aditya birla health insurance co. limited registration no ... · aditya birla health insurance co....

Aditya Birla Health Insurance Co. Limited

Registration No. 153 and Dated 11 July 2016

FORM NL-1-B-RA

REVENUE ACCOUNT FOR THE QUARTER ENDED 31 DECEMBER 2016

(Rs.’000)

S.No Particulars Schedule

For The Quarter Ended

31st December 2016

Upto Quarter

Ended 31st

December 2016

For The Quarter

Ended 31st December

2015

Upto Quarter

Ended 31st

December 2015

1 Premiums earned (Net) NL-4-Premium Schedule 25,050 25,050 - -

2 Profit/ Loss on sale/redemption of Investments - - - -

3 Others (to be specified) 29 29 - -

4 Interest, Dividend & Rent – Gross - - - -

TOTAL (A) 25,079 25,079 -

1 Claims Incurred (Net) NL-5-Claims Schedule 26,746 26,746 - -

2 Commission NL-6-Commission

Schedule

20,692 20,692 - -

3 Operating Expenses related to Insurance Business NL-7-Operating Expenses

Schedule

2,25,761 3,37,209 - -

4 Premium Deficiency 24,426 24,426 - -

TOTAL (B) 2,97,624 4,09,072 -

Operating Profit/(Loss) from Fire/Marine/Miscellaneous

Business C= (A - B)

(2,72,545) (3,83,993) - -

APPROPRIATIONS

Transfer to Shareholders’ Account (2,72,545) (3,83,993) - -

Transfer to Catastrophe Reserve - - - -

Transfer to Other Reserves - - - -

TOTAL (C) (2,72,545) (3,83,993) - -



FORM NL-2-B-PL

PROFIT AND LOSS ACCOUNT FOR THE QUARTER ENDED 31 DECEMBER 2016

(Rs.’000)


For The Quarter

Ended 31st December

2016

Upto Quarter Ended

31st December 2016

For The Quarter

Ended 31st December

2015

Upto Quarter Ended

31st December 2015

1 OPERATING PROFIT/(LOSS)

(a) Fire Insurance - - - -

(b) Marine Insurance - - - -

(c ) Miscellaneous Insurance (2,72,545) (3,83,993) - -

2 INCOME FROM INVESTMENTS

(a) Interest, Dividend & Rent – Gross 3,378 3,378 - -

(b) Profit on sale of investments 109 53,806 44 44

Less: Loss on sale of investments - - - -

3 OTHER INCOME 37,007 37,007 - -

TOTAL (A) (2,32,051) (2,89,802) 44 44

4 PROVISIONS (Other than taxation)

(a) For diminution in the value of investments - - - -

(b) For doubtful debts - - - -

(c) Others (to be specified) - - - -

5 OTHER EXPENSES

(a) Expenses other than those related to Insurance Business - 54,088 23,747 42,425

(b) Bad debts written off - - - -

(c) Others (To be specified) - - - -

TOTAL (B) - 54,088 23,747 42,425

Profit Before Tax (2,32,051) (3,43,890) (23,703) (42,381)

Provision for Taxation - - - -

APPROPRIATIONS

(a) Interim dividends paid during the year - - - -

(b) Proposed final dividend - - - -

(c) Dividend distribution tax - - - -

(d) Transfer to any Reserves or Other Accounts (to be specified) - - - -

Balance of profit/ loss brought forward from last year (2,63,846) (1,52,007) (18,678) -

Balance carried forward to Balance Sheet (4,95,897) (4,95,897) (42,381) (42,381)



FORM NL-3-B-BS

BALANCE SHEET AS AT 31 DECEMBER 2016

(Rs.’000)



31st December 2016


31st December 2015

SOURCES OF FUNDS

1 SHARE CAPITAL NL-8-Share Capital Schedule 10,04,412 82,625

2 SHARE APPLICATION MONEY PENDING ALLOTMENT - -

3 RESERVES AND SURPLUS NL-10-Reserves and Surplus Schedule 14,70,588 -

4 FAIR VALUE CHANGE ACCOUNT - -

5 BORROWINGS NL-11-Borrowings Schedule - -

TOTAL 24,75,000 82,625

APPLICATION OF FUNDS

1 INVESTMENTS NL-12-Investment Schedule 23,92,708 34,350

2 LOANS NL-13-Loans Schedule - -

3 FIXED ASSETS NL-14-Fixed Assets Schedule 2,50,681 1,131

4 DEFERRED TAX ASSET

5 CURRENT ASSETS

Cash and Bank Balances NL-15-Cash and bank balance

Schedule

19,810 139

Advances and Other Assets NL-16-Advancxes and Other

Assets Schedule

1,52,968 5,213

Sub-Total (A) 1,72,778 5,352

6 CURRENT LIABILITIES NL-17-Current Liabilities

Schedule

3,32,590 589

7 PROVISIONS NL-18-Provisions Schedule 5,04,475 -

8 DEFERRED TAX LIABILITY - -

Sub-Total (B) 8,37,065 589

NET CURRENT ASSETS (C) = (A - B) (6,64,287) 4,763

9 MISCELLANEOUS EXPENDITURE (to the extent not written

off or adjusted)

NL-19-Miscellaneous

Expenditure Schedule

- -

10 DEBIT BALANCE IN PROFIT AND LOSS ACCOUNT 4,95,897 42,381

TOTAL 24,75,000 82,625



FORM NL-4-PREMIUM SCHEDULE

PREMIUM EARNED [NET]

(Rs.’000)

