Annexes to the rule

Annexe No. 1

REQUEST FOR APPROVAL1)

The undersigned

...... asmember/members of the management of the insurer/insurers...... , hereby request/requests approval, in accordance with the draft terms of the merger/division, and authorisation of the insurers/reinsurers2expected to result from the merger/division.

In support of our request, we hereby attach the documentation3referred to in Art. 11 Letters b) – l) of Rule No. …../2015 on the operation of the insurers supervised under the national regime.

We also provide the following information to support the viability of the draft terms submitted4, in accordance withArt. 11 Letters m)and n) if the rule mentioned above:

1......

2......

3......

etc.

Contact address......

......

(date) (signature and stamp)

______

1To be filled in and send by the parties involved in the transfer

2The reinsurers resulting from the division shall be subject to Law No. 237/2015, Part I, and shall supplement accordingly the documentation for authorisation purposes

3The documentation attached hereto shall be filed together with an index of documents

4To be filled in, where appropriate, filed and included in the index of documents

Annexe No. 2

Statement of the ceding insurer’s portfolio

Policy number / Nameof contracting party and beneficiary / Insurance class / Insured risks / Date from which the ceding insurer becomes liable / Date from which the ceding insurer is no longer liable / Insurance premium (RON) / Insured amount (RON) / Premium reserve (RON)

Annexe No. 3

Available solvency margin, minimum solvency marginandnon-life insurance security fund

Template No. 1 - Available solvency margin

X = Total available solvency margin = X1 + Z1 + Z2 + Z3 + A9 + A10
A1 = Subscribed and paid-in share capital or paid in reserve fund
A2 = All insurer’s reserves, other than the technical reserves, namely: capital premium reserves, revaluation reserves, legalreserves, statutoryreserves, translationreserves, otherreserves
A3 = Net profit resulting after deduction of dividends to be paid or, where appropriate, loss incurred by the insurer
A4 = Profit/loss carried forward
A5.1 = Value of own shares held directly by the insurer
A5.2 = Value of the insurer’s holdings in other insurers
A5.3 = Value of the insurer’s holdings in reinsurers
A5.4 = Value of the insurer’s holdings in insurance holdings
A5.5 = Value of the insurer’s holdings in credit institutions and financial institutions defined in accordance with Government Emergency Ordinance No. 99/2006 on credit institutions andcapital adequacy, approved as amended and supplemented by Law No. 227/2007
A5.6 = Value of the insurer’s holdings in investment firms defined in accordance with Government Emergency Ordinance No. 99/2006 on credit institutions and capital adequacy, approved as amended and supplemented by Law No. 227/2007
A5.7 = Value of the instruments referred to in Art. 31(3) Letterc) Point (i) of the rules
A5.8 = Value of the receivables and instruments referred to in Art. 31(3) Letterc) Point (ii) of the rules
ANC = intangible assets
X1 = Available solvency margin = A1 + A2 + /-A3 + /-A4 - A5.1 - A5.2 - A5.3 - A5.4 - A5.5 - A5.6 - A5.7 - A5.8 - ANC
A61 = Cumulative preferential shares and/or subordinated debts
Z = min. (X1;Y)
Z1 = min (A6; 0.5 * Z)
A72 = Securities with no specified maturity date and other securities, including cumulative preferential shares not included in A6
Z2 = min (A7; 0.5 * Z)
A83 = Not paid share capital or not paid reserve fund, as appropriate
Z3 = min (0.5 * A8; 0.5 * Z)
A94 = Value calculated in accordance with Art. 31(5) Letterb) of the rules
A10 = Hidden net reserves arising out of the valuation of assets, in so far as such hidden net reserves are not of an exceptional nature

1In line with Art. 31(4) Lettera) of this rule.

2In line with Art. 31(4) Letterb) of this rule.

3In line with Art. 31(5) Lettera) of this rule.

4In line with Art. 31(5) Letterb) of this rule.

