Page 1 of 12
APPLICATION FORM: APPROVAL OF STATUTORY ACTUARY OR ALTERNATE STATUTORY ACTUARY
General instructions:
1. This application form must be completed in accordance with the Information relating to an application for approval of statutory actuary or alternate statutory actuary-document included at the end of this application form.An application form that does not comply with the instructions and guidance provided in this document will not be considered.
2. All questions must be answered or marked not applicable (N/A).
Insurer Name
Insurer Number
Type of Application/s (please indicate with “x”for all the questions in the spaces provided below):
1.Application under the -
Long-term Insurance ActShort-term Insurance Act
2.Application for approval of appointment of –
Statutory ActuaryAlternate Statutory Actuary
Instructions:
1. All questions must be answered or marked not applicable (N/A).
2. If any questions are answered with a “YES”, full details must be attached to the application form. Any supporting documentation attached must be indicated in Part 3 of this form.
Explanatory Note:
In this Part, “related party” has the meaning defined in section 26 of the Long-term Insurance Act and section 25 of the Short-term Insurance Act.
1.1Name of proposed statutory
actuary / alternate statutory actuary
1.2Date of appointment
1.3Are you required by the Act to appoint a statutory actuary?
YESNO
1.4If another statutory actuary was previously appointed by the insurer or if the current statutory actuary has been appointed as the alternate statutory actuary, has that statutory actuary’s statement referred to in section 20(5) of the of the Long-term Insurance Act and section 19A(5) of the Short-term Insurance Act, been submitted to the Registrar?
YESNO
If NO please attach the actuary’s statement to this application form.
1.5What is the statutory actuary’s / alternate statutory actuary’s relationship with the insurer?
EmployeeDirector
Professional service provider
1.6If the statutory actuary / alternate statutory actuary is a professional service provider, has a written contract been entered into with the latter?
YESNO
1.7Does the statutory actuary / alternate statutory actuary or his/her related party hold securities or an interest in securities of the insurer?
YESNO
1.8If the answer to 1.7 is yes,please indicate the number and class of securities held /the interest in securities held by the statutory actuary /alternate statutory actuary and/or each related party and the % voting rights that the statutory actuary / alternate statutory actuary or related party may exercise at a general meeting of the insurer.
Who holds securities / interest in securities (in respect of related parties the relationship with the statutory actuary / alternate statutory actuary must be specified)
/Number & class of securities / interest in securities
/Voting rights that may be exercised at a general meeting of the insurer
1.9How many securities,options or interest in securities if any, in the insurer or a related party of the insurer does the statutory actuary / alternate statutory actuary have or may the statutory actuary / alternate statutory actuary become eligible for?
Insurer / related party of insurer / Number of options/ interest / Current value / Vesting conditions / Vesting date(s)1.10Is there any other matter, relationship or interest that may cause, potentially cause or be perceived to cause a conflict of interest for the statutory actuary / alternate statutory actuary vis a vis the insurer?
YESNO
I, ………………………………………………………………………………………………..[full name of public officer], identity / passport number ……………………………………………………. hereby certify, to the best of my knowledge, that the answers and attached information are complete, accurate, true and not misleading in any respect.
I, ………………………………………………………………………………………………..[full name of public officer], Identity/passport number ………………………………………………… hereby authorise the Financial Services Board, and its duly authorised verification agent, to request or confirm any personal information as well as any other information provided in support of this application with any personal data holders (including but not limited to the South African Police Services, the Government of the Republic, industry bodies and associations, employers and any educational, training, credit bureau and fraud prevention organisations) for the purpose of verifying information.
I further authorise the personal data holders (including but not limited to the aforesaid institutions) to furnish information to the Financial Services Board and it’s duly authorised verification agent. I unconditionally indemnify the Financial Services Board, its verification agent and the personal data holders against any liability that may result from furnishing information in this regard.
