GUERNSEY FINANCIAL SERVICES COMMISSION

THE INSURANCE MANAGERS AND INSURANCE INTERMEDIARIES (BAILIWICK OF GUERNSEY) LAW, 2002, AS AMENDED

Initial notification of

OVERSEAS INSURER INSURING BAILIWICK OF GUERNSEY DOMICILED RISKS

Recognised insurers (not requiring licensing)

NOTES:

Complete all sections as fully as possible giving reasons for non-compliance if any, and attaching supplementary sheets where appropriate.

Fees are not charged to recognised (but not licensed) insurers.

Form should be submitted together with all supporting documents, where applicable, to:

Authorisations

Guernsey Financial Services Commission

PO Box 128, Glategny Court, Glategny Esplanade, St Peter Port, Guernsey GY1 3HQ

Telephone: 712706 International dialling code: 44 1481

Email: Internet:

(Any supporting documentation may be submitted electronically)

1.Name of applicant.

2.Address of registered office.

3.Name and address of the supervisory authority in your home country where you are principally conducting insurance business.

4.Description of business authorised to be carried out in your home jurisdiction.

5.Confirmation of authorisation in your home jurisdiction.

6.Name and addresses of the director or officer who has responsibility for the Guernsey risks.

7.Description of insurance business carried on, or intended to be carried on, in Guernsey.

8.Names and addresses of all insurance intermediaries in Guernsey to whom you have granted agencies. Include those to whom you intend to grant agencies.

9.If you intend to write third party motor insurance business, please complete a separate Motor Insurance Application Form (Form FM), available on the Commission’s website. It should be noted that Form FM requires a separate declaration confirming that the applicant is a member of the Motor Insurers’ Bureau.

10.Please state whetheryou need authorisation under any of the following laws:

  • The Surf Riding (Longboards) (Compulsory Third Party Insurance) (Guernsey) Law, 1969
  • The Vessels and Speedboats (Compulsory Third Party Insurance, Mooring Charges and Removal of Boats) (Guernsey) Law, 1972
  • The Steam Boilers (Insurance) Ordinance, 1952

11.Please state whether you intend to write new business in Guernsey, manage an existing book of business, or both.

12. We agree to provide the Commission, on an annual basis, with statistics in respect of the Guernsey business, specifically gross premium income, commissions paid and claims paid.

Signed:………………………………….
(Duly authorised signatory) / Signed:………………………………….
(Duly authorised signatory)
Name:…………………………………...
(In BLOCK CAPITALS) / Name:…………………………………...
(In BLOCK CAPITALS)
Position Held:…………………………..
(In BLOCK CAPITALS) / Position Held:…………………………..
(In BLOCK CAPITALS)
Date:……………………………………. / Date:…………………………………….

Note:

The Data Protection (Bailiwick of Guernsey) Law, 2017

For the purpose of the Data Protection (Bailiwick of Guernsey) Law, 2017, please note that any personal data provided to the Commission will be used by the Commission to discharge its functions.