S.No Particulars

For The Quarter

Ended 31st December

2016

Upto Quarter Ended

31st December 2016


31st December 2015

Upto Quarter Ended

31st December 2015

1 Premium from direct business written 3,35,272 3,35,272 - -

2 Add: Premium on reinsurance accepted - - - -

3 Less : Premium on reinsurance ceded 16,926 16,926 - -

4 Net Premium 3,18,346 3,18,346 - -

5 Adjustment for change in reserve for unexpired risks 2,93,295 2,93,295 - -

Total Premium Earned (Net) 25,050 25,050 - -

Premium Income from Business effected :

a) In India 25,050 25,050 - -

b) Outside India - - - -

Total Premium Earned (Net) 25,050 25,050 - -



FORM NL-5 - CLAIMS SCHEDULE

CLAIMS INCURRED [NET]

(Rs.’000)

S.No Particulars


31st December 2016

Upto Quarter

Ended 31st

December 2016


31st December 2015

Upto Quarter Ended

31st December 2015

Claims paid

1 Direct claims 892 892 - -

2 Add: Re-insurance accepted - - - -

3 Less: Re-insurance Ceded 49 49 - -

Net Claims Paid 843 843 - -

4 Add Claims Outstanding at the end of the period 25,903 25,903 - -

5 Less Claims Outstanding at the beginning of the period - - - -

Total Claims Incurred 26,746 26,746 - -



FORM NL-6-COMMISSION SCHEDULE

(Rs.’000)

S.No Particulars


31st December 2016

Upto Quarter Ended

31st December 2016


31st December 2015

Upto Quarter Ended 31st

December 2015

Commission paid

1 Direct Commission 22,375 22,375 - -

2 Add: Re-insurance Accepted - - - -

3 Less: Commission on Re-insurance Ceded 1,683 1,683 - -

Net Commission 20,692 20,692 - -

Break-up of the expenses (Gross) incurred to procure

business to be furnished as per details indicated below:

Agents 381 381 - -

Brokers 21,987 21,987 - -

Corporate Agency 7 7 - -

Referral - - - -

Others (pl. specify) - - - -

TOTAL (B) 22,375 22,375 - -



FORM NL-7-OPERATING EXPENSES SCHEDULE

OPERATING EXPENSES RELATED TO INSURANCE BUSINESS

(Rs.’000)

S.No Particulars


31st December 2016

Upto Quarter Ended

31st December 2016


31st December 2015

Upto Quarter Ended

31st December 2015

1 Employees’ remuneration & welfare benefits 1,38,464 2,07,395 - -

2 Travel, conveyance and vehicle running expenses 13,374 16,311 - -

3 Training expenses 1,802 2,056 - -

4 Rents, rates & taxes 14,898 21,537 - -

5 Repairs 240 488 - -

6 Printing & stationery 765 1,303 - -

7 Communication 1,305 1,385 - -

8 Legal & professional charges 21,167 23,213 - -

9 Auditors' fees, expenses etc

(a) As auditor 26 25 - -

(b) As adviser or in any other capacity, in respect of

(i) Taxation matters - - - -

(ii) Insurance matters - - - -

(iii) Management services; and (11) 20 - -

(c) In any other capacity - - - -

10 Advertisement and publicity 26,576 26,576 - -

11 Interest & Bank Charges - 309 - -

12 Others (to be specified)

(a) Membership and Subscription 743 1,045 - -

(b) Loss on Foreign Exchange Fluctuation - 1 - -

(c) Insurance 39 129 - -

(d) Sitting Fee 310 510 - -

(e) Miscellaneous Expenses 5,072 19,653 - -

(f) Stamp duty - 842 - -

(j) IT expenses 991 1,411 - -

13 Depreciation - 12,999 - -

TOTAL 2,25,761 3,37,209 - -



FORM NL-8-SHARE CAPITAL SCHEDULE

SHARE CAPITAL

(Rs.’000)

S.No Particulars As at 31st December 2016 As at 31st December 2015

1 Authorised Capital

101,000,000 Equity Shares of Rs 10 each (Previous year: 100,000,000

Equity Shares of Rs. 10 each)

10,10,000 10,00,000

2 Issued Capital

100,441,178 Equity Shares of Rs 10 each ((Previous year: Out of

10,000,000 shares of face value Rs. 10, 6,950,000 shares are of Rs.

7.50/- each partly paid up)

10,04,412 82,625

3 Subscribed Capital

100,441,178 Equity Shares of Rs 10 each (Previous year: Out of



10,04,412 82,625

4 Called-up Capital

100,441,178 Equity Shares of Rs 10 each (Previous year: Out of



10,04,412 82,625

Less : Calls unpaid - -

Add : Equity Shares forfeited (Amount originally paid up) - -

Less : Par Value of Equity Shares bought back - -

Less : Preliminary Expenses - -

Expenses including commission or brokerage on - -

Underwriting or subscription of shares - -

TOTAL 10,04,412 82,625



FORM NL-9-PATTERN OF SHAREHOLDING SCHEDULE

SHARE CAPITAL

PATTERN OF SHAREHOLDING

Shareholder

Number of Shares % of Holding Number of Shares % of Holding

Promoters

Indian 5,12,25,001 51% 1,00,00,000 100%

Foreign 4,92,16,177 49% - 0%

Others - - - -

TOTAL 10,04,41,178 100% 1,00,00,000 100%

AS AT

31ST DECEMBER 2015

AS AT

31ST DECEMBER 2016



FORM NL-10-RESERVE AND SURPLUS SCHEDULE

RESERVES AND SURPLUS

(Rs.’000)