I furthermore authorise the Financial Services Board to provide any information provided in this application form or by any personal data holders to the Financial Services Board to any other body designated in national legislation to supervise, regulate or enforce legislation or a similar body designated in the laws of a country other than the Republic to supervise, regulate or enforce legislation of that country. I unconditionally indemnify the Financial Services Board and such other bodies against any liability that may result from furnishing information.
……………………………….. …………………….
Signature of public officer Date
Page 1 of 12
Instructions:
1. All questions must be answered or marked not applicable (N/A).
2. If any questions are answered with a “YES”, full details must be attached to the application form. Any supporting documentation attached must be indicated in Part 3 of this form.
3. Certified copies of the following must be attached and indicated as attached in Part 3 of this form:
-the identification document of the statutory actuary / alternate statutory actuary;
-if the statutory actuary / alternate statutory actuary is not a South African citizen, his/her passport, permanent residence permit and work permit;
- the academic qualificationsof the statutory actuary / alternate statutory actuary;
-the practising certificate issued by the Actuarial Society of South Africa.
A. Details of statutory actuary / alternate statutory actuary
A.1Title
A.2Full names
A.3Surname
A.4Previous names / surnames
(if applicable)
A.5Date of birth
A.6Place of birth
A.7Are you a South African citizen?
YESNO
A.8If your answer to A.7 is YES,
what is youridentity number?
(proceed to A.10)
A.9If your answer to A.7 is NO,
what is your nationality?
A.9.1What is your passport number?
A.9.2When will your passport expire?
A.9.3Do you own residential property in South Africa?
YESNO
A.9.4Are you a permanent resident of South Africa?
YESNO
A.9.5Are you allowed to legally work within South Africa?
YESNO
A.10E-mail address
A.11Physical business address
Postal Code
A.12Postal business address
Postal Code
A.13Physical residential address
Postal Code
A.14Postal residential address
Postal Code
A.15Business telephone number
A.16Mobile phone number
A.17Fax Number
A.18Previous residential addresses
duringthe last 10 years
B.Membership of professional bodies
B.1Are you a fellow member of the Actuarial Society of South Africa?
YESNO
B.2In what year were you admitted as a fellow memberof the
Actuarial Society of South Africa?
B.3Are you a member of any other national or international professional bodies?
YESNO
B.4If the answer to B.3 is YES –
Professional body /Year you became a member
/ Details of membershipC.Qualifications and Experience
C.1Qualifications
Institution that issued the qualification
/Qualification
/Year obtained
C.2Experience
Provide details of your actuarial experience during the last 5 years, including the name of the employer/organisation for which actuarial work was undertaken, the nature of the business (e.g. insurance, pension fund), the nature of actuarial experience (e.g. valuations, new product design, pricing, capital modelling).
Name of employer / organisation /Nature of business
/Duration
/ Details of actuarial experience(If you are of the opinion that experience gained prior to qualificationas an actuary is relevant to your application, you may include such experience in the table, highlighting that it isexperience gained prior to qualification.)
C.3Do you have a relevant and valid practising certificate issued by the Actuarial Society of South Africa?
YESNO
D.Operational abilities
D.1Are you fully aware of all the obligations and duties of a statutory actuary as set out in the relevant Act?
YESNO
D.2Are you fully aware of all the obligations and duties of a statutory actuary as set out in the applicable professional guidance notes issued by the Actuarial Society of South Africa?
YESNO
D.3Are you confident that you will have enough time to fulfill these duties, in accordance with the obligations and duties as set out in the professional guidance notes issued by the Actuarial Society of South Africa,taking into account other appointments as statutory actuary and commitments that you may have?
YESNO
D.4Provide details of other currentappointments as statutory actuary or alternate statutory actuary.
Name of Insurer / Appointed as statutory actuary or alternate? / Appointment dateE.Business Interests (other than in the insurer)
Provide details of your business interests, other than those relating to the insurer.
