ANNEXE

Chapter I

Classification–FormsofOwnership

CODE NAME

20MIXEDOWNERSHIP(Stateandprivatelyowned)

MIXEDOWNERSHIP(Stateowned–lessthan50%)

21Domesticallystate-ownedandforeignstate-ownedtradingcompanies

22Domesticandforeignstateandprivatelyownedtradingcompanies

23Domesticstateandprivatelyownedtradingcompanies

24Foreignstateandprivatelyownedtradingcompanies

MIXEDOWNERSHIP(Stateowned-50%andmorethan50%)

25Domesticallystate-ownedandforeignstate-ownedtradingcompanies

26Domesticandforeignstateandprivatelyownedtradingcompanies

27Domesticstateandprivatelyownedtradingcompanies

28Foreignstateandprivatelyownedtradingcompanies

30INDIVIDUALOWNERSHIP-PRIVATE

(domesticprivatelyowned,domesticandforeignprivatelyowned,foreignprivatelyowned)

34jointstockcompanies

35limitedliabilitycompanies

ChapterII

Forms for the financial statements/accounting reporting, instructions for filling out, related correlations for insurers, insurance brokers and subunits of the undertakings in the insurance field as at 31 December 2015

Section1

INSURERS

County______|_|_|
Legalperson______
Address:locality______,
sector____,Str.______No.___,
Block______,Entrance______,Apt.____
Telephone______,Fax______
RegisteredwiththeTradeRegistryunderNo.______/ Formofownership______|_|_|
Mainactivity
(CAENclassname)______
CAENclasscode______|_|_|_|_|
SoleRegistrationCode
______|_|_|_|_|_|_|_|_|_|_|