S.No ParticularsAS AT 31ST

DECEMBER 2016

AS AT 31ST

DECEMBER 2015

1 Capital Reserve - -

2 Capital Redemption Reserve - -

3 Share Premium 14,70,588

General Reserves - -

Less: Debit balance in Profit and Loss

Account

- -

Less: Amount utilized for Buy-back - -

5 Catastrophe Reserve - -

6 Other Reserves - -

7 Balance of Profit in Profit & Loss

Account

- -

TOTAL 14,70,588 -

4



FORM NL-11-BORROWINGS SCHEDULE

BORROWINGS

(Rs.’000)


DECEMBER 2016

AS AT 31ST

DECEMBER 2015

1 Debentures/ Bonds - -

2 Banks - -

3 Financial Institutions - -

4 Others (to be specified) - -

TOTAL - -



FORM NL-12-INVESTMENT SCHEDULE

Statement as on: 31st December, 2016

Investments Schedule

(Rs.’000)


DECEMBER 2016

AS AT 31ST

DECEMBER 2015

LONG TERM INVESTMENTS

1 Government securities and Government guaranteed bonds including

Treasury Bills

3,82,960 -

2 Other Approved Securities 1,00,341 -

3 Other Investments - -

( a) Shares - -

(aa) Equity - -

(bb) Preference - -

( b) Mutual Funds - -

(c) Derivative Instruments - -

(d) Debentures/ Bonds - -

(e) Other Securities (to be specified) - -

(f) Subsidiaries - -

(g) Investment Properties-Real Estate - -

4 Investments in Infrastructure and Social Sector 4,12,712 -

5 Other than Approved Investments - -

SHORT TERM INVESTMENTS

1 Government securities and Government guaranteed bonds including

Treasury Bills

- -

2 Other Approved Securities - -

3 Other Investments - -

(a) Shares - -

(aa) Equity - -

(bb) Preference - -

(b) Mutual Funds 3,02,509 34,350

(a) Derivative Instruments - -

(b) Debentures/ Bonds - -

(c) Other Securities (to be specified) - -

(d) Subsidiaries - -

(e) Investment Properties-Real Estate - -

4 Investments in Infrastructure and Social Sector - -

5 Other than Approved Investments 11,94,185 -

TOTAL 23,92,708 34,350

Notes:

1

2

3

4

Aggregate Book Value of Investments (Other Than Listed Equities & Derivative Instruments) is ₹ 23,92,707.51 thousand

(previous year ₹ 34,368.52 thousand).

Aggregate Market Value of Investments (Other Than Listed Equities & Derivative Instruments) is ₹ 23,84,100.94 thousand

(previous year ₹ 34,368.52 thousand).

Includes investment in mutual fund amounting to ₹ 14,96,694.59 thousand (previous year ₹ 34,368.52 thousand)

Includes investments qualifying for infrastructure and social sector investments of ₹ 4,12,712.15 thousand (previous year

₹ NIL thousand)



FORM NL-13-LOANS SCHEDULE

LOANS

(Rs.’000)


DECEMBER 2016

AS AT 31ST

DECEMBER 2015

1 SECURITY-WISE CLASSIFICATION

Secured - -

(a) On mortgage of property - -

(aa) In India - -

(bb) Outside India - -

(b) On Shares, Bonds, Govt. Securities - -

(c) Others - -

Unsecured - -

TOTAL - -

2 BORROWER-WISE CLASSIFICATION

(a) Central and State Governments - -

(b) Banks and Financial Institutions - -

(c) Subsidiaries - -

(d) Industrial Undertakings - -

(e) Others - -

TOTAL - -

3 PERFORMANCE-WISE CLASSIFICATION

(a) Loans classified as standard - -

(aa) In India - -


(b) Non-performing loans less provisions - -

(aa) In India - -


TOTAL - -

4 MATURITY-WISE CLASSIFICATION

(a) Short Term - -

(b) Long Term - -

TOTAL



FORM NL-14-FIXED ASSETS SCHEDULE

FIXED ASSETS

(Rs.’000)

Opening Additions Deductions ClosingUp to Last

Year

For The

Period

On

Sales/AdjustmentsTo Date

AS AT

31ST

DECEMBER 2016

AS AT

31ST DECEMBER

2015Goodwill - - - - - - - - - -

Intangibles - 76,154 - 76,154 - 4,894 - 4,894 71,260 -

Land-Freehold - - - - - - - - - -

Leasehold Property - - - - - - - - - -

Buildings - - - - - - - - - -

Furniture & Fittings - 2,146 - 2,146 - 162 - 162 1,984 -

Information Technology

Equipment

1,747 74,106 - 75,853 123 6,905 - 7,028 68,825 -

Vehicles - 4,045 - 4,045 - 366 - 366 3,679 -

Office Equipment 1,011 6,475 - 7,486 119 672 - 792 6,694 1,131

Others - - - - - - - - - -

TOTAL 2,758 1,62,926 - 1,65,684 243 12,999 - 13,242 1,52,442 1,131

Work in progress 2,730 95,509 - 98,239 - - - - 98,239 -

Grand Total 5,488 2,58,435 - 2,63,923 243 12,999 - 13,242 2,50,681 1,131

PREVIOUS YEAR - 1,218 - 1,218 - 87 - 87 1,131

Net BlockCost/ Gross Block Depreciation

Particulars



FORM NL-15-CASH AND BANK BALANCE SCHEDULE

CASH AND BANK BALANCES

(Rs.’000)