Name of Company/Close corporation/other juristic person / Relationship(e.g. executive director/non-executive director/member etc) / Percentage interest, if more than 15% / Duration
F.Characteristics of Honesty and IntegrityYESNO
F.1 / Has an adverse finding been made against you within a period of five years preceding the date of application in any civil or criminal proceedings by a court of law (whether in South Africa or elsewhere) in which you were found to have acted fraudulently, dishonestly, unprofessionally, dishonourably or in breach of a fiduciary duty?F.2 / Have you within a period of five years preceding the date of application been found guilty by any professional or financial services industry body (whether in South Africaor elsewhere), of an act of dishonesty, negligence, incompetence or mismanagement?
F.3 / Have you within a period of five years preceding the date of application been denied membership of any professional bodybecause of an act of dishonesty, negligence, incompetence or mismanagement?
F.4 / Have you ever held a practising certificate issued by any Actuarial Society subject to conditions?
F.5 / Have you within a period of five years preceding the date of application been found guilty by any regulatory or supervisory body (whether in South Africa or elsewhere) of an act of dishonesty, negligence, incompetence or mismanagementor has an authorisation to carry on business been refused, suspended or withdrawn by any such body on account of an act of dishonesty, negligence, incompetence or mismanagement?
F.6 / Have you at any time prior to the date of application been disqualified or prohibited by any court of law (whether in South Africa or elsewhere) from taking part in the management of any company or other statutorily created, recognised or regulated body, irrespective whether such disqualification has since been lifted or not?
F.7 / Have you, in South Africaor elsewhere, been dismissed from any office of employment?
F.8 / Have you been refused the right to carry on or restricted from carrying on a trade, business or profession for which a specific license, registration or other authority is required by law in any country?
F.9 / Have you been issued with a prohibition order under any Act administered by the Financial Services Board or been prohibited by other regulatory bodies from operating in the financial services industry?
F.10 / Have you been involved with a corporation that has been censured, disciplined, suspended or refused membership or registration by a stock exchange, futures exchange, other market or regulatory authority?
F.11 / Have you had any judgment (including a finding of fraud, misrepresentation or dishonesty) given against you in any civil proceedings, in South Africa or elsewhere or are there any proceedings now pending which may lead to such a judgment?
F.12 / Have you knowingly or negligently aided or abetted other persons in the breaching of any laws, regulations, exchange rules and/or codes of conduct?
F.13 / Have you been the subject of any investigation or disciplinary proceedings by any regulatory authority (whether in South Africaor elsewhere) or exchange, professional body or government body or agency?
F.14 / Has your estate ever been sequestrated?
F.15 / Have you ever been a controlling shareholder, director of a company or member of a close corporation at the time it was placed under judicial management or in provisional or final liquidation?
F.16 / Have you ever been refused a license or registration in any place under any law, which requires licensing or registration in relation to securities, futures, leveraged foreign exchange or insurance activities?
F.17 / Have you ever been refused authorisation to carry on business by any regulatory body (whether in South Africa or elsewhere), recognised by the Financial Services Board or has such authorisation ever been suspended or revoked by any such body, because of negligence, incompetence or mismanagement?
F.18 / Do you have any additional information, which should be brought to the Registrar’s attention, which may have an impact on the evaluation by the Registrar of your good character and integrity?
G. Declaration
I …………………………………………………………………………………….. [full name of the statutory actuary / alternate statutory actuary]confirm that the information contained in this application is accurate and true in all material aspects.
I hereby acknowledge that I am familiar with the provisions of the Long-term Insurance Act / Short-term Insurance Act [delete the Act that is not applicable] and the duties imposed by it on a statutory actuary.
…………………………….. …………………….
Signature Date
H. Indemnity
I, ………………………………………………………………………………………………..[full name of the statutory actuary / alternate statutory actuary], Identity/passport number …………………… hereby authorise the Financial Services Board, and its duly authorised verification agent, to request or confirm any personal information as well as any other information that I have provided in support of my application to any personal data holders (including but not limited to the South African Police Services, the Government of the Republic, industry bodies and associations, employers and any educational, training, credit bureau and fraud prevention organisations) for the purpose of verifying my personal credentials and records.