1. BALANCESHEETINSURERS

asat31 December2015

01 -lei-

Caption / Row no. / Balanceat:
01.01.2015 / 31.12.2015
A / B / 1 / 2
ASSETS
A / INTANGIBLEASSETS
I.Intangiblefixedassets
1.Set-upcosts(501-58011-58021-58031) / 01
2.Developmentcosts(503-58013-58023-59013- 59023-58033-59033) / 02
3.Concessions,patents,licences,trademarksandsimilarrightsandassets(505-58015-58025-59015-59025 -58035-59035) / 03
4.Goodwill(5071-58017-58027-59017-59027-58037-59037) / 04
5.Payments on account andintangiblefixed assetsinprogress
(523+524-59213-59223-59233) / 05
6.Otherintangiblefixed assets (508-58018-58028-59018-59028-58038-59038) / 06
TOTAL (rows01to06) / 07
B / INVESTMENTS
I.Investmentsintangiblefixed assetsandinprogress
1.Landandbuildings(211-281-291) / 08
2.Payments on account andinvestments in tangiblefixed assetsin the course of construction (231+232-293) / 09
TOTAL(rows 08+09) / 10
II.Investmentsinaffiliatedundertakingsandasparticipatinginterestsandotherinvestments infinancialfixed assets
1.Sharesinaffiliatedundertakings(261-29611-29621-29661) / 11
2.Debtsecuritiesorloanstoaffiliatedundertakings(26711+26721+26731++26741-29615-29625+26751+26761-29665) / 12
3.Holdingsinundertakingswithparticipatinginterests
(263-29613-29623-29663) / 13
4.Debtsecuritiesandloanstoundertakingswithparticipatinginterests
(26713+26723+26733+26743-29617-29627+26752+26762-29667) / 14
5.Otherinvestmentsinfinancialfixed assets
(265+26712+26714+26722+26724+26732
+26734+26742+26744-29614-29616-29619-29624-29626-29629+26753+26763-29664-29669) / 15
TOTAL(rows 11to15) / 16
III.Otherfinancialinvestments
1.Sharesandothervariable-yieldsecuritiesandunitsininvestmentpools
(2711+2712+273-29711-29713-29721-29723+2713-29731-29733) / 17
2.Bondsandotherfixed-incomesecurities
(2721+2722-29712-29722+2723-29732) / 18
3.Participationininvestmentpools(274-29714-29724-29734) / 19
4.Loansguaranteedbymortgages(26715+26725-29631) / 20
5.Otherloans(26716+26726-29632) / 21
6.Depositsplacedwithcreditinstitutions
(26717+26727+26737+26747-29641-29651+26754-26764-2967) / 22
7.Otherfinancialinvestments(278-29718-29728-29738) / 23
TOTAL(rows 17to23) / 24
IVDepositswithcedingundertakings(268-29642-29652) / 25
C / INVESTMENTSRELATINGTOLIFEINSURANCEFORWHICHTHE EXPOSURETOTHE INVESTMENTRISKISTRANSFERREDTOPOLICYHOLDERS(241-294) / 26
TOTAL INVESTMENTS(rows 10+16+24+25+26) / 27
D / PARTOFTECHNICALRESERVESRELATINGTOREINSURANCECEDEDCONTRACTS
I.Partoftechnicalreservesrelatingtoreinsurancecededcontractstonon-lifeinsurance
1.Partofthepremiumreserverelatingtoreinsurancecededcontracts(395) / 28
2.Partofthereserveforparticipationinthebenefitsanddiscountsrelatingtoreinsurancecededcontracts.(3922) / 29
3.Partoftheclaimreserverelatingtoreinsurancecededcontracts.(397) / 30
4.Partofothertechnicalreservesrelatingtoreinsurancecededcontracts
a)Partoftheunexpiredriskreservesrelatingtoreinsurancecededcontracts(3992) / 31
b)Partofthecatastrophereserverelatingtoreinsurancecededcontracts(3991) / 32
c)Partofothertechnicalreservesrelatingtoreinsurancecededcontracts(3993) / 33
TOTAL(rows28to33) / 34
II. Partoftechnicalreservesrelating toreinsurancecededcontractstolifeinsurance
1.Partofthemathematicalreserverelatingtoreinsurancecededcontracts(391) / 35
2.Partofthepremiumreserverelatingtoreinsurancecededcontracts(398) / 36
3.Partofthereserveforparticipationinthebenefitsanddiscountsrelatingtoreinsurancecededcontracts(3921) / 37
4.Partoftheclaimsreserverelatingtoreinsurancecededcontracts(396) / 38
5.Partofothertechnicalreservesrelatingtoreinsurancecededcontracts(393) / 39
TOTAL(rows35to39) / 40
III. Part of the mathematical reserve for the life insurance for which the exposure to the investment risk is transferred to policyholders reinsurance ceded (394) / 41
TOTAL(rows34+40+41) / 42
E / RECEIVABLES
Amountsowedbyaffiliatedundertakings(4511+4518-495) / 43
Amountsreceivablefromparticipatinginterests(4521+4528-495+4523) / 44
TOTAL(rows43+44) / 45
I Receivablesfromdirectinsuranceoperations
Insured persons(401*-491) / 46
Insuranceintermediaries(404-491) / 47
Otherreceivablesfromdirectinsuranceoperations(4051+4052-491) / 48
TOTAL(rows46to48) / 49
IIReceivablesfromreinsuranceoperations(411*+412*-491) / 50
IIIOtherreceivables
(425+4282+431*+437*+4382+441*+4424+4428*+443*+444*+445+446*+447*+448*+4581+461+464+475*-496+54512+54522+4284+4384+54532) / 51
IVReceivablesregardingtheunpaidsubscribedsharecapital(456-495) / 52
F / OTHERASSETS
ITangiblefixed assetsandinventories
1.Plantandmachinery
(51112+51113+51114+51122+51123++51124-58112-58113-58114-58122-58123-58124-59112-59113—59114-59122-59123-59124+51132+51133+51134-58132-58133-58134-59132-59133-59134) / 53
2.Otherfixturesandfittings,toolsandequipment(51116+51126-58116-58126-59116-59126+51136-58136-59136) / 54
3.Payments on account and tangible fixed assets in the course of construction (5211+5212+5221+5222-59211-59221+5213+5223-59231) / 55
TOTAL(rows53to55) / 56
Inventories
4.Consumables(531+532-593-594) / 57
5.Advancepaymentsforpurchasesofinventories
(ofacc.461) / 58
TOTAL(rows57+58) / 59
IICashatbankandinhand
(543+544+547+548+551+552) / 60
IIIOtherassets (542-596) / 61
G / ADVANCE PAYMENTS
IAccruedinterestandrents(471) / 62
IIDeferredacquisitioncosts
TOTAL(rows64+65) / 63
1.Deferredacquisitioncostsrelatingtonon-lifeinsurance(4722) / 64
2.Deferredacquisitioncostsrelatingtolifeinsurance(4721) / 65
IIIOtherdeferredcharges(473) / 66
TOTAL(rows62+63+66) / 67
TOTALASSETS(row07+27+42+45+49+50+51+52+56+59+60+61+67) / 68
LIABILITIES
A / CAPITALANDRESERVES
ICapital
Sharecapital (1011+1012+1013)ofwhich: / 69
-sharecapitalsubscribedandpaidin(10112+10122+10132) / 70
IIPremium related to capital(1041+1042+1043) / 71
IIIRevaluationreserve(1051+1052+1053) / 72
IVReserves
1.Legalreserves(10611+10621+10631) / 73
2.Statutoryorcontractualreserves(10613+10623+10633) / 74
3.Reservesrepresentingsurplusfromrevaluationreserves(10615+10625+10635) / 75
4.Otherreserves(10618+10628+10638) / 76
5.Ownshares(1091+1092+1093) / 77
TOTAL(rows73to76-77) / 78
VProfit/loss carried forward
1.Profit/losscarriedforward(11711+11721+11731) / BalanceC / 79
BalanceD / 80
2.Profit or loss carried forward duetotheadoptionofIAS
forthefirsttime,withtheexceptionofIAS29(11712+11722) / BalanceC / 81
BalanceD / 82
3.Profit or loss carried forwardresultingfromthecorrectionofaccountingerrors(11714+11724+11734) / BalanceC / 83
BalanceD / 84
4.Profit or loss carried forwardresultingfromtheadoptionofAccountingRegulationsaccordingtotheEuropeanDirectives(11716+11726) / BalanceC / 85
BalanceD / 86
VIProfit(loss)ofthefinancialyear(121) / BalanceC / 87
BalanceD / 88
VIIProfitappropriation(129) / 89
TOTAL(rows69+71+72+78+79-80+81-82+83-84+85-86+87-88-89) / 90
B / SUBORDINATEDDEBTS(1631+1632+1633) / 91
C / TECHNICALRESERVES
I.Technicalreservesrelating tonon-lifeinsurance(rows 93+94+95+98) / 92
1.Premiumreservesrelating tonon-lifeinsurance(315) / 93
2.Reserve forparticipationinthebenefitsanddiscountsrelating tonon-lifeinsurance(332) / 94
3.Outstanding claimsreserverelating tonon-lifeinsurance(rows96+97) / 95
a)Outstandingclaimsreserves-RBNS(3271) / 96
b)Outstandingclaimsreserves–IBNR(3272) / 97
4.Othertechnicalreservesfornon-lifeinsurance(rows99+100+101) / 98
a)Unexpiredriskreserve(334) / 99
b)Catastrophereserve(333) / 100
c)Othertechnicalreserves(335) / 101
II. Technicalreservesrelating tolifeinsurance(rows103+104+105+106+109) / 102
1. Mathematicalreserves(311) / 103
2.Lifeinsurancepremiumreserve (318) / 104
3. Reserveforparticipationinthebenefitsanddiscountsrelating tolifeinsurance.(312) / 105
4.Outstanding claims reserves relating tolifeinsurance(rows107+108) / 106
a)Outstandingclaimsreserves-RBNS (3261) / 107
b)Outstandingclaimsreserves–IBNR(3262) / 108
5.Othertechnicalreservesforlifeinsurance(313) / 109
III.Equalisationreserve(338) / 110
TOTAL(rows92+102+110) / 111
D / MATHEMATICAL RESERVE FOR THE LIFE INSURANCE FOR WHICH THE EXPOSURE TO THE INVESTMENT RISK IS TRANSFERRED TO POLICYHOLDERS (314) / 112
E / PROVISIONS
1.Provisionsforpensionsandsimilarobligations(15115+15125+15135) / 113
2.Provisionsfortaxation(15116+15126+15136) / 114
3.Otherprovisions (15111+15113+15114+15118+15121+15123+15124+15128+15131+15134+15138) / 115
TOTAL(rows113to115) / 116
F / DEPOSITSRECEIVEDFROMREINSURERS(1651+1652+16818+16828) / 117
G / DEBTS
Amountsowedtoaffiliatedundertakings(16411+16421+16815+16825+26911+26921+4511**+4518**+16431+16835+26931) / 118
Amountsowedrelating toparticipatinginterests(16412+16422+16816+16826+26912+26922+
4521**+4528**+16432+16836+26932+4523) / 119
IDebtsfromdirectinsuranceoperations
(402+404+405**) / 120
IIDebtsfromreinsuranceoperations
(411**+412**) / 121
IIIBondloans (16111+16114+16115+16117+16118+16121+16124+16125+16127+16128+16811+16821-1691-1692) / 122
IVAmountsowedtocreditinstitutions
(16211+16212+16214+16215+16217+16218+
16221+16222+16224+16225+16227+16228+
16812+16822+16832+16231+16232+16234+
16235+16237+16238) / 123
V Other creditors, including tax and social security authorities
(16213+16216+16223+16226+1671+1672+
16817+16827+421+422+423+426+427+ 4281**+431**+437**+4381+441**+4423+4428**+443**+444**+446**+447**+448**+4551+4558+456**+457+4582**+462+463+475**+249+26913+26923+279+549+54511+
54521+5461+5462+1673+16233+16236+4283+4383+16837+26933+4553++54531+5463) / 124
TOTAL(rows118to124) / 125
H / DEFERREDINCOME
I.Investmentsubsidies(1311+1312+1313) / 126
IIDeferredincome(4741+4742+4743) / 127
TOTAL(rows126+127) / 128
TOTALLIABILITIES(rows90+91+111+112+116+117+125+128) / 129

*debtorbalancesofsuchaccounts

**creditorbalancesofsuchaccounts

DIRECTOR / DRAWNUP1
Surnameandfirstname______/ Surnameandfirstname______
Signature______/ Capacity2
Signature______
Stampoftheunit / Registrationnumberwithprofessionalbody
______

