0 0 0 0 0
b. Infrastructure Investments Not less than 10% 0 0 0 0 0
1. Approved Investments 935.29 1943.41 2878.69 8.6 704.41
2. Other Investments 188.75 392.21 580.96 1.74 -4
c. Approved Investments Not exceeding 55% 3831.45 7657.15 11488.6 34.34 24606.1
d. Other Investments (not exceeding 25%) 1332.03 2767.78 4099.8 12.25 -134.14
Total Investment Assets 1 10968.67 22487.38 33456.05 100 25172.37

Certification:

1. Central Govt. Securities includes Treasury Bills, Deposit Under Section 7 of Insurance Act, 1938 and Deposit with CCIL (securities)

2. Shareholder and Policyholder Funds have been bifurcated in the ratio of 32.49:67.51 as per B/s as on 31.12.2015

Certified that the information given herein are correct, complete and nothing has been concealed or suppressed, to the best of my knowledge and belief.