DECEMBER 2016

AS AT 31ST

DECEMBER 2015

1 Cash (including cheques, drafts and stamps) 131 -

2 Bank Balances

(a) Deposit Accounts

(aa) Short-term (due within 12 months) 500 -

(bb) Others - -

(b) Current Accounts 19,179 139

(c) Others (to be specified) - -

3 Money at Call and Short Notice

(a) With Banks - -

(b) With other Institutions - -


TOTAL 19,810 139

Balances with non-scheduled banks included in 2 and

3 above

- -



FORM NL-16-ADVANCES AND OTHER ASSETS SCHEDULE

ADVANCES AND OTHER ASSETS

(Rs.’000)


DECEMBER 2016

AS AT 31ST

DECEMBER 2015

ADVANCES

1 Reserve deposits with ceding companies - -

2 Application money for investments 1,715 -

3 Prepayments 3,275 -

4 Advances to Directors/Officers - -

5 Advance tax paid and taxes deducted at source (Net of provision for taxation) - -

6 Others:

(a) Advance to Suppliers 7,899 -

Less: Provisions made - -

Sub-total 7,899 -

(b) Other advances (Gross Amount) 15,363 -

Less: Provisions made - -

Sub-total 15,363 -

TOTAL (A) 28,252 -

OTHER ASSETS

1 Income accrued on investments 15,152 -

2 Outstanding Premiums - -

3 Agents’ Balances - -

4 Foreign Agencies Balances - -

5 Due from other entities carrying on insurance business(including reinsurers) 1,732 -

6 Due from subsidiaries/ holding 19,402 -

7 Deposit with Reserve Bank of India[Pursuant to section 7 of Insurance Act, 1938] - -

8 Others:

(a) Rent and other deposits 46,702 1,347

(b) Service tax on input services (net) 41,730 3,866

TOTAL (B) 1,24,716 5,213

TOTAL (A+B) 1,52,968 5,213



FORM NL-17-CURRENT LIABILITIES SCHEDULE

CURRENT LIABILITIES

(Rs.’000)


DECEMBER 2016

AS AT 31ST

DECEMBER 2015

1 Agents’ Balances 25,943 -

2 Balances due to other insurance companies 75,498 -

3 Deposits held on re-insurance ceded - -

4 Premiums received in advance 67,506 -

5 Unallocated Premium 2,076 -

6 Sundry creditors 15,545 110

7 Due to subsidiaries/ holding company 286 -

8 Claims Outstanding 25,903 -

9 Due to Officers/ Directors - -

10 Unclaimed Amount - -


(a) Tax deducted payable 7,076 479

(b) Other statutory dues 56,286 -

(c) Provident fund payable 3,127 -

(d) Advance from Corporate Clients - -

(e) Due to employees 1,927 -

(f) Payable for investment 51,418 -

TOTAL 3,32,590 589



FORM NL-18-PROVISIONS SCHEDULE

PROVISIONS

(Rs.’000)


DECEMBER 2016

AS AT 31ST

DECEMBER 2015

1 Reserve for Unexpired Risk 2,93,295 -

2 For taxation (less advance tax paid and taxes deducted at source) - -

3 For proposed dividends - -

4 For dividend distribution tax - -


(a) For Gratuity 28,060 -

(b) For Leave Encashment 6,536 -

(f) For Other operating expense related 1,52,157 -

6 Reserve for Premium Deficiency 24,427 -

TOTAL 5,04,475 -



FORM NL-19 MISC EXPENDITURE SCHEDULE

MISCELLANEOUS EXPENDITURE

(To the extent not written off or adjusted)

(Rs.’000)


DECEMBER 2016

AS AT 31ST

DECEMBER 2015

1 Discount Allowed in issue of shares/ debentures - -


TOTAL - -



FORM NL-21 Statement of Liabilities

(Rs in Lakhs)

Reserves

for

unexpired

risks

Reserve for

Outstandin

g Claims

IBNR

Reserves

Total

Reserves

Reserves

for

unexpired

risks

Reserve for

Outstandin

g Claims

IBNR

Reserves

Total

Reserves

1 Fire - - - - - - - -

2 Marine - - - - - - - -

a Marine Cargo - - - - - - - -

b Marine Hull - - - - - - - -

3 Miscellaneous - - - - - - - -

a Motor - - - - - - - -

b Engineering - - - - - - - -

c Aviation - - - - - - - -

d Liabilities - - - - - - - -

e Others - - - - - - - -

4 Health Insurance 3,177 175 84 3,436 - - - -

5 Total Liabilities 3,177 175 84 3,436 - - - -

AS AT 31ST

DECEMBER 2015

AS AT 31ST

DECEMBER 2016

S.No. Particular



FORM NL-22 - Geographical Distribution of Business

(Rs in Lakhs)