2.PROFITANDLOSSACCOUNTINSURERS

2.1.NON-LIFEINSURANCE TECHNICAL ACCOUNT

asat31 December2015

02 -lei-

Caption / Row no. / Resultsrelatedtothereportingperiod
previous / current
A / B / 1 / 2
1.Premiumincome,netofreinsurance
a)grosswrittenpremiumincome(+) / 01
b)reinsurancecededpremiums(-) / 02
c)variation inpremiumreserve(+/-) / 03
d)variation inreinsurancecededpremiumreserve(+/-) / 04
TOTAL(rows01-02-03+04) / 05
2.Shareofthe investmentnetincome(the difference between the investment income and expenses)transferredfromthenon-technicalaccount(+) / 06
3.Othertechnicalincome,netofreinsurance(+) / 07
4.Expenses relating to claims,netofreinsurance
a)claimspaid (rows09-10): / 08
grossamounts / 09
reinsurers’share(-) / 10
b)variation inoutstanding claimreserve,netofreinsurance:(+/-) / 11
TOTAL(rows08+11) / 12
5.Variationinothertechnicalreserves, netofreinsurance,ofwhich:
a)Variation inunexpiredrisksreserve (+/-) / 13
b)Variation incatastrophereserve(+/-) / 14
c) Variation inothertechnicalreserves(+/-) / 15
TOTAL(rows13+14+15) / 16
6.Variation inthe reserveforparticipationinbenefitsanddiscounts(+/-) / 17
7.Netoperatingexpenses
a)acquisitioncosts / 18
b)variation inamountofdeferredacquisitioncosts(+/-) / 19
c)administrativecosts / 20
d)commissionsreceivedfromreinsurersandparticipationinbenefits(-) / 21
TOTAL(rows18+19+20-21) / 22
8.Othertechnical expenses,netofreinsurance / 23
9.Variationinequalisationreserve(+/-) / 24
10.Technicalresultofnon-lifeinsurance
Profit(rows05+06+07-12-16-17-22-23-24) / 25
Loss(rows12+16+17+22+23+24-05-06-07) / 26
DIRECTOR / DRAWNUP1
Surnameandfirstname______/ Surnameandfirstname______
Signature______/ Capacity2
Signature______
Stampoftheunit / Registrationnumberwithprofessionalbody
______

2.2.LIFE INSURANCE TECHNICALACCOUNT

asat31 December2015

03 -lei-

Caption / Row no. / Resultsrelating tothereportingperiod
previous / current
A / B / 1 / 2
1.Premiumincome,netofreinsurance
a)grosswrittenpremiumincome(+) / 01
b) reinsurancecededpremiums(-) / 02
c)variation inpremiumreserve,netofreinsurance(+/-) / 03
TOTAL(rows01-02-03) / 04
2.Investmentincome
a)Incomefromholdingsinundertakingswithparticipatinginterests,ofwhich: / 05
-investmentincomeinaffiliatedundertakings / 06
b)Otherinvestmentincome presenting separately the investmentincomeinaffiliatedundertakings,ofwhich: / 07
Incomefromlandandbuildings / 08
Otherinvestmentincome / 09
c)Incomefromadjustmentsforimpairment/loss of valueofinvestments / 10
d)Incomefromrealisationoninvestments / 11
TOTAL(rows05+07+10+11) / 12
3.Unrealised gains frominvestments / 13
4.Othertechnicalincome,netofreinsurance / 14
5.Expenses relating to claims,netofreinsurance
TOTAL(rows16+19) / 15
a)the amountspaid(rows17-18): / 16
-grossamounts / 17
-reinsurers’share(-) / 18
b)variation inoutstanding claimreserve(+/-)(rows20-21) / 19
-grossamount / 20
-reinsurers’share(-) / 21
6.Variationintechnicalreservesforlifeinsurance
TOTAL(rows23+26+29) / 22
a)variation inmathematicalreserve(rows24-25) / 23
-grossamount / 24
-reinsurers’share(-) / 25
b)Variation inthe reserveforparticipationinbenefitsanddiscounts(rows27-28) / 26
-grossamount / 27
-reinsurers’share(-) / 28
c)Variation inother technicalreserves(rows30-31) / 29
-grossamount / 30
-reinsurers’share(-) / 31
7.Variation inmathematicalreservefor thelifeinsuranceforwhichtheexposuretoinvestmentriskistransferredtothe policyholder,reinsuranceceded(+/-)
TOTAL(rows33-34) / 32
-grossamount / 33
-reinsurers’share / 34
8.Netoperatingexpenses:
a)acquisitioncosts / 35
b)variation in theamountofdeferredacquisitioncosts / 36
c)administrativecosts / 37
d)commissionsreceivedfromreinsurersandparticipationinbenefits(-) / 38
TOTAL(rows35+36+37-38) / 39
9.Expenses relating to investments:
a)Investmentmanagementexpenses,includinginterest / 40
b)Expenses relating to adjustments for impairment/loss of value of investments / 41
c)Lossesontherealisationoninvestments / 42
TOTAL(rows40+41+42) / 43
10.Unrealised lossesfrominvestments / 44
11.Othertechnical expenses,netofreinsurance / 45
12.Shareofthe investmentnetincometransferredtothenon-technicalaccount / 46
13.Technicalresultoflifeinsurance
Profit(rows04+12+13+14-15-22-32-39-43-44-45-46) / 47
Loss(rows15+22+32+39+43+44+45+46-04-12-13-14) / 48
DIRECTOR, / DRAWNUP1
Surnameandfirstname______/ Surnameandfirstname______
Signature______/ Capacity2
Signature______
Stampoftheunit / Registrationnumberwithprofessionalbody
______

2.3.NON-TECHNICALACCOUNT

asat31 December2015

04 -lei-

Caption / Row no. / Resultsrelatedtothereportingperiod
previous / current
A / B / 1 / 2
1.Technicalresultofnon-lifeinsurance
Profit / 01
Loss / 02
2.Technicalresultoflifeinsurance
Profit / 03
Loss / 04
3.Investmentincome
a)Incomefromholdingsinundertakingswithparticipatinginterests / 05
ofwhichinvestmentincomeinaffiliatedundertakings / 06
b)Otherinvestmentincome / 07
-ofwhichinvestmentincomeinaffiliatedundertakings: / 08
Incomefromlandandbuildings / 09
Otherinvestmentincome / 10
c)Incomefromadjustmentsforimpairment/loss of value ofinvestments / 11
d)Incomefromrealisationoninvestment / 12
TOTAL(rows05+07+11+12) / 13
4.Unrealised gains frominvestments / 14
5.Shareofthe investmentnetincometransferredfromthelife insurance technicalaccount / 15
6.Expenses relating to investments
TOTAL(rows17+18+19) / 16
a)Investmentmanagementexpenses,includinginterest / 17
b)Expenses relating to adjustments for impairment/loss of value of investments / 18
c)Lossesontherealisationoninvestments / 19
7.Unrealised lossesfrominvestments / 20
8.Shareofthe investmentnetincometransferredtothenon-life insurance technicalaccount / 21
9.Othernon-technicalincome / 22
10.Othernon-technical expenses,including provisions and value adjustments / 23
11.Income from the voluntary pension fund management* / 24
12.Expenses from the voluntary pension fund management* / 25
13.Profit from the voluntary pension fund management*(rows24-25) / 26
14.Lossfrom the voluntary pension fund management*(rows25-24) / 27
15.Currentresult-
Profit(rows01-02+03-04+13+14+15-16-20-21+22-23+26-27) / 28
Loss(rows02-01+04-03-13-14-15+16+20+21-22+23+27-26) / 29
16.Extraordinaryincome / 30
17.Extraordinaryexpenses / 31
18.Extraordinaryresult
Profit(rows30-31) / 32
Loss(rows31-30) / 33
19.Totalincome / 34
20.Totalexpenses / 35
21.Grossresult
Profit(rows34-35);(rows28-29+32-33); / 36
Loss(rows35-34);(rows 29-28+33-32); / 37
22.Taxonprofit / 38
23.Othertaxes(not mentioned under the previous items) / 39
24.Netresultfortheyear
Profit(rows36-38-39) / 40
Loss(row37+38+39) / 41

*TobecarriedfromtheStatementofincomeandexpensesfortheinsurersmanagingvoluntarypensionfunds