Template No. 2 -Minimum solvency margin

Y = Minimum solvency marginat the reporting date = max (Y3;Y5)
Y3 = Minimum solvency margin = max (Y1;Y2)
Y4 = Minimum solvency marginreported at the end of the previous financial year
e1 = Ratio between the value of the net outstanding claims reserves - RBNS and IBNR at the end of the reporting period and value of the value of the net outstanding claims reserves - RBNS and IBNR at the beginning of the current financial year
e = min (1;e1)
Y5 = e * Y4

Method 1 – Method concerning premiums

B1 = Total value of Gross written premiums or direct insurance contributions
B2 = Value of written premiums relating to reinsurance acceptances
B3 = Value of gross premiums or cancelled contributions
B41 = Total amount of taxes and levies pertaining to the premiums
B5 = Change in the gross premium reserve
B6 = B1 + B2 – B3 – B4
B7 = B6 – B5
B8 = max (B6;B7)
b1 = Ratio between the amount of net losses in the last 3 financial years and the value of gross losses in the last 3 financial years
b = max (0.5;b1)
= Y1 = Minimum solvency margincalculated with theMethod concerning premiums =
= b * B8

1The amount of taxes and levies shall comprise the amount of the operation fee, contribution to the Guarantee Fund

Method 2 – Method concerning losses

C12 = Amount of gross payments on claims relating to the direct insurance business of the reference period
C22 = Amount of gross payments on claims relating to the reinsurance acceptances of the reference period
C3 = Amount of gross outstanding claims reserves - RBNS and IBNR established at the end of the reporting period, both for direct insurance and for reinsurance acceptances
C42 = Amount of losses recovered from third parties by subrogation to the rights of policyholders in the reference period
C53 = Amount of gross outstanding claims reserves - RBNS and IBNR establishedat the beginning of the 35th calendar month preceding the reporting month, both for direct insurance and for reinsurance acceptances, if the reference period is 36 months
C6 = C1 + C2 + C3 – C4 – C5
c = Variable coefficient whose value is 1/n, where n is the reference period expressed in years
C7 = RON equivalent ofEUR 42.9 million
b1 = Ratio between the amount of net losses in the last 3 financial years and the value of gross losses in the last 3 financial years
b = max (0.5;b1)
Y21 = Minimum solvency margincalculated with theMethod concerning losses =
= b * [min (c*C6;C7) * 0.26 + max (c*C6 – C7;0) * 0.23]

1Where health insurance is pursued on a similar technical basis to that of death insurance, provided that the conditions laid down in Art. 34(6) are met, account shall be taken of only one third of the amount obtained by the calculation formula.

2Where an insurer covers one or more risks: storm, hail or frost, the reference period shall correspond to the last 84 calendar months preceding the reporting date.

3Where thereference period is 84 months, the amount of gross outstanding claims reserves established at the beginning of the 83rd calendar monthpreceding the reporting month shall be deducted.

Template No. 3 - Security fund

FS1 = Y/3
FS2 = RON equivalent of the minimum amount of the security fund
FS = Security fund = max (FS1;FS2)

Annexe No. 4

Available solvency margin, minimum solvency marginandsecurity fundfor life insurance

