Section 17

National Credit Regulator
FORM 39 STATISTICAL RETURN
1	Name of Registered Entity
2	NCR Registration Number
3	Start of reporting period			dd/mm/yyyy
4	End of reporting period			dd/mm/yyyy
This section is to be completed by all registered credit providers except for pawnbrokers
Section 17: Insurance
		17.1	a) Credit Insurance sold with credit agreements			b) Insurance products substituted by clients
			R Value of Credit	R value of Credit Insurance (Total of premiums)		R Value of Credit	Number of agreements
Credit Life1			Sum "Loan Total"	sum "GLP Total Premium for loan incl VAT"
Cover for immovable property
Cover for movable property
Cover for cards, pins and similar2
Optional 3 -Describe
Please give a description of the types of optional insurance on offer
17.2 Cost and fees of credit insurance per different classification of credit
Please indicate the charge for each of the following on a per R1000 per month basis
For each product classification indicate an average price for products in the specific classification
18.2.1	Mortgages		Cost  Risk Cover	Administration	Commission	Other	Total Premium
	Credit Life1
	Cover for immovable property
	Cover for cards, pins and similar2
	Optional 3
18.2.2	Credit Facilities		Cost  Risk Cover	Administration	Commission	Other	Total Premium
	Credit Life1
	Cover for movable property
	Cover for cards, pins and similar2
	Optional 3
18.2.3	Unsecured Credit		Cost  Risk Cover	Administration	Commission	Other	Total Premium
	Credit Life1
	Cover for cards, pins and similar2
	Optional 3
18.2.4	Short Term Credit transaction		Cost  Risk Cover	Administration	Commission	Other	Total Premium
	Credit Life1
	Cover for movable property
	Cover for cards, pins and similar2
	Optional 3
18.2.5	Other credit agreements		Cost  Risk Cover	Administration	Commission	Other	Total Premium
	Credit Life1
	Cover for movable property
	Cover for cards, pins and similar2
	Optional 3
18.2.6	Developmental credit		Cost  Risk Cover	Administration	Commission	Other	Total Premium
	Credit Life1
	Cover for immovable property
	Cover for movable property
	Cover for cards, pins and similar2
	Optional 3
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Section 17: Insurance Continue
17.3 Claims analysis
The following is an analysis of claims finalised (paid or rejected) in this reporting period. This is regardless of whether claims were submitted to the insurer in this or previous reporting periods.
Note:  Exclude claims for which the outcome is still pending from this analysis.
			(a) = b+c             Number of claims finalised by insurer during reporting period	(b)        Number claims Rejected	(c)     Number paid out	R Value Claimed  (claims finalised by insurer this period)	R Value Received from Insurer (claims finalised this period)
Credit Life1
Cover for immovable property
Cover for movable property
Cover for cards, pins and similar2
Optional 3
Items 1-2 is as per the definitions of Credit Insurance and Credit Life Insurance in the Act. Item 3 relates to Section 106(3) of the Act
17.4 List of Insurers
Please indicate the name of insurer for whom you act as an intermediary for credit insurance.
	Hollard			Momentum		African Life
	SA Eagle			Old Mutual		RMB
	Standard General			Capital Alliance		Metropolitan
	Outsurance			Auto and General
	Other	X		Name	ABC Insurance
	Other			Name
	Other			Name
	Other			Name
Is one of the insurers mentioned above related to the credit provider. Either being a sister, holding or subsidiary company?
	Yes		No
Is one or more of the insurers mentioned above a Cell Captive or similar structure in which the credit provider is a stakeholder?
	Yes		No