DIRECTOR / DRAWNUP1
Surnameandfirstname______/ Surnameandfirstname______
Signature______/ Capacity2
Signature______
Stampoftheunit / Registrationnumberwithprofessionalbody
______
3.INFORMATIVEDATA

asat31 December2015

05 - lei-

I.DataonLossorProfitregistered / Row no. / No.units / Amounts
1 / 2
Unitswhichregisteredprofit / 01
Unitswhichregisteredloss / 02
II.Dataonoverduepayments / No.
row / Total
col.2+3 / ofwhich:
Forcurrentactivity / Forinvestmentactivity
A / B / 1 / 2 / 3
Overduepayments-total(row04+08+12+18to22+26)ofwhich: / 03
Outstandingliabilitiesfromdirectinsuranceoperations(fromacc.402+404+405)
Total(rows05+06+07) / 04
upto30days / 05
between30and90days / 06
over90days / 07
Outstandingliabilitiesfromreinsuranceoperations(fromacc.411+412)
Total(rows09+10+11),ofwhich: / 08
upto30days / 09
between30and90days / 10
over90days / 11
Outstandingliabilitiestothesocial securitybudget
total(rows13to17)ofwhich: / 12
-ContributionstotheStatesocial securityowedbyemployers,employeesandothersimilarpersons(fromacc.4311+4312+43151+43161) / 13
-Contributionstothehealthsocial securityfundowedbyemployersandinsured persons(fromacc.4313+4314+43152+43162) / 14
-Contributiontotheadditionalpension / 15
-Contributionstotheunemploymentinsurancebudgetowedbyemployersandinsured persons(fromacc.4371+4372+4373+4374) / 16
-Othersocialdebts(fromacc.4381+4383) / 17
Outstandingliabilitiestospecialfundsbudgets(fromacc.443+447) / 18
Outstandingliabilitiestoothercreditors(fromacc.161+164+167+168+269+279+421+423+426+427+4281+451+457+4582+462+4283) / 19
TaxesanddutiesnotpaidontermtotheStatebudget(fromacc.441+442+444+446+448) / 20
Taxesanddutiesnotpaidontermtothelocalbudgets(fromacc.441+442+444+446+448) / 21
Bankloansnotrepaidwhendue(fromacc.162+546)–total(row23to25),ofwhich: / 22
-overdueafter30days / 23
-overdueafter90days / 24
-overdueafter1year / 25
Overdueinterest(fromacc.16812+16822+54617+54627+16832+54637) / 26
III.Averagenumberofemployees / Row no. / 31 Decemberpreviousyear / 31 Decembercurrentyear
A / B / 1 / 2
Averagenumberofemployees / 27
Actualnumberofemployeesexistingattheendofthereportingperiod,i.e.31 December / 28
IV.Interest,dividendsandroyaltiespaidoverthereportingperiod.Subsidiescollectedandoverduereceivables / No.
row / Amounts
- lei-
A / B / 1
Grossincomefrominterestpaidtonon-residentnaturalpersons,ofwhich: / 29
-taxowedtotheStatebudget / 30
Grossincomefrominteresttonon-residentnaturalpersonsofMemberStatesoftheEuropeanUnion,ofwhich: / 31
-taxowedtotheStatebudget / 32
Grossincomefrominterestpaidtonon-residentlegalpersons,ofwhich: / 33
-taxowedtotheStatebudget / 34
Grossincomefrominterestpaidtonon-residentassociated legalpersons*)ofMemberStatesoftheEuropeanUnion,ofwhich: / 35
-taxowedtotheStatebudget / 36
Grossincomefromdividendspaidtonon-residentnaturalpersons,ofwhich: / 37
-taxowedtotheStatebudget / 38
Grossincomefromdividendspaidtonon-residentlegalpersons,inaccordancewithArt.117Letterh)ofLawNo.571/2003ontheFiscalCode,assubsequentlyamendedandsupplemented,ofwhich: / 39
-taxowedtotheStatebudget / 40
Grossincomefromroyaltiespaidtonon-residentlegalpersons,ofwhich: / 41
-taxowedtotheStatebudget / 42
Incomefromroyaltiespaidtonon-residentassociatedlegalpersons*)ofMemberStatesoftheEuropeanUnion,ofwhich: / 43
-taxowedtotheStatebudget / 44
Rentspaidoverthereportingperiodforlands** / 45
Grossincomefromservicespaidtonon-residentpersons,ofwhich: / 46
-taxowedtotheStatebudget / 47
Grossincomefromservicespaidtonon-residentpersonsofMemberStatesoftheEuropeanUnion,ofwhich: / 48
-taxowedtotheStatebudget / 49
Subsidiescollectedoverthereportingperiod,ofwhich: / 50
-subsidiescollectedoverthereportingperiodcorrespondingtoassets / 51
-subsidiescorrespondingtoincome,ofwhich: / 52
-subsidiesforboostinglabourforce**) / 53
Overduereceivableswhichwerenotcollectedonthetermsprovidedinthecommercialcontractsand/orlegislationinforce,ofwhich: / 54
-overduereceivablesfromentitiesinthemajorityorwhollyState-ownedsector / 55
-overduereceivablesfromentitiesintheprivatesector / 56
V.MealVouchers / No.
row / Amounts-lei-
Countervalueofmealvoucherstoemployees(acc.645) / 57
VI.Otherinformation / Row no. / 31 Decemberpreviousyear / 31 Decembercurrentyear
Advancepaymentsforintangiblefixed assets
(acc.524) / 58
Advancepaymentsfortangiblefixed assets(acc.522) / 59
Financialfixedassets,ingrossamounts(rows61+69),ofwhich: / 60
Sharesinaffiliatedentities,participatinginterests,otherlongterminvestmentsandbonds,ingrossamounts(acc.261+263+265)(rows62to68),ofwhich: / 61
-quotedsharesissuedbyresidents / 62
-unquotedsharesissuedbyresidents / 63
-sharesissuedbyresidents / 64
-bondsissuedbyresidents / 65
-unitsissuedbyundertakingsforcollectiveinvestmentissuedbyresidents / 66
-sharesandsocialpartsissuedbynon-residents / 67
-bondsissuedbynon-residents / 68
Longtermreceivables,ingrossamounts
(row70+71),ofwhich: / 69
-longtermreceivablesinleianddenominatedinlei,settleddependingonthecurrencyrate(fromacc.267) / 70
-longtermreceivablesinforeigncurrency(fromacc.267) / 71
Tradereceivables,advancepaymentstosuppliersandothersimilaraccounts,ingrossamounts(fromacc.461) / 72
Receivablesfromdirectinsuranceoperations,Total(rows74+78+82),ofwhich: / 73
-Insured persons-total (row75to77),(acc.401),ofwhich: / 74
-upto30days / 75
-between30and90days / 76
-over90days / 77
-Insuranceintermediaries-total(rows79to81)(acc.404,ofwhich: / 78
-upto30days / 79
-between30and90days / 80
-over90days / 81
-Otherreceivablesfromdirectinsuranceoperations-total(rows83to85)(acc.405),ofwhich: / 82
-upto30days / 83
-between30and90days / 84
-over90days / 85
Receivablesfromreinsuranceoperations
(rows87to89)(411+412) / 86
-upto30days / 87
-between30and90days / 88
-over90days / 89
Employee-relatedclaimsandsimilaraccounts(acc.425+4282) / 90
Receivableswiththesocial securitybudgetandStatebudget(acc.431+437+4382+441+4424+4428+444+445+446+447+4482),(row92to96)ofwhich: / 91
-claimswiththesocial securitybudget(acc.431+437+4382) / 92
-taxreceivableswithStatebudget(acc.441+4424+4428+444+446) / 93
-subsidiesreceivable(acc.445) / 94
-specialfunds–taxesandsimilarliabilities(acc.447) / 95
-otherclaimsreceivablewiththeStatebudget(acc.4482) / 96
Receivablesoftheentitywithaffiliatedentities(acc.451) / 97
Receivableswiththesocial securitybudgetandStatebudgetnotcollectedonterm(fromacc.431+437+4382+441+4424+4428+444+445+446+447+4482) / 98
Otherreceivables(acc.451+452+456+4581+461+471+475),(row100to102) / 99
-transactionwithassociates,transactionswithshareholders/associatesrelating tocapital,transactionsrelating tojointoperations(451+452+456+4581) / 100
-otherreceivableswithnaturalandlegalpersons,otherthanreceivableswithpublicinstitutions(Stateinstitutions),
(fromacc.461+471+475) / 101
-theamountscarriedfromacc.552“Cashadvances”representingcashadvances,grantedaccordingtolawandnotsettleduntil31.12.2014(fromacc.461) / 102
Accruedinterestreceivable(acc.54512+54522),ofwhich / 103
-fromnon-residents / 104
Valueofloanstoeconomicoperators**** / 105
Shortterminvestments,ingrossamounts(acc.271+272+273+274+278) (rows107to113),ofwhich: / 106
-quotedsharesissuedbyresidents / 107
-unquotedsharesissuedbyresidents / 108
-sharesissuedbyresidents / 109
-bondsissuedbyresidents / 110