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

For The

Quarter

Ended 31st

Dec' 2016

Upto

Quarter

Ended 31st

Dec' 2016

Andhra Pradesh - - - - - - - - - - - - - - - - 1 - - - - - - - - -

Arunachal Pradesh - - - - - - - - - - - - - - - - - - - - - - - - - -

Assam - - - - - - - - - - - - - - - - - - - - - - - - - -

Bihar - - - - - - - - - - - - - - - - - - - - - - - - - -

Chhattisgarh - - - - - - - - - - - - - - - - - - - - - - - - - -

Goa - - - - - - - - - - - - - - - - - - - - - - - - - -

Gujarat - - - - - - - - - - - - - - - - 56 - - - - - - - - -

Haryana - - - - - - - - - - - - - - 0 - 62 - - - - - - - - -

Himachal Pradesh - - - - - - - - - - - - - - - - - - - - - - - - - -

Jammu & Kashmir - - - - - - - - - - - - - - - - - - - - - - - - - -

Jharkhand - - - - - - - - - - - - - - - - - - - - - - - - - -

Karnataka - - - - - - - - - - - - - - 4 - 106 - - - - - - - - -

Kerala - - - - - - - - - - - - - - - - - - - - - - - - - -

Madhya Pradesh - - - - - - - - - - - - - - - - - - - - - - - - - -

Maharashtra - - - - - - - - - - - - - - 5 - 2,919 - - - - - - - - -

Manipur - - - - - - - - - - - - - - - - - - - - - - - - - -

Meghalaya - - - - - - - - - - - - - - - - - - - - - - - - - -

Mizoram - - - - - - - - - - - - - - - - - - - - - - - - - -

Nagaland - - - - - - - - - - - - - - - - - - - - - - - - - -

Orissa - - - - - - - - - - - - - - - - - - - - - - - - - -

Punjab - - - - - - - - - - - - - - - - - - - - - - - - - -

Rajasthan - - - - - - - - - - - - - - - - - - - - - - - - - -

Sikkim - - - - - - - - - - - - - - - - - - - - - - - - - -

Tamil Nadu - - - - - - - - - - - - - - - - 14 - - - - - - - - -

Telangana - - - - - - - - - - - - - - 3 - 66 - - - - - - - - -

Tripura - - - - - - - - - - - - - - - - - - - - - - - - - -

Uttar Pradesh - - - - - - - - - - - - - - 2 - 68 - - - - - - - - -

Uttrakhand - - - - - - - - - - - - - - - - - - - - - - - - - -

West Bengal - - - - - - - - - - - - - - - - 5 - - - - - - - - -

Andaman & Nicobar Is. - - - - - - - - - - - - - - - - - - - - - - - - - -

Chandigarh - - - - - - - - - - - - - - - - - - - - - - - - - -

Dadra & Nagra Haveli - - - - - - - - - - - - - - - - - - - - - - - - - -

Daman & Diu - - - - - - - - - - - - - - - - - - - - - - - - - -

Delhi - - - - - - - - - - - - - - 1 - 39 - - - - - - - - -

Lakshadweep - - - - - - - - - - - - - - - - - - - - - - - - - -

Puducherry - - - - - - - - - - - - - - - - - - - - - - - - - -

Total - - - - - - - - - - - - - - 16 - 3,336 - - - - - - - - -

Marine (Hull) Engineering

STATES

Motor Own Damage Motor Third PartyFire Marine (Cargo) All Other Miscellaneous Grand TotalLiability insurance Personal Accident Medical InsuranceOverseas medical

InsuranceCrop Insurance



FORM NL-23 - Reinsurance Risk Concentration

(Rs in Lakhs)

Proportional Non-Proportional Facultative

1 No. of Reinsurers with rating of AAA and above - - - - -

2 No. of Reinsurers with rating AA but less than AAA - - - - -

3 No. of Reinsurers with rating A but less than AA 2 169 - - 100%

4 No. of Reinsurers with rating BBB but less than A - - - - -

5 No. of Reinsurres with rating less than BBB - - - - -

Total 2 169 - - 100%

Reinsurance Risk Concentration

Premium ceded to

reinsurers / Total

reinsurance premium

ceded (%)

No. of

reinsurers

Premium ceded to reinsurers

S.No. Reinsurance Placements



FORM NL-24 - Ageing of Claims

(Rs in Lakhs)

1 month 1 - 3 months 3 - 6 months 6 months - 1 year > 1 year

1 Fire - - - - - - -

2 Marine Cargo - - - - - - -

3 Marine Hull - - - - - - -

4 Engineering - - - - - - -

5 Motor OD - - - - - - -

6 Motor TP - - - - - - -

7 Health 34 - - - - 34 9.57

8 Overseas Travel - - - - - - -

9 Personal Accident - - - - - - -

10 Liability - - - - - - -

11 Crop - - - - - - -

12 Miscellaneous - - - - - - -

Ageing of Claims

S.No.No. of claims paid Total No. of

claims paid

Total amount

of claims paidLine of Business



FORM NL-25 - Quarterly claims data for Non-Life

No. of claims only

S. No. Claims Experience FireMarine

Cargo

Marine

Hull

Enginee

ring

Motor

OD

Motor

TPHealth

Overseas

Travel

Personal

AccidentLiability Crop Credit Miscellaneous Total

1 Claims O/S at the beginning of the period - - - - - - - - - - - - - -

2 Claims reported during the period - - - - - - 430 - - - - - - 430

3 Claims Settled during the period - - - - - - 34 - - - - - - 34

4 Claims Repudiated during the period - - - - - - 10 - - - - - - 10

5 Claims closed during the period - - - - - - - - - - - - - -

6 Claims O/S at End of the period - - - - - - 386 - - - - - - 386

Less than 3months - - - - - - 386 - - - - - - 386

3 months to 6 months - - - - - - - - - - - - - -

6months to 1 year - - - - - - - - - - - - - -

1year and above - - - - - - - - - - - - - -



FORM NL-26 - CLAIMS INFORMATION - KG Table I

Solvency for the quarter ended

Required solvency margin based on net premium and net incurred claims (Rs. in Lacs)

Gross

Premium

Net

Premium

Gross incurred

claim

Net incurred

Claim

1 Fire - - - - - - -

2 Marine Cargo - - - - - - -

3 Marine Hull - - - - - - -

4 Motor - - - - - - -

5 Engineering - - - - - - -

6 Aviation - - - - - - -

7 Laibilities - - - - - - -

8 Others - - - - - - -

9 Health 3,353 3,183 282 267 637 80 5,000

Total 3,353 3,183 282 267 637 80 5,000

RSM

ClaimsItem

No.Description RSM-1

PREMIUM

RSM-2



FORM NL-27 - Offices information for Non-Life

S. No. Number

1 No. of offices at the beginning of the year -

2 No. of branches approved during the year 9

3 Out of approvals of previous year -

4 Out of approvals of this year 9

5 No. of branches closed during the year -

6 No of branches at the end of the year -

7 No. of branches approved but not opend -

8 No. of rural branches -

9 No. of urban branches -

No. of branches opened during the

year

Office Information



FORM NL-28-STATEMENT OF ASSETS - 3B

Statement as on: 31st December 2016

Statement of Investment Assets (General Insurer, Re-insurers)