Credential verification types include, but are not limited to, educational qualifications, professional membership, employment history, employment references including industry employment registers, consumer credit, criminal records, drivers’ licence, and fraud prevention checks.
I authorise the personal data holders (including but not limited to the aforesaid institutions) to furnish information regarding my credentials, whether claimed or not, to the Financial Services Board and it’s duly authorised verification agent. I unconditionally indemnify the Financial Services Board, its verification agent and the personal data holders against any liability that may result from furnishing information in this regard.
I further authorise the Financial Services Board to provide any information provided in this application form or by any personal data holders to the Financial Services Board to any other body designated in national legislation to supervise, regulate or enforce legislation or a similar body designated in the laws of a country other than the Republic to supervise, regulate or enforce legislation of that country. I unconditionally indemnify the Financial Services Board and such other bodies against any liability that may result from furnishing information.
…………………………….. …………………….
Signature Date
Page 1 of 12
Clearly indicate any attachments that have been included with this application form.
Description / Number of pagesAttachment A
Attachment B
Attachment C
Attachment D
Attachment E
Attachment F
Attachment G
Attachment H
Attachment I
Attachment J
Attachment K
Attachment L
Attachment M
Explanatory Note:
Details of the public officer must be provided. The Registrar will liaise with the public officer and all correspondence from the Registrar will be sent to the public officer.
4.1 Full name and surname
4.2 Telephone number
4.3 Cellphone number
4.4 Fax number
4.5 E-mail address
INFORMATION RELATING TO AN APPLICATION FOR APPROVAL OF STATUTORY ACTUARY OR ALTERNATE STATUTORY ACTUARY
A.Introduction
The application form relates to the approval of the appointment of a statutory actuary or an alternate statutory actuary under the Long-term Insurance Act No. 52 of 1998 or the Short-term Insurance Act No. 53 of 1998.
The Long-term Insurance Act requires every long-term insurer to appoint, and at all times have, a statutory actuary. It allows such an insurer to appoint an alternate to act in the place of its statutory actuary during the latter’s absence for any reason. The Registrar must approve the appointment of a statutory actuary or his or her alternate before such an appointment can take effect.
The Short-term Insurance Act requires every short-term insurer to appoint, and at all times have, a statutory actuary under the circumstances determined by the Registrar. Where the Registrar has not determined the circumstances under which a statutory actuary must be appointed, a short-term insurer may, of its own accord, decide to appoint a statutory actuary. Under both these situations, the short-term insurer may appoint an alternate to act in the place of its statutory actuary during the latter’s absence for any reason. The Registrar must approve the appointment of a statutory actuary or his or her alternate (irrespective of the fact that the appointment is required by the Act or the Registrar or not) before such an appointment can take effect.
An insurer that is required to or, of its own accord, decides to appoint a statutory actuary or an alternate statutory actuary, must complete the application form.
B.Interpretation
In the application form any word or expression defined in the Long-term Insurance Act or the Short-term Insurance Act, as the case may be, including any measure referred to in the definitions of “the Act” in sections 1(1) of the Acts, have, unless the context otherwise indicates, the meaning so defined.
Note that, if there is any discrepancy between the application form and the provisions of the Long-term Insurance Act or the Short-term Insurance Act, as the case may be, the provisions in the Act will be deemed correct.
Section 20 of the Long-Term Insurance Act and section 19A of the Short-term Insurance Act provides that a statutory actuary or alternate statutory actuary -
- must be a natural person;
- who is permanently resident in the Republic;
- is a Fellow of the Actuarial Society of South Africa; and
- has, as an actuary, appropriate practical experience relating to long-term insurance business or short-term insurance business, as the case may be.
C.Instructions
1.An application form must be submitted directly to the Financial Services Board.
2.The application form must be completed in full by the responsible person and be signed by the person duly authorised to sign this form. The public officer of the insurer must complete Parts 1, 3 and 4 of this application form. If a person other than the public officer of the insurer signs the form, proof of the authorisation must be attached to the application form.