-unitsissuedbyundertakingsforcollectiveinvestment / 111
-sharesissuedbynon-residents / 112
-bondsissuedbyresidents / 113
Otheroutstandinglodgements(acc.548) / 114
Pettycashinleiandinforeigncurrencies(rows116+117),ofwhich: / 115
-inlei(acc.54711+54721) / 116
-inforeigncurrencies (acc.54714+54724) / 117
Cashatbankinleiandinforeigncurrencies
(row119+121),ofwhich: / 118
-inlei(acc.54411+54421),ofwhich: / 119
-bankaccountsin leiwithnon-residentbanks / 120
-inforeigncurrencies(acc.54414+54424),ofwhich / 121
-bankaccountsinforeigncurrencieswithnon-residentbanks / 122
Othercurrentaccountsatbanksandlettersofcredit
(rows124+125),ofwhich: / 123
-amountsundersettlement,lettersofcreditandotheroutstandinglodgements,inlei(acc.543+54415+54425+55111+55122) / 124
-amountsundersettlementandlettersofcreditinforeigncurrencies (acc.54415+54425+55112+55122) / 125
Debts(rows127+130+133+136+139+142+145+148+151+154+157+158+162+163+164+166+167+172+173+174+179)ofwhich: / 126
-Bondloans,ingrossamounts(acc.161)(row128+129),ofwhich: / 127
-inlei / 128
-inforeigncurrencies / 129
Accruedinterestonbondloans,ingrossamounts(fromacc.168),(rows131+132),ofwhich: / 130
-inlei / 131
-inforeigncurrencies / 132
Shorttermdomesticloans(fromacc.5461+5462)(rows134+135),ofwhich: / 133
-inlei / 134
-inforeigncurrencies / 135
Accruedinterestonshorttermdomesticloans(fromacc.54617+54627),(rows137+138),ofwhich: / 136
-inlei / 137
-inforeigncurrencies / 138
Shorttermforeignloans(fromacc.5461+5462)(rows140+141),ofwhich: / 139
-inlei / 140
-inforeigncurrencies / 141
Accruedinterestonshorttermforeignloans(fromacc.5461+5462),(row143+144),ofwhich: / 142
-inlei / 143
-inforeigncurrencies / 144
Longtermloans(fromacc.1621+1622)(rows146+147),ofwhich: / 145
-inlei / 146
-inforeigncurrencies / 147
Accruedinterestonlongtermloans(fromacc.1681+1682),(rows149+150),ofwhich: / 148
-inlei / 149
-inforeigncurrencies / 150
Longtermforeignloans
(acc.1621+1622)(rows152+153),ofwhich: / 151
-inlei / 152
-inforeigncurrencies / 153
Accruedinterestonlongtermforeignloans(fromacc.1681+1682),(row155+156),ofwhich: / 154
-inlei / 155
-inforeigncurrencies / 156
Statetreasuryloansandaccruedinterest(acc.16216+16226+fromacc.168) / 157
Otherloansandaccruedinterest(acc.163+164+165+167+fromacc.168)(rows159+160),ofwhich: / 158
-inleianddenominatedinlei,settleddependingonthecurrencyrate / 159
-inforeigncurrencies / 160
Valueofconcessionsreceived(fromacc.167) / 161
Debtsfromdirectinsuranceoperations
(acc.402+404+405) / 162
Debtsfromreinsuranceoperations
(acc.411+412) / 163
Tradepayables,advancepaymentsfromclientsandothersimilaraccounts,ingrossamounts(fromacc.462),ofwhich: / 164
-tradepayables,advancepaymentsfromforeignclientsandothersimilaraccounts,ingrossamounts / 165
Employee-relateddebtsandsimilaraccounts
(acc.421+422+423+ 426+427+4281) / 166
Debtswiththesocial securitybudgetandState budget(acc.431+437+4381+441+4423+4428+444+446+447+4481),row(168to171),ofwhich: / 167
-debtswiththesocial securitybudget(acc.431+437+4381) / 168
-taxdebtswiththeStatebudget(acc.441+4423+4428+444+446) / 169
-specialfunds–taxesandsimilarliabilities(acc.447) / 170
-otherdebtspayabletotheStatebudget(acc.4481) / 171
Debtsoftheentitywithaffiliatedentities*****(acc.451) / 172
Amountsowedtoshareholders/associates(acc.455) / 173
Otherdebts(acc.131+451+452+455+457+4582+462+474+475+249+269+279+549),row(175to178),ofwhich: / 174
-transactionwithassociates,transactionswithshareholders/associatesrelating tocapital,transactionsrelating tojointoperations(451+452+455+457+4582) / 175
-debtswithnaturalandlegalpersons,otherthandebtswithpublicinstitutions(Stateinstitutions)(fromacc.462+ 474+475) / 176
-subsidiesnotrecordedunderincome(fromacc.131) / 177
-amountspayableforfinancialfixedassetsandshortterminvestments(acc.249+269+279+549) / 178
Accruedinterestpayable(acc.54511+54521) / 179
Valueofloansreceivedfromeconomicoperators*** / 180
Subscribedandpaidinsharecapital(acc.10112+10122+10132),ofwhich: / 181
-quotedshares / 182
-unquotedshares / 183
-shares / 184 / X / X
-sharecapitalsubscribedandpaidinbynon-residents / 185
Patentsandlicenses(fromacc.505) / 186
VII.Researchanddevelopmentexpenditure / Row no. / 31 Decemberpreviousyear / 31 Decembercurrentyear
A / B / 1 / 2
Researchanddevelopmentexpenditure,ofwhich: / 187
- depending on the financing source, of which: / 188
-frompublicfunds / 189
-fromprivatefunds / 190
-depending on the nature of expenses: / 191
- current expenses / 192
- capital expenditure / 193
VIII.Informationonexternallycontractedmanpower / Row no. / 31 Decemberpreviousyear / 31 Decembercurrentyear
Externallycontractedmanpower(acc.65611+65621) / 194
Commissionsandfees(acc.65612+65622) / 195
IX. Paid in share capital / Row No. / 31 Decemberprevious year / 31 December current year
Amount / % / Amount / %
Paid in share capital (acc.1012)
(rows 197+200+204+205+206+207), of which: / 196 / x / x
-held by public institutions, of which: / 197
-held by public institutionssubordinated at the national level; / 198
-held by public institutionssubordinated at the local level; / 199
-held by state-owned undertakings, of which: / 200
- fully state-owned; / 201
- majority state-owned; / 202
- minority state-owned; / 203
-held by autonomous administration[regii autonome] / 204
-held by private equity undertakings / 205
-held by natural persons / 206
-held by other entities / 207
Row No / Amounts
A / B / 2014 / 2015
X. Dividends/payments due to the State or local budget, to be distributed from the profit of the financial year by the national companies, national firms, companies and autonomous administrations, of which: / 208
-to central public institutions; / 209
-to local public institutions; / 210
-to other shareholders in which the state/territorial administrative units/public institutions hold directly/indirectlyshares or participations irrespective of their percentage / 211
Row No. / Amounts
A / B / 2014 / 2015
XI. Dividends/payments due to the State or local budget, transferred during the reporting period from the profit of the national companies, national firms, companies and autonomous administrations, of which: / 212
-dividends/payments from the profit of the previous financial year, of whichtransferred: / 213
-to central public institutions; / 214
-to local public institutions; / 215
-to other shareholders in which the state/territorial administrative units/public institutions hold directly/indirectlyshares or participations irrespective of their percentage / 216
-dividends/payment from the profit of the financial years preceding the previous year, of which: / 217
-to central public institutions; / 218
-to local public institutions; / 219
- to other shareholders in which the state/territorial administrative units/public institutions hold directly/indirectlyshares or participations irrespective of their percentage / 220
XI. Assigned receivables from legal persons / Row No. / Amounts
A / B / 2014 / 2015
Assigned receivables from legal persons (at their nominal value), of which: / 221
-assigned receivables from affiliated legal persons / 222
Assigned receivables from legal persons (at acquisition cost), of which: / 223
-assigned receivables from affiliated legal persons / 224