Template No. 1 - Available solvency margin

X = Total available solvency margin = X1 + Z1+ Z2 + A8 + A9 + Z3
A1 = Subscribed and paid-in share capitalor paid in reserve fund
A2 = All undertaking’s reserves, other than the technical reserves, namely: capital premium reserves, revaluation reserves, legalreserves, statutoryreserves, translationreserves, otherreserves
A3 = Net profit resulting after deduction of dividends to be paid or, where appropriate, loss incurred by the insurer
A4 = Profit/loss carried forward
A5.1 = Value of own shares held directly by the insurer
A5.2 = Value of the insurer’s holdings in other insurers
A5.3 = Value of the insurer’s holdings in reinsurers
A5.4 = Value of the insurer’s holdings in insurance holdings
A5.5 = Value of the insurer’s holdings in credit institutions and financial institutionsdefined in accordance with Government Emergency Ordinance No. 99/2006 on credit institutions and capital adequacy, approved as amended and supplemented by Law No. 227/2007
A5.6 = Value of the insurer’s holdings in investment firms defined in accordance with Government Emergency Ordinance No. 99/2006, approved as amended and supplemented by Law No. 227/2007
A5.7 = Value of the instruments referred to in Art. 31(3) Letterc) Point (i) of the rules
A5.8 = Value of the receivables and instruments referred to in Art. 31(3) Letterc) Point (ii) of the rules
ANC = intangible assets
X1 = Available solvency margin = A1 + A2 +/-A3 +/-A4 - A5.1 - A5.2 - A5.3 - A5.4 - A5.5 - A5.6 - A5.7 - A5.8 - ANC
A61 = Cumulative preferential shares and/or subordinated debts
Z = min (X1; Y)
Z1 = min (A6; 0.5 * Z)
A72 = Securities with no specified maturity date and other securities, including preferential shares not included in A6
Z2 = min (A7; 0.5 * Z)
A8 = Value calculated in accordance with Art. 31(5) Letterb) of the rules
A9 = Hidden net reserves arising out of the valuation of assets, in so far as such hidden net reserves are not of an exceptional nature
A103 = Not paid share capital or not paid reserve fund, as appropriate
Z3 = min (0.5 * A10; 0.5 * Z)

1In line with Art. 31(4) Lettera) of this rule;

2In line with Art. 31(4) Letterb) of this rule;

3In line with Art. 31(5) Lettera) of this rule;

Template No. 2 -Minimum solvency margin

Y = Minimum solvency margin = M+N+Q+T
M = Minimum solvency marginfor kinds of life insurance referred to in Art. 2(6) Point (i) and (ii) of Law No. 237/2015, other than assurances linked to investment funds = R1+R2
B1 = Gross mathematical reserves
b1 = Ratio between net mathematical reservesandgross mathematical reserves, calculated at the end of the last financial year
b = max (0.85; b1)
R1 = 0.04*b*B1
Ba1 = Gross amount at risk relating to contracts with a duration ofmore than 5 years (inclusive)
Bb1 = Gross amount at risk relating to contracts with a duration between 3 years and 5 years
Bc1 = Gross amount at risk relating to contracts with a duration ofup to 3 years (inclusive)
c1 = Ration between the net amount at risk and gross amount at risk, calculated at the end of the last financial year, only for policies with positive amount at risk
c = max (0.5; c1)
R2 = c*(Ba*0.003+Bb*0.0015+Bc*0.001)
N2 = Minimum solvency marginfor kinds of additional life insurance referred to in Art. 2(6) Lettera) Point (iii) of Law No. 237/2015
Q = Minimum solvency marginfor kinds of life insurance linked to investment funds, set out in Class C3 of Annexe No. 1, Section C of Law No. 237/2015 = S1+ S2 + S3 + S4
D1 = Technical reserves for the cases in which the insurer bears the investment risk
e1 = Ratio between the net technical reserves and gross technical reserves, calculated at the end of the last financial year
e = max (0.85; e1)
S1 =0.04*e*D1
D2 = Technical reserves for the cases in which the insurer does not bear the investment risk, but the allocation to cover management expenses exceeds 5 years
eb1 = Ratio between the net technical reserves and gross technical reserves, calculated at the end of the last financial year, if the insurer does not bear the investment risk and the allocation to cover management expenses exceeds 5 years
eb = max (0.85; eb1)
S2 = 0.01*eb*D2
D3 = The net management expenses corresponding to the activity at issue of the last financial year if the insurer does not bear the investment risk and the allocation to cover management expenses years does not exceed 5 years
S3 = 0.25*D3
Da1 = Gross amount at risk relating to contracts with a duration ofmore than 5 years
Db1 = Gross amount at risk relating to contracts with a duration between 3 years and 5 years (inclusive)
Dc1 = Gross amount at risk relating to contracts with a duration ofup to 3 years (inclusive)
f1 = Ration between the net amount at risk and gross amount at risk, calculated at the end of the last financial year
f = max (0.5; f1)
S4 = f*(Da*0.003+Db*0.0015+Dc*0.001)
T2 = Minimum solvency marginfor insurance classes A1 and A2 set out inAnnexe No. 1 to Law No. 237/2015

