Template BNB Cartouches

Boulevard de Berlaimont 14 – BE-1000 Brussels Phone +32 2 221 35 88 – fax +32 2 221 31 04 Company number: 0203.201.340 RPM (Trade Register) Brussels www.nbb.be

Bruxelles, le 2 June 2017

Annex 2 Communication NBB_2017_18

Form for the notification of the pursuit of business under the freedom to provide services

NB: this form may also be used in the event of changes in the nature of the business pursued under the freedom to provide services or in the manner in which it is pursued. In that case, the insurance company should only fill out those parts of this form which contain the information which has changed.

1. Details

Type of notification [notification of the pursuit of new business under the freedom to provide services / notification of modification of information relating to existing business pursued under the freedom to provide services]

Host Member State or third country where the [to be completed by the company] company wishes to operate

Name, Legal Entity Identifier (LEI), administrative [to be completed by the company] code, reference number and address of the head office of the insurance or reinsurance company

Name, telephone number and e-mail of the contact [to be completed by the company] person within the company

2. Proposed activities in the host Member State

2.1. Description of the strategy followed by the company regarding this request to operate under the freedom to provide services

[to be completed by the company]

NBB_2017_18 – 2 June 2017 Annex 2 – Page 1/7 2.2. Types of activities the company wishes to pursue in the host Member State

2.2.1 Classes of insurance

Classes of non-life insurance (Annex 1 of the Law)

A(1) B(1)

  1. Accident. (including industrial injury and occupational diseases)

  2. Sickness.

  3. Land vehicles (other than railway rolling stock)

  4. Railway rolling stock.

  5. Aircraft.

  6. Ships (sea, lake and river and canal vessels)

  7. Goods in transit (including merchandise, baggage, and all other goods)

  8. Fire and natural forces.

  9. Other damage to property.

  10. Motor vehicle liability.

  11.Aircraft liability.

  12.Liability for ships (sea, lake and river and canal vessels)

  13.General liability.

  14.Credit.

  15.Suretyship.

  16.Miscellaneous financial loss.

  17.Legal expenses.

  18.Assistance.

Annex 2 – Page 2/7 NBB_2017_18 – 2 June 2017 NBB_2017_18 – 2 June 2017 Annex 2 – Page 3/7 (1) Indicate in column A the classes of insurance for which the company already has an authorisation and in column B the classes for which an application for authorisation is submitted at the same time as the notification of the foreign business.

Classes of life insurance (Annex 2 of the Law)

A(1) B(1) (2) (3)

  21 I Non-linked life insurance, except marriage and birth insurance.

  22 II Non-linked marriage and birth insurance

Life insurance, marriage and birth insurance linked to investment 23 III   funds.

The type of insurance existing in Ireland and the United Kingdom 24 IV   known as permanent health insurance not subject to cancellation

  25 V Tontines

  26 VI Capital redemption operations

  27 VII Management of group pension funds.

The operations referred to in Chapter 1, Title 4 of Book IV of the 28 VIII   French ‘Code des assurances’.

Operations relating to the length of human life which are prescribed by or provided for in social insurance legislation, when they are 29 IX   effected or managed at their own risk by insurance companies in accordance with the laws of a Member State.

(1)Indicate in column A the classes of insurance for which the company already has an authorisation and in column B the classes for which an application for authorisation is submitted at the same time as the notification of business abroad.

(2) Numbering of classes of life activities according to Annex II of the Law.

(3) Numbering of classes of life activities according to Annex II of the Directive.

Annex 2 – Page 4/7 NBB_2017_18 – 2 June 2017 2.2.2 Reinsurance

Group of reinsurance activities

A(1) B(1)

  Non-life reinsurance activities

  Life reinsurance activities

(1) Indicate in column A the groups of activities for which the company already has an authorisation and in column B the groups of activities for which an application for authorisation is submitted at the same time as the notification of business abroad.

2.3. Nature of the risks or commitments which the company proposes to cover in the host Member State (characteristics of the main products that will be marketed)

2.4. Description of the commercial strategy which will be followed by the company for the business pursued under the freedom to provide services (types of customers, etc.)

3. Organisational aspects which will be set up within the company governed by Belgian law with regard to the business pursued under the freedom to provide services a) Description of the internal control mechanisms of the company that will govern the business pursued under the freedom to provide services:

[to be completed by the company] a) description of the organisation that will be set up within the company to monitor the business pursued under the freedom to provide services (including at the level of the board of directors and the management committee)

[to be completed by the company] c) description of all the (quantitative and qualitative) reports that will be delivered concerning the business pursued under the freedom to provide services

[to be completed by the company] d) Information on the manner in which the business pursued under the freedom to provide services will be taken into account in the work of the company's four independent control functions (internal audit, risk management, compliance and actuarial function)

[to be completed by the company] e) Impact of the business pursued under the freedom to provide services on the company's risk profile

[to be completed by the company] f) Presentation of the risk management measures that will be put in place within the company to monitor the evolution of the risks associated with the business pursued under the freedom to provide services

NBB_2017_18 – 2 June 2017 Annex 2 – Page 5/7 [to be completed by the company] e) Impact of the business pursued under the freedom to provide services on the company's ORSA

[to be completed by the company] h) Information on the measures taken by the company regarding the IT system with respect to the business pursued under the freedom to provide services

4. Financial aspects

4.1. Guiding principles as to reinsurance or retrocession with regard to the business pursued under the freedom to provide services (reinsurance mode and identity of the reinsurers)

4.2. Forecast balance sheet for the company covering a period of three years (Table 1) excluding and including the business pursued under the freedom to provide services.

4.3. For the first three financial years, estimates of the solvency capital requirement (SCR), as laid down in Article 151 of the Law of 13/03/2016, on the basis of the forecast balance sheet referred to above, as well as the calculation method used to establish these estimates (Table 2 in case of standard formula, Table 3 in case of partial internal model and Table 4 in case of full internal model)

4.4. For the first three financial years, estimates of the minimum capital requirement (MCR), as laid down in Article 189 of the Law of 13/03/2016, on the basis of the forecast balance sheet referred to in 4.1., as well as the calculation method used to establish these estimates (Table 5 in case of non-life business and Table 6 in case of life business)

4.5. For the first three financial years, estimates of the financial resources intended to cover the technical provisions, the minimum capital requirement and the solvency capital requirement (Table 7)

Annex 2 – Page 6/7 NBB_2017_18 – 2 June 2017 4.6. For the first three financial years, estimates of management expenses related to the business pursued under the freedom to provide services, in particular current general expenses and commissions, as well as estimates of premiums or contributions and claims (Table 8 in case of non-life and reinsurance business and Table 9 in case of life business)

5. Other information

5.1. If the insurance company wishes to cover, under the freedom to provide services, risks belonging to class 10 as set out in Annex I of the Law of 13/03/2016, with the exception of the carrier's liability, the dossier should include the name and the address of the claims representative and, if this is required by the host Member State, a declaration that the insurance company is affiliated to the national bureau and the national guarantee fund of the host Member State.

[if appropriate, Indicate the name and address of the claims representative or attach the required declaration]

5.2. If the insurance company should wish to cover risks belonging to class 17 as set out in Annex I of the Law of 13/03/2016, it should indicate the type(s) of claims management as described in Article 4 of the Royal Decree of 12 October 1990 on legal expenses insurance (Article 200 of the Solvency II directive), that it will use in the State of the branch.

[to be completed by the company if appropriate]

NBB_2017_18 – 2 June 2017 Annex 2 – Page 7/7