*)TheprovisionsofArt.12420,Letterb)ofLawNo.571/2003onFiscalCode,assubsequentlyamendedandsupplemented,shallbetakenintoaccountforthestatusof“associatedlegalpersons”.

**)Tofilloutwiththerentspaidforoccupiedlands(agriculturalcrops,pastures,grassland,etc.)andrelatedtocommercialpremises(terraces,etc.)ofprivateownersorunitsofpublicadministration,includingrentsfortheuseofwatersforrecreationorotherpurpose(fishing,etc.).

***)Subsidiesforboostinglabourforce(transfersfromtheStatebudgettotheemployer)representtheamountsgrantedtoemployerstopayeducationinstitutions’graduates,incentivizeunemployedpersonswhoarehiredbeforetheexpiryoftheunemploymentperiod,incentivizeemployerswhohireforanindefiniteperiodtheunemployedagedover45yearsold,unemployedpersonswhoarethesoleprovidersfortheirfamiliesorunemployedwho,within3yearsaftertheemploymentdate,meettheconditionstoapplyforpartialearlyretirementpensionorforold-agepension,orothersituationsstipulatedbythelegislationinforceconcerningtheunemploymentinsurancesystemandboostinglabourforce.

****)ThecategoryofeconomicoperatorsshallnotincludetheentitiesregulatedandsupervisedbytheNationalBankofRomania,andtheFinancialSupervisoryAuthority,undertakingsreclassifiedinthesectorofpublicadministrationandnon-profitcompaniesservinghouseholds.

*****)TheprovisionsofArt.7,Para(1),Item21,Letterc)ofLawNo.571/2003onFiscalCode,assubsequentlyamendedandsupplemented,shallbetakenintoaccountforthestatusof“affiliatedlegalpersons”.

DIRECTOR
Surnameandfirstname______
Signature______
Unitstamp______/ DRAWNUP1
Surnameandfirstname______
Signature______
Capacity2______

______

1Theannualfinancialstatementsaresignedbythepersonsauthorisedaccordingtolaw,indicatingtheirnameinprint.

2Therowcorrespondingtothecapacityofthepersonwhodraftedthefinancialstatementsshallbefilledoutasfollows:

-economicmanager,chiefaccountantorotherpersonauthorisedtoholdsuchpositionaccordingtolaw

STATEMENT OF NON-CURRENT ASSETS

as at 31 December 2015

06 - lei -

Gross values
Non-current asset items / Row No. / Initial balance / Increases / Decreases / Final Balance
(col. 5 = 1+2-3)
Total / Of which: stripped and retired
A / B / 1(1) / 2(2) / 3(3) / 4(4) / 5(5)
Intangible fixed assets
Set-up costs and development costs (501+503) / 01 / X
Other intangible fixed assets (505+507+508) / 02 / X
Payments on account and intangible fixed assets in progress (523+524) / 03 / X
TOTAL (rows 01 to 03) / 04 / X
Investments in tangible fixed assets
Land (21111+21121+21131) / 05 / X
Buildings (21112+21122+21132) / 06
Investments in tangible fixed assets in the course of construction(231+232) / 07
Operating tangible fixed assets
Technological equipment and, measuring, control and regulating equipment and appliances (51112+ 51113 + 51122+51123+ 51132+51133) / 08
Means of transport, furniture, office supplies, human and material values protection equipment and other tangible assets (51114+51116+51124+51126+ 51134+51136) / 09
Payments on account and tangible fixed assets in progress (521+522) / 10
TOTAL (rows 05 to 10) / 11
Investments in financial fixed assets and relating to life insurance for which the investment risk is transferred to the policyholder
(241+261+263+264+265+267+
268+271+272+273+274+278) / 12 / X
NON-CURRENT ASSETS - TOTAL
(rows 04+11+12) / 13
STATEMENT OF AMORTISATION OF NON-CURRENT ASSETS
06 -lei-
Non-current asset items / Row No. / Initial balance / Amortisation over the year / Amortisation for non-current assets written off / Amortisation at the end of the year (col. 9 = 6+7-8)
A / B / 6(1) / 7(2) / 8(3) / 9(4)
Intangible fixed assets
Set-up costs and development costs (58011+58013+58021+58023+58031+58033) / 14
Other intangible fixed assets
(58015+58017+58018+58025+
58027+58028+58035+58037
+58038) / 15
TOTAL (rows 14 + 15) / 16
Investments in tangible fixed assets
Land (28111+28121+28131) / 17
Buildings (28112+28122+28132) / 18
Operating tangible fixed assets
Technological equipment and, measuring, control and regulating equipment and appliances (58112+58113+58122+58123+
58132+58133) / 19
Means of transport, furniture, office supplies, human and material values protection equipment and other tangible assets (58114+58116+58124+58126+
58134+58136) / 20
TOTAL (rows 17 to 20) / 21
AMORTISATION – TOTAL
(rows 16+21) / 22
STATEMENT OF ADJUSTMENTS FOR IMPAIRMENT
06 -lei-
Non-current asset items / Row No / Initial balance / Adjustments over the year / Adjustments reversed in income / Final balance
(col. 13 = 10+11-12)
A / B / 10(1) / 11(2) / 12(3) / 13(4)
Intangible fixed assets
Set-up costs and development costs (59013+59023+59033) / 23
Other intangible fixed assets (59015+59017+59018+59025+
59027+59028+59035+59037+
59038) / 24
Payments on account and intangible fixed assets in progress (59213+59223+59233) / 25
TOTAL (rows 23 to 25) / 26
Investments in tangible fixed assets
Lands (29111+29121+29131) / 27
Buildings (29112+29122+29132) / 28
Investments in tangible fixed assets in the course of construction(293) / 29
Operating tangible fixed assets
Technological equipment and, measuring, control and regulating equipment and appliances (59112+59113+59122+59123+
59132+59133) / 30
Means of transport, furniture, office supplies, human and material values protection equipment and other tangible assets (59114+59116+59124+59126+
59134+59136) / 31
Advance payments and tangible fixed assets in progress (59211+59221+59231) / 32
TOTAL (rows 27 to 32) / 33
Investments in financial fixed assets and relating to life insurance for which the investment risk is transferred to the policyholder (294+296+297) / 34
ADJUSTMENTSFOR IMPAIRMENT–
TOTAL (rows 26+33+34) / 35
DIRECTOR, / DRAWN UP1,
Surname and first name______/ Surname and first name ______
Signature______/ Capacity 2
Unit stamp______/ Signature ______
Registration number with professional body ______