1When calculating the amount at risk, account shall be taken of the insurance compensation corresponding to the death risk.

2The insurer covering at least one of the kinds of insurance referred to in Art. 2(6) Lettera) Point iii) and/or Classes A1 and/or A2 set out inAnnexe No. 1 to Law No. 237/2015 shall calculate the minimum solvency marginfor these kinds of insurance in accordance with the provisions applicable to the non-life insurance business of this ruleandshall report to FSAas set out in Annexe No.3 to this rule.

Template No. 3 - Security fund

FS1 = Y/3
FS2 = RON equivalent of the minimum amount of the security fund
FS = Security fund = max (FS1;FS2)

Annexe No. 5

Ratio used to determine the part of the outstanding claims reserve - IBNRrelating toreinsurance ceded contracts, admitted to covergross technical reserves

IBNRcededadmitted by insurance class1 = IBNRceded total by insurance class2 x (RBNScededadmitted by insurance class 3/RBNSceded total by insurance class4),

1 IBNRcededadmitted by insurance class –part of the outstanding claims reserve – IBNR relating toreinsurance ceded contracts, representing the assets admitted to cover gross technical reserves, by insurance class;

2 IBNRceded total by insurance class–total value of the part of the outstanding claims reserve – IBNRrelating toreinsurance ceded contracts, by insurance class;

3 RNBScededadmittedby insurance class–part of theoutstanding claims reserve – RBNSrelating toreinsurance ceded contracts, representing the assets admitted to cover gross technical reserveswithin the limits set out inthis rule, by insurance class;

4 RBNSceded total by insurance class - total value of the part of the outstanding claims reserve – RBNSrelating toreinsurance ceded contracts, by insurance class.

Annexe No. 6

Investment income of assets
admitted to cover gross technical reservesfor

non-life and life insurance

- Annual reporting -
on: |______|

RON
No. / Name of indicator / Amount
1. / Interest income
2. / Investment income of fixed-income securities
3. / Investment income of variable-yield securities
4. / Rental income
5. / Other income
Total income (row 1 torow 5)

Annexe No. 7

Employees and persons with mandate contracts

- Annual reporting -
on: |______|

No. / Description / MU / employment contract for an indefinite period / fixed-term employment contract / Mandate contract1
1. / Total number of persons, of which: / no.
- of the executive management / no.
- of the operations management / no.
2. / average gross monthly salary /employee / RON

1in accordance with Company Law No. 31/1990, republished.

Annexe No. 8
to the rules

Technical resultdetermined by each non-life insurance class

- Annual reporting -
on: |______|

RON
No. / Indicators / Amount
1. / Net premiums written1
2. / Change in the reinsurance net premium reserve
3. / Fees received from undertakings2
4. / Income from recoveries and recourse net of reinsurance
5. / Total income= (1)-(2)+(3)+(4)
6. / Net compensation paid
7. / Change in the outstanding claims reserve RBNS and IBNR net of reinsurance
8. / Total expenses with claims = (6)+(7)
9. / Acquisition costs3
10. / Administrative costs
11. / Other expenses
12. / Total expenses = (8)+(9)+(10)+(11)
13. / Technical result (surplus/deficit) = (5)-(12)
14. / Loss rating, net of reinsurance= [(8)-(4)]/[(1)-(2)]
15. / Combined loss rating, net of reinsurance = [(12)-(3)-(4)]/[(1)-(2)]

1Net written premiums = Gross written premiums (diminished by cancelled premiums) - Gross written premiums ceded.