(Business within India)

Periodicity of Submission: Quarterly

(Rs in Lakhs)

S.No PARTICULARS SCH AMOUNT

1 Investments 8 23,927

2 Loans 9 -

3 Fixed Assets 10 2,507

4 Current Assets

a. Cash & Bank Balance 11 198

b. Advances & Other Assets 12 1,530

5 Current Liabilities

a. Current Liabilities 13 3,242

b. Provisions 14 1,868

c. Misc. Exp not Written Off 15 -

d. Debit Balance of P&L A/c 4,959

Application of Funds as per Balance Sheet (A) 18,093

Less: Other Assets SCH Amount

1 Loans (if any) 9 -

2 Fixed Assets (if any) 10 2,507

3 Cash & Bank Balance (if any) 11 198

4 Advances & Other Assets (if any) 12 1,530

5 Current Liabilities 13 3,242

6 Provisions 14 1,868

7 Misc. Exp not Written Off 15 -

8 Debit Balance of P&L A/c 4,959

TOTAL (B) (5,834)

'Investment Assets' As per FORM 3B (A-B) 23,927

Balance FRSM+

(a) (b) (c) d = (b+c) (e) (d + e)

1 G. Sec. Not less than 20% - 3,830 - 3,830 16% - 3,830 3,780

2 G. Sec or Other Apporved Sec. (incl. (1) above) Not less than 30% - 4,833 - 4,833 21% - 4,833 4,761

3 Investment subject to Exposure Norms -

1. 'Housing & Loans to SG for Housing and FFE, Infrastructure

InvestmentsNot less than 15% - 1,554 2,573 4,127 18% - 4,127 4,113

2. Approved Investments Not exceeding 55% - 2,629 387 3,015 13% 10 3,025 3,025

3. Other Investments (not exceeding 25%) - 11,582 - 11,582 49% 360 11,942 11,942

Total Investment Assets 100% - 20,597 2,960 23,557 100% 370 23,927 23,841

S.No 'Investment' represented as Reg. %

SHTotal Market

Value

PHBook Value

(SH + PH)

FVC

Amount

%

Actual



FORM NL-29 - Detail regarding debt securities

(Rs in Lakhs)

As at 31st

December, 2016

As % of total for

this class

As at 31st

December, 2015

As % of total for

this class

As at 31st

December, 2016

As % of total for

this class

As at 31st

December, 2015

As % of total for

this class

Break down by credit rating

AAA rated 4,113 46% - 0% 4,127 46% - 0%

AA or better - 0% - 0% - 0% - 0%

Rated below AA but above A - 0% - 0% - 0% - 0%

Rated below A but above B - 0% - 0% - 0% - 0%

Any other 4,761 54% - 0% 4,833 54% - 0%

8,874 100% - 0% 8,960 100% - 0%

BREAKDOWN BY RESIDUALMATURITY

Up to 1 year - 0% - 0% - 0% - 0%

more than 1 yearand upto 3years 1,024 12% - 0% 1,025 11% - 0%

More than 3years and up to 7years 3,090 35% - 0% 3,102 35% - 0%

More than 7 years and up to 10 years 4,761 54% - 0% 4,833 54% - 0%

above 10 years - 0% - 0% - 0% - 0%

8,874 100% - 0% 8,960 100% - 0%

Breakdown by type of the issurer

a. Central Government 3,780 - 3,830 -

b. State Government 981 - 1,003

c.Corporate Securities 4,113 - 4,127

8,874 100% - 0% 8,960 100% - 0%

Note

1. In case of a debt instrument is rated by more than one agency, then the lowest rating will be taken for the purpose of classification.

2. Market value of the securities will be in accordnace with the valuation method specified by the Authority under Accounting/ Investment regulations.

Market Value Book Value

Detail Regarding debt securities

S.No



FORM NL-30 - Analytical Ratios

(Rs in Lakhs)

S.No ParticularsFor The Quarter

Ended 31st December

2016

Upto Quarter Ended

31st December 2016

For The Quarter

Ended 31st December

2015

Upto Quarter Ended

31st December 2015

1 Gross Premium Growth Rate NA NA NA NA

2 Gross Premium to shareholders' fund ratio 0.17 0.17 NA NA

3 Growth rate of shareholders'fund 4818% 4818% NA NA

4 Net Retention Ratio 95% 95% NA NA

5 Net Commission Ratio 6% 6% NA NA

6 Expense of Management to Gross Direct Premium Ratio 74% 107% NA NA

7 Combined Ratio 74% 108% NA NA

8 Technical Reserves to net premium ratio 108% 108% NA NA

9 Underwriting balance ratio -86% -121% NA NA

10 Operationg Profit Ratio -73% -91% NA NA

11 Liquid Assets to liabilities ratio 4.41 4.41 9.09 9.09

12 Net earning ratio -73% -108% NA NA

13 return on net worth ratio -12% -17% NA NA

14 Available Solvency argin Ratio to Required Solvency Margin Ratio 3.95 3.95 NA NA

15 NPA Ratio NA NA

Gross NPA Ratio - - NA NA

Net NPA Ratio - - NA NA

(Rs in Lakhs)