1 The annual financial statements are signed by the persons authorised according to law, indicating their name in print.

2The row corresponding to the capacity of the person who drafted the financial statements shall be filled out as follows:

economic manager, chief accountant or other person authorised to hold such position according to law

4. STATEMENTS SUBMITTED BY THE INSURERS MANAGING VOLUNTARY PENSION FUNDS

4.1.Statementofassets,liabilitiesandequities

asat31 December2015

-lei-

Caption / Row No. / Balanceat01.01.2015 / Balanceat31.12.2015
A / B / 1 / 2
A.NON-CURRENTASSETS
I.INTANGIBLEFIXED ASSETS*
1.Set-upcosts / 01
2.Developmentcosts / 02
3.Concessions,patents,licences,trademarksand
similarrightsandassetsandotherintangibleassetsatremainingvalue / 03
4.Goodwill / 04
5.Payments on accountandintangibleassetsinprogress / 05
TOTALINTANGIBLEFIXED ASSETS(rows01to05) / 06
II.TANGIBLEFIXED ASSETS
1.Landandbuildings** / 07
2.Plantandmachinery / 08
3.Otherfixturesandfittings,toolsandequipment / 09
4.Payments on accountandtangiblefixed assetsinthe course of construction / 10
TOTALTANGIBLEFIXED ASSETS(rows07to10) / 11
III.FINANCIALFIXED ASSETS
1.Sharesinaffiliatedundertakings / 12
2.Loanstoaffiliatedundertakings / 13
3.Participatinginterests / 14
4.Loanstoundertakingswithwhichtheundertakingislinkedbyparticipatinginterests / 15
5.Investmentsintheformoflandandbuildings*** / 16
6.Investmentsheldasnon-currentsassets / 17
7.Otherloans / 18
TOTALFINANCIALFIXED ASSETS
(rows12to18) / 19
TOTALNON-CURRENTASSETS(rows06+11+19) / 20
B.CURRENTASSETS
I.INVENTORIES
1.Consumablesandotherinventories / 21
2.Advancepaymentsforpurchasesofinventories / 22
TOTALINVENTORIES(rows21+22) / 23
II.RECEIVABLES
1.Tradereceivables / 24
2.Amountspayablebyaffiliatedundertakings / 25
3.Amountsreceivablefromparticipatinginterests / 26
4.Otherreceivables / 27
5.Receivablesregardingtheunpaidsubscribedsharecapital / 28
TOTALRECEIVABLES (rows 24to28) / 29
III.SHORTTERMFINANCIALINVESTMENTS
1.Sharesinaffiliatedundertakings / 30
2.Othershorttermfinancialinvestments / 31
TOTALSHORTTERMFINANCIALINVESTMENTS
(rows30+31) / 32
IV.CASHATBANKANDINHAND / 33
TOTALCURRENTASSETS(rows23+29+32+33) / 34
C.DEFERREDCHARGES / 35
D.DEBTSTOBEPAIDNOLATERTHANONEYEAR
1.Bondloans / 36
2.Amountsowedtocreditinstitutions / 37
3.Paymentsreceivedonaccountofclients / 38
4.Commercialdebts / 39
5.Notespayable / 40
6.Amountsowedtoaffiliatedundertakings / 41
7.Amountsowedrelating toparticipatinginterests / 42
8.Otherdebts,includingtaxdebtsandothersocial securitydebts / 43
TOTALDEBTSTOBEPAIDNOLATERTHANONEYEAR(rows36to43) / 44
E.NETCURRENTASSETS,NETCURRENTDEBTS(rows34+35-44-61) / 45
F.TOTALCURRENTASSETSMINUSDEBTS(rows20+45-60) / 46
G.DEBTSTOBEPAIDWITHINMORETHANONEYEAR
1.Bondloans / 47
2.Amountsowedtocreditinstitutions / 48
3.Paymentsreceivedonaccountofclients / 49
4.Commercialdebts / 50
5.Notespayable / 51
6.Amountsowedtoaffiliatedundertakings / 52
7.Amountsowedrelating toparticipatinginterests / 53
8.Otherdebts,includingtaxand social security / 54
TOTALDEBTSTOBEPAIDWITHINMORETHANONEYEAR(rows47to54) / 55
H.PROVISIONS
1.Provisionsforpensionsandsimilarobligations / 56
2.Provisionsfortaxation / 57
3.Otherprovisions / 58
TOTALPROVISIONS (rows56to58) / 59
I.DEFERREDINCOME
1.Investmentsubsidies / 60
2.Deferredincome / 61
TOTALDEFERREDINCOME(rows 60+61) / 62
J.CAPITALANDRESERVES
I.CAPITAL ofwhich:
-Paidsubscribedsharecapital / 63
-Unpaidsubscribedsharecapital / 64
TOTALCAPITAL(rows63+64) / 65
II.CAPITALPREMIUM / 66
III.REVALUATIONRESERVE
BalanceC / 67
IV.RESERVES
1.Legalreserves / 68
2.Statutoryorcontractualreserves / 69
3.Reservesrepresentingsurplusfromrevaluationreserves / 70
4.Otherreserves / 71
5.Ownshares / 72
TOTALRESERVES(rows68to71–72) / 73
V.PROFIT/LOSS CARRIED FORWARD
BalanceC / 74
BalanceD / 75
VI.PROFIT (LOSS) FOR THE FINANCIAL YEAR
BalanceC / 76
BalanceD / 77
TOTALEQUITIES(rows65+66+67+73+74-75+76-77) / 78
DIRECTORDRAWNUP1
Surnameandfirstname______Surnameandfirstname______
Signature______Capacity2______
Signature______Stampoftheunit Registrationnumberwithprofessionalbody
______

*)Intangibleandtangiblefixed assetsareenteredatnetvalues.