2Influenced by the change in the acquisition costs carried forward,ceded.

3Influenced by the change in the gross acquisition costs carried forward.

Annexe No. 9

Statement of claims paidandof outstanding claims reserveRBNS
by each non-life insurance class, depending on the year of occurrence of the insured event
- Annual reporting -
on: |______|

Amount of gross payments on claims

RON
Period / 0 / 1 / 2 / 3 / 4 / 5
T1 / d(1,0) / d(1,1) / d(1,2) / d(1,3) / d(1,4) / d(1,5)
T2 / d(2,0) / d(2,1) / d(2,2) / d(2,3) / d(2,4)
T3 / d(3,0) / d(3,1) / d(3,2) / d(3,3)
T4 / d(4,0) / d(4,1) / d(4,2)
T5 / d(5,0) / d(5,1)
T6 / d(6,0)

Gross outstanding claims reserve RBNS

RON
Period / 0 / 1 / 2 / 3 / 4 / 5
T1 / R(1,0) / R(1,1) / R(1,2) / R(1,3) / R(1,4) / R(1,5)
T2 / R(2,0) / R(2,1) / R(2,2) / R(2,3) / R(2,4)
T3 / R(3,0) / R(3,1) / R(3,2) / R(3,3)
T4 / R(4,0) / R(4,1) / R(4,2)
T5 / R(5,0) / R(5,1)
T6 / R(6,0)

Explanations:

1. T1, T2,..., T6 –represent the last 6 annual periods prior to the reporting date (T1 the oldest year).

2. d(i,j) (i = 1, 2,..., 6; j = 0, 2,..., 5; and i+j < = 6) –represent the amount of gross payments on claims paid in the Period Ti+j andrelating to the insured events occurred in the Period Ti, without being influenced by the amount of recoveries and recourses.

3. R(i,j) (i = 1, 2,..., 6; j = 0, 2,..., 5; and i+j <= 6) –represent the amount of gross outstanding claims reserve RBNSat the end of the period Ti+j and relating to the insured events occurred in the Period Ti, without being influenced by the amount of recoveries and recourses.

Annexe No. 10

History and structure of share capital

- Bi-annual/annual reporting-
on: |______|

RON
No. / Informative data / Initial balance (at the beginning of the financial year) / Increases in theReporting period / Decreases in theReporting period / Final balance (at the end of the reporting period)
I. / Subscribed share capital - total, of which:
1. / - in cash
- foreign investor - amount
participation share (%)/foreign investor
2. / - in kind
- foreign investor - amount
participation share (%)/foreign investor
II. / Paid in share capital - total, of which:
1. / - in cash
- foreign investor - amount
participation share (%)/foreign investor
2. / - in kind
- foreign investor - amount
participation share (%)/foreign investor

Annexe No. 11

Intra-group transactions

- Quarterly/bi-annual/annual reporting -
on: |______|

Template No. 1

RON
No. / Transaction type / Loans
Received by insurer / Granted by insurer
Name of undertaking / Balance at the beginning of the financial year / Movements / Balance at the end of the reporting period / Name of undertaking / Balance at the beginning of the financial year / Movements / Balance at the end of the reporting period
In / Out / In / Out
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11
1.
2.
3.

Template No. 2

RON
No. / Transaction name / Off balance sheet guarantees and transactions1
Name of the contracting party within the group / Document numberand date / Exercise period / Balance at the beginning of the financial year / Movements / Balance at the end of the reporting period
In / Out
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8
1.
2.
3.

1Information taken from the off balance sheet accrual and securities accounts, received or granted, as set out in the notes to the annual financial statements/bi-annual accounting reports.

Template No. 3

RON
No. / Elements eligible for thesolvency margin
Item name / Balance at the beginning of the financial year / Movements / Balance at the end of the reporting period
In / Out
1 / 2 / 3 / 4 / 5
1.
2.
3.