1 (a) No. of shares 10,04,41,178 10,04,41,178 1,00,00,000 1,00,00,000

2 (b) Percentage of shareholding (Indian / Foreign)

-Indian 51% 51% 100% 100%

-Foreign 49% 49% 0% 0%

3 ( c) %of Government holding (in case of public sector insurance companies) NA NA NA NA

4(a) Basic and diluted EPS before extraordinary items (net of tax expense) for the

period (not to be annualized)-2.31 -4.32 -7.04 -23.69

5(b) Basic and diluted EPS after extraordinary items (net of tax expense) for the

period (not to be annualized)-2.31 -4.32 -7.04 -23.69

6 (iv) Book value per share (Rs) 19.70 19.70 4.02 4.02

Analytical Ratios for Non-Life companies

Equity Holding Pattern



FORM NL-31 - : Related Party Transactions

(Rs in Lakhs)

For The Quarter

Ended 31st December

Upto Quarter Ended

31st December 2016


31st December 2015

Upto Quarter Ended

31st December 2015

1 Aditya Birla Financial Services Limited Shareholder Allotment of Equity Shares - (3,323) - -

Reimbursement of expenses - 11 - -

Reimbursement of expenses received - (2) - -

Transfer of asset on transfer of employee - 2 - -

Transfer of employee benefits on transfer of employee (28) (51) - -

2 MMI Strategic Investment Pty Ltd. Shareholder Allotment of Equity Shares - (19,628) - -

Allocated Travel Cost and Reimbursement 60 199 - -

Reimbursement of expenses received - (147) - -

3 Aditya Birla Nuvo Limited Aditya Birla Group Company Allotment of Equity Shares - - (671) (826)

Reimbursement of expenses - - - 123

4 Birla Sun Life Insurance Company Limited Aditya Birla Group Company Insurance expense 1 2 - -

Insurance premium (1,337) (1,337) - -

Space sharing cost 3 9 - -

Transfer of asset on transfer of employee - 9 - -

Transfer of employee benefits on transfer of employee (12) (33) - -

5 Aditya Birla Financial Shared Services Limited Aditya Birla Group Company Insurance premium (27) (27) - -

Shared Admin and Emp Cost 8 12 - -

6 Aditya Birla Wellness Private Limited Aditya Birla Group Company Cost of Services 3 3 - -

Reimbursement of expenses received (47) (47) - -

7 Aditya Birla Customer Services Limited (Formerly known as Aditya Birla Customer Services Private Limited)Aditya Birla Group Company Digital Marketing cost 17 17 - -

8 Aditya Birla Finance Ltd. Aditya Birla Group Company Shared Admin Cost (2) (2) - -

9 Aditya Birla Money Mart Ltd Aditya Birla Group Company Shared Admin Cost (3) (3) - -

10 Aditya Birla Housing Finance Ltd. Aditya Birla Group Company Shared Admin Cost (0) (0) - -

Related Party Transactions

S.No. Name of the Related PartyNature of Relationship with

the CompanyDescription of Transactions / Categories

Consideration paid / (received)*



FORM NL-32 - Products Information

List below the products and/or add-ons introduced during the period

S. No. Name of Product Co. Ref. No. IRDA Ref.no. Class of

Business* Category of product

Date of filing of

Product

Date IRDA confirmed

filing/ approval

1 Group Activ Health - IRDAI/HLT/ABHI/P-H(G)/V.I/19/2016-17 Health Insurance Class Rated Product 27-09-2016 30-09-2016

2 Group Activ Secure - IRDAI/HLT/ABHI/P-H(G)/V.I/18/2016-17 Health Insurance Class Rated Product 08-09-2016 30-09-2016

3 Activ health - IRDAI/HLT/ABHI/P-H/V.I/32/16-17 Health Insurance Class Rated Product 05-07-2016 31-10-2016

Products Information



FORM NL-33 - SOLVENCY MARGIN - KGII

Solvency for the Quarter ended 31st December 2016

Available Solvency Margin and Solvency Ratio

(Rs in Lakhs)

Item Description Notes No. Amount

(1) (2) (3) (4)

1 Available Assets in Policyholders’ Funds (adjusted value

of Assets as mentioned in Form IRDA-Assets-AA): 4,900

Deduct:

2 Liabilities (reserves as mentioned in Form HG) 3,436

3 Other Liabilities (other liabilities in respect of

Policyholders’ Fund as mentioned in Balance Sheet) 1,451

4 Excess in Policyholders’ Funds (1-2-3) 13

5 Available Assets in Shareholders’ Funds (value of

Assets as mentioned in Form IRDA-Assets-AA): 23,242

Deduct:

6 Other Liabilities (other liabilities in respect of

Shareholders’ Fund as mentioned in Balance Sheet) 3,484

7 Excess in Shareholders’ Funds (5-6) 19,758

8 Total Available Solvency Margin [ASM] (4+7) 19,771

9 Total Required Solvency Margin [RSM] 5,000

10 Solvency Ratio (Total ASM/Total RSM) 3.95



FORM NL-34 - Board of Directors & Key Person

S. No. Name of person Role/designation

1 Mr. Ajay Srinivasan Non Executive Director

2 Mr. Sushil Agarwal Non Executive Director

3 Mr. Devajyoti Bhattacharya Non Executive Director

4 Mr. Asokan Naidu Non Executive Director

5 Mr. Danie Botes Non Executive Director

6 Mr. S Ravi Independent Director

7 Ms. Sukanya Kripalu Independent Director

8 Mr. P Vijay Bhaskar Independent Director

9 Mr. C N Ram Independent Director

10 Mr. Mahendren Moodley Independent Director Appointed w.e.f. October 1, 2016

11 Mr. Mayank Bathwal CEO & Whole Time Director

S. No. Name of person Role/designation

1 Mr. Mayank Bathwal CEO & Whole Time Director

2 Ms. Shikha Bagai Chief Finance Officer

4 Ms. Anuradha Sriram Appointed Actuary

3 Mr. Rajiv Joshi Head - Legal, Risk, Compliance and Secretarial

8 Mr. Srinivasan SubramaniamHead - Operations

5 Mr. Amar Joshi Chief Distribution Officer

8 Ms. Darshana Shah Chief Marketing Officer

6 Mr. Sanjay Karnatak Head - Information Technology

7 Mr. Santanu Banerjee Head - Human Resource

Key Persons as defined in the Corporate Governance Guidelines issued by the IRDAI.