**)Nottobefilledinbyinsurersmanagingvoluntarypensionfunds.

***)Tobefilledinbyinsurersmanagingvoluntarypensionfunds.

4.2.STATEMENT OF INCOME AND EXPENSES

asat31 December2015

-lei-

CAPTION / Row no. / Resultsrelating tothereportingperiod
previous / current
A / B / 1 / 2
OPERATINGINCOME
1.Operatingincomerelating tothepensionfund management / 01
2.Otheroperatingincome / 02
OPERATINGINCOME -TOTAL(row01+02) / 03
OPERATINGEXPENSES
I.COSTSOFMATERIALS
3.Costsofmaterialsandotherexternalcosts(rows05to07) / 04
a)Costsofconsumables / 05
b)Othercostsofmaterials / 06
c)Otherexternalcosts(energyandwater) / 07
4.Personnelexpenses(rows09+10) / 08
a)Salaries / 09
b)Social security and health contributions / 10
5.Adjustments
a)Valueadjustmentregardingtangibleandintangiblefixed assets(rows12-13) / 11
a.1)Expenses / 12
a.2)Income / 13
b)Valueadjustmentregardingcurrentassets(row15-16) / 14
b.1)Expenses / 15
b.2)Income / 16
6.Otheroperatingexpenses(rows18to20) / 17
a)Costsofexternalservices / 18
b)Othertaxes,dutiesandsimilarexpenses / 19
c)Expenseswithcompensation,donationsandassetsdisposed of / 20
7.Adjustmentsofprovisions(rows 22-23) / 21
a)Expenses / 22
b)Income / 23
OPERATINGEXPENSES-TOTAL (row04+08+11+14+17+21) / 24
PROFITORLOSSFROMOPERATINGACTIVITY
Profit(rows 03-24) / 25
Loss(rows 24-03) / 26
FINANCIALINCOME
8.Incomefromparticipatinginterests / 27
-ofwhich,incomeobtainedfromaffiliatedundertakings / 28
9.Incomefromotherinvestmentandloansbelongingtonon-currentassets / 29
-ofwhich,incomeobtainedfromaffiliatedundertakings / 30
10.Interestincomeandsimilarincome / 31
-ofwhich,incomeobtainedfromaffiliatedundertakings / 32
11.Otherfinancialincome / 33
FINANCIALINCOME-TOTAL(rows27+29+31+33) / 34
FINANCIALEXPENSES
12.Valueadjustmentoffinancialfixed assetsandfinancialinvestmentsheldascurrentassets
(rows36-37) / 35
Expenses / 36
Income / 37
13.a)Interestexpenseandsimilarexpenses / 38
-ofwhich,expenseswithaffiliatedundertakings / 39
14.Otherfinancialexpenses / 40
FINANCIALEXPENSES-TOTAL(rows35+38+40) / 41
FINANCIALPROFITORLOSS
Profit(rows 34-41) / 42
Loss(rows 41-34) / 43
PROFITORLOSSFROMCURRENTACTIVITY
Profit(rows03+34-24-41) / 44
Loss(rows24+41-03-34) / 45
15.EXTRAORDINARYINCOME / 46
16.EXTRAORDINARYEXPENSES / 47
17.PROFITORLOSSFROMEXTRAORDINARYACTIVITY
Profit(rows46-47) / 48
Loss(rows47-46) / 49
TOTALINCOME(rows03+34+46) / 50
TOTALEXPENSES(rows24+41+47) / 51
GROSSPROFITORLOSS
Profit(rows 50-51) / 52
Loss(rows 51-50) / 53
DIRECTOR
Surnameandfirstname______
Signature______
Stampoftheunit
______/ DRAWNUP1
Surnameandfirstname______
Capacity2______
Signature______
Registrationnumberwithprofessionalbody

1Theaccountingreportsaresignedbythepersonsauthorisedaccordingtolaw,indicatingtheirnameinprint.

2Therowcorrespondingtothecapacityofthepersonwhodraftedthefinancialstatementsshallbefilledoutasfollows:

-economicmanager,chiefaccountantorotherpersonauthorisedtoholdsuchpositionaccordingtolaw

OR

-naturalorlegalpersons,authorisedaccordingtolaw,membersoftheBodyofExpertandLicensedAccountsofRomania.

Section2

INSURANCEBROKERS

1.BALANCESHEETasat31 December2015

County______|_|_|
Legalperson______
Address:locality______,
sector____,Str.______No.___,
Block______,Entrance______,Apt.____
Telephone______,Fax______
RegisteredwiththeTradeRegistryunderNo.______/ Formofownership______|_|_|
Mainactivity
(CAENclassname)______
CAENclasscode______|_|_|_|_|
SoleRegistrationCode
______|_|_|_|_|_|_|_|_|_|_|
01 / -lei-
Caption / Row no. / Balanceat:
01.01.2015 / 31.12.2015
A / B / 1 / 2
A. / NON-CURRENTASSETS

I.INTANGIBLEFIXED ASSETS

1.Set-upcosts

(acc.201-2801) / 01

2.Developmentcosts

(acc.203-2803-2903) / 02

3.Concessions,patents,licences,trademarksandsimilarrightsandassets,totheextentthattheywereacquiredforvaluableconsideration

(acc.205+208-2805-2808-2905-2908) / 03

4.Goodwill

(2071-2807-2907) / 04

5.Payments on accountandintangible fixedassetsinprogress(acc.233+234-2932)

/ 05

TOTAL(rows01to05)

/ 06

II.TANGIBLEFIXED ASSETS

1.Landandbuildings
(acc.211+212-2811-2812-2911-2912) / 07
2.Plantandmachinery
(acc.213-2813-2913) / 08
3Otherfixturesandfittings,toolsandequipment
(acc.214-2814-2914) / 09
4.Payments on accountandtangiblefixed assetsinthe course of construction(acc.231+232-2931) / 10
TOTAL(rows07to10) / 11
III.FINANCIALFIXED ASSETS
1.Participatinginterestsinaffiliatedundertakings(acc.261-2961) / 12
2.Loanstoaffiliatedundertakings
(acc.2671+2672-2964) / 13
3.Participatinginterests
(acc.263-2962) / 14
4.Loanstoundertakingswithwhichtheundertakingislinkedbyparticipatinginterests
(acc.2673+2674-2965) / 15
5.Investmentsheldasnon-currentsassets
(acc.265-2963) / 16
6.Otherloans
(acc.2675+2676+2678+2679-2966-2968) / 17
TOTAL(rows12to17) / 18
NON-CURRENTASSETS–TOTAL
(rows06+11+18) / 19
B. / CURRENTASSETS

I.INVENTORIES

1.Consumablesandothercurrentassetsintheformofinventories
(acc.302+303-392-393) / 20
2.Advancepaymentsforpurchasesofinventories
(fromacc.461) / 21

TOTAL(rows20+21)

/ 22

II.RECEIVABLES

1.Receivablesrelating tointermediationactivity

(acc.403+411+412-491) / 23

2.Amountspayablebyaffiliatedundertakings

(acc.451-495) / 24

3.Amountsreceivablefromundertakingswithwhichtheundertakingislinkedbyparticipatinginterests

(acc.452-495) / 25

4.Otherreceivables

(acc.425+4282+431+437+4382+441+4424+4428+443*+444+445+446+447+4482+4581+461+464+473-496+5182) / 26

5.Receivablesregardingtheunpaidsubscribedsharecapital

(acc.456-495) / 27

TOTAL(rows23to27)

/ 28

III.SHORTTERMINVESTMENTS

  1. Participatinginterestsinaffiliatedundertakings
(acc.501-591) / 29

2.Othershortterminvestments

(acc.505+506+508-595-596-598+5112+5113) / 30

TOTAL(rows29to30)

/ 31

IV.CASHATBANKANDINHAND

(acc.5111+512+531+532+541+542) / 32

CURRENTASSETS–TOTAL

(rows22+28+31+32) / 33
C. / DEFERREDCHARGES (acc.471) / 34
D. /

DEBTS:AMOUNTSTOBEPAIDNOLATERTHANONEYEAR

1.Bondloanswithseparatepresentationofconvertiblebondloans

(acc.161+1681-169) / 35

2.Amountsowedtocreditinstitutions

(acc.1621+1622+1624+1625+1627+1628+1682+5191+5192+5198) / 36

3.Debtswithintermediationactivity

(acc.401+402+403**) / 37
4.Amountsowedtoaffiliatedundertakings
(acc.1641+1685+2691+451**) / 38
5.Amountsowedtoundertakings withwhichtheundertakingislinkedbyparticipatinginterests
(acc.1642+1686+2692+452**) / 39
6.Otherdebts,including tax and social security authorities
(acc. 1623+1626+167+1687+2693+421+423+425+426+427+4281+431**+437**+4381+441**+4423+4428**+443**+444**+446**+447**+4481+455+456**+457+4582+462+463+473**+509+5181+5194+5195+5196+5197) / 40
TOTAL(rows35to40) / 41
E. /

NETCURRENTASSETS/NETCURRENTDEBTS