Template No. 4

RON
No. / Name of the undertaking in which investment was made / Investments within the group
Investment type / Balance at the beginning of the financial year / Movements / Balance at the end of the reporting period
In / Out
1 / 2 / 3 / 4 / 5 / 6
1.
2.
3.

Template No. 5

RON
No. / Name of the undertaking - reinsurance ceded / Reinsurance cessions
Gross written premiums ceded or reinsurance during the reporting period / Gross premiums paid for reinsurance cessions during the reporting period / Fees charged for the reinsurance ceded premiums during the reporting period / Compensation received for reinsurance cessions during the reporting period
1 / 2 / 3 / 4 / 5
1.
2.
3.

Template No. 6

RON
No. / Received for reinsurance
Name of the undertaking – reinsurance received / Gross written premiums from reinsurance acceptances during the reporting period / Gross premiums earned from reinsurance acceptances during the reporting period / Fees paid for the premiums received for reinsurance during the reporting period / Compensationpaid for reinsurance acceptances during the reporting period
1 / 2 / 3 / 4 / 5
1.
2.
3.

Annexe No. 12

Transactions carried out for the non-life insurance activity

- Quarterly reporting -
on: |______|

RON
No. / Indicators / Class
A11 / Class
A21 / Class A31 / Class A41 / Class A51 / Class A61 / Class A71 / Class A81 / Class A91 / Class A161 / Class A171 / Class A181* / Total
1. / Number of contractsin forceat the end of the reporting period– Nos.
2. / Number of new contractsandwhich were not cancelled, concluded during the reporting period–Nos
3. / Number of claims reported but not yet settledat the end of the reporting period–Nos
4. / Number of claims reported but not yet settled during thereporting period–Nos
5. / Number of loss files settled and partially paid during the reporting period–Nos
6. / Gross premiums written2) - total, of which:
7. / a) from direct insurance
8. / b) from reinsurance acceptances
9. / Gross premiums earned3) - total, of which:
10. / a) from direct insurance
11. / b) from reinsurance acceptances
12. / Gross premiums written, cancelled
13. / Gross premiums written2 cededfor reinsurance - total, of which:
14. / a) from direct insurance
15. / b) from reinsurance acceptances
16. / Reinsurance net premiums written- total, of which:
17. / a) from direct insurance
18. / b) from reinsurance acceptances
19. / Reinsurance net premiums earned4 - total, of which:
20. / a) from direct insurance
21. / b) from reinsurance acceptances
22. / Gross premiums earned- total, of which:
23. / a) from direct insurance
24. / b) from reinsurance acceptances
25. / Gross premiums written2mediated by brokers
26. / Commission income for premiums ceded for reinsurance
27. / Commission expenses relating to reinsurance acceptances
28. / Gross compensation paid5 - total, of which:
29. / a) for direct insurance
30. / b) for reinsurance acceptances
31. / Gross compensation paid5 - total, of which:
32. / a) relating to the claims of previous years
33. / -reported in previous years
34. / -reported in the reporting year
35. / b) relating to the claims of the reporting year
36. / -for the contractsin forceat the end of the previous financial year
37. / -for the new contracts concluded in the reporting year
38. / Net compensation paid - total, of which:
39. / a) for direct insurance
40. / b) for reinsurance acceptances
41. / Acquisition and administrative costs - total a)+b):
42. / a) Acquisition costs - total, of which:
43. / - Commission expenses from the insurance activity
44. / - advertising and publicity costs
45. / b) administrative costs
46. / Income from recoveries and recourse net of reinsurance
47. / Income from recoveries and recourse –gross amount
48. / Insured amounts relating to the contracts in force, at the end of the reporting period
49. / Insured amounts relating to thenew contracts andwhich were not cancelled, concluded during the reporting period

1Insurance classes areset out inAnnexe No. 1, SectionAof Law No. 237/2015