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APPLICATION FORM: TRANSITIONAL EXEMPTION FROM A SECTION(S) IN BOARD NOTICE 158 OF 2014[1]
General instructions:
The application form must be completed with reference to the applicable Legal and Policy Framework that appears at the end of the application form.
Insurer Name
Insurer Number
Type of application (please indicate with “x” for all the questions in the spaces provided below):
Application under the -
Exemption
[Insurers are required to complete the table below, with a separate row used for each aspect from which exemption is sought]
Section from which exemption is sought / Reason for requiring exemption (explain why the practicalities require progressive application of the specific section) / Proposed Date for compliance / Key Actions (with expected completion dates in brackets)section1 replace this with the appropriate numbers (e.g. 10(1)) /section1 / reason1 delete this text and replace with the reason /reason1 / date1 dd/mm/yyyy/date1 / actions1
· Action 1 (mmm yy)
· Action 2 (mmm yy
· etc</actions1>
section2 replace this with the appropriate numbers (e.g. 10(1)) /section2 / reason2 delete this text and replace with the reason /reason2 / date2 dd/mm/yyyy/date2 / actions2
· Action 1 (mmm yy)
· Action 2 (mmm yy
· etc</actions2
section3 replace this with the appropriate numbers (e.g. 10(1)) /section3 / reason3 delete this text and replace with the reason /reason3 / date3 dd/mm/yyyy/date3 / actions3
· Action 1 (mmm yy)
· Action 2 (mmm yy
· etc</actions3
section4 replace this with the appropriate numbers (e.g. 10(1)) /section4 / reason4 delete this text and replace with the reason /reason4 / date4 dd/mm/yyyy/date4 / actions4
· Action 1 (mmm yy)
· Action 2 (mmm yy
· etc</actions4
section5 replace this with the appropriate numbers (e.g. 10(1)) /section5 / reason5 delete this text and replace with the reason /reason5 / date5 dd/mm/yyyy/date5 / actions5
· Action 1 (mmm yy)
· Action 2 (mmm yy
· etc</actions5
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 contactid /contactid 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 application 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
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INFORMATION RELATING TO AN APPLICATION FOR TRANSITIONAL EXEMPTION FROM A SECTION(S) IN BOARD NOTICE 158 OF 2014
A. Introduction
This application form relates to an application for transitional exemption from a section(s) in Board Notice 158 of 2014.
B. Interpretation/Legal framework
1. In the application 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 application 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 section 30 of Board Notice 158 of 2014 an insurer may, where practicalities require the progressive application of a specific section of Board Notice 158 of 2014, apply for an exemption from that specific section for a specific period on specific conditions. To apply for such an exemption, the insurer is required to complete the table in Part 1 of this application form, with a separate row used for each aspect from which exemption is sought.
C. Instructions
1. The application must be submitted directly to the Registrar of Long-term Insurance or Short-term Insurance at the Financial Services Board.
2. Applications 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 application form must be completed in full by the responsible person and be signed by the person duly authorised to sign this form.
4. The application form must be completed with reference to the instructions provided in the application form and this information document in respect of each part of this form.
5. The format of the application 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 application.
[1] 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.