BOD and Key Person information

Details of change in the quarter ended December 31, 2016

Key Persons

Details of change in the quarter ended December 31, 2016



FORM NL-35-NON PERFORMING ASSETS-7A


Details of Investment Portfolio

Periodicity of Submission : Quarterly

%Has there been

revision?Amount

Board

Approval Ref

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - -

COI Company NameInstrument

Type

Interest RateTotal O/s

(Book Value)

Default

Principal

(Book Value)

Default

Interest (Book

Value)

----------------------------------------------Nill------------------------------------

Provision (Rs)Rolled

Over?

Has there been any Principal

Waiver?Classification

Provision

(%)

Principal

Due from

Interest Due

from

Deferred

Principal

Deferred

Interest



FORM NL-36-YIELD ON INVESTMENTS 1


Statement of Investment and Income on Investment


(Rs in Lakhs)

Book Value Market Value Book Value Market Value Book Value Market Value

A01 Central Government Bonds CGSB 2,758 3,780 17 0.61% 0.61% 2,758 3,780 17 0.61% 0.61% - - - 0.00% 0.00%

B GOVERNMENT SECURITIES / OTHER APPROVED SECURITIES

B02 State Government Bonds SGGB 1,003 981 5 0.53% 0.53% 1,003 981 5 0.53% 0.53% - - - 0.00% 0.00%

C a) HOUSING & LOANS TO STATE GOVT. FOR HOUSING AND FFE

C10 Bonds / Debentures issued by Authority constituted under any Housing / Building Scheme approved by Central / State / any Authority or Body constituted by Central / State ActHTDA 2,211 2,568 12 0.56% 0.56% 2,211 2,568 12 0.56% 0.56% - - - 0.00% 0.00%

(b) OTHER INVESTMENTS (HOUSING) - - - 0.00% 0.00% - - - - - - - - 0.00% 0.00%

(c) INFRASTRUCTURE INVESTMENTS

C27 Infrastructure - PSU - Debentures / Bonds IPTD 1,105 1,546 4 0.35% 0.35% 1,105 1,546 4 0.35% 0.35% - - - 0.00% 0.00%

D APPROVED INVESTMENT SUBJECT TO EXPOSURE NORMS

D29 Mutual Funds - Gilt / G Sec / Liquid Schemes EGMF 516 1,470 42 8.13% 8.13% 2,346 1,470 88 3.77% 3.77% - - - 0.00% 0.00%

D30 Mutual Funds - (under Insurer's Promoter Group) EMPG 2,652 1,555 139 5.25% 5.25% 4,699 1,555 251 5.34% 5.34% 53 344 0 0.82% 0.82%

E OTHER INVESTMENTS

E15 Mutual Funds - Debt / Income / Serial Plans OMGS 12,266 8,367 199 1.62% 1.62% 11,642 8,367 199 1.71% 1.71% - - - 0.00% 0.00%

E16 Mutual Funds (under Insurer's Promoter Group) OMPG 3,065 3,575 - 0.00% 0.00% 2,500 3,575 - 0.00% 0.00%

TOTAL 25,577 23,841 418 28,265 23,841 576 53 344 0

Current Quarter

S.No Category of InvestmentCategory

Code

Year to Date Previous Year

Net Yield

(%)²

Income on

Investment

(Rs.)

Gross Yield

(%)¹

Net Yield

(%)²

Investment (Rs.) Investment (Rs.) Investment (Rs.) Net Yield

(%)²

Gross Yield

(%)¹

Income on

Investment

(Rs.)

Income on

Investment

(Rs.)

Gross Yield

(%)¹



FORM NL-37-DOWN GRADING OF INVESTMENT-2


Statement of Down Graded Investments


(Rs in Lakhs)

S.No Name of the Security COI AmountDate of

PurchaseRating Agency Original Grade Current Grade

Date of

DowngradeRemarks

A. During the Quarter ¹ - - - - - - - -

- - - - - - - -

B. As on Date ² - - - - - - - -

- - - - - - - -

----------------------------------------------Nill------------------------------------



FORM NL-38 - Quarterly Business Returns across line of Business

(Rs in Lakhs)

Premium No. of Policies Premium No. of Policies Premium No. of Policies Premium No. of Policies

1 Fire - - - - - - - -

2 Cargo & Hull - - - - - - - -

3 Motor TP - - - - - - - -

4 Motor OD - - - - - - - -

5 Engineering - - - - - - - -

6 Workmen's Compensation - - - - - - - -

7 Employer's Liability - - - - - - - -

8 Aviation - - - - - - - -

9 Personal Accident 16 19 - - 16 19 - -

10 Health 3,336 244 - - 3,336 244 - -

11 Others*

Quarterly Business Returns across line of Business

For the Period Ended 31 Dec 2015For the Period Ended 31 Dec 2016For the Quarater 31 Dec 2016 For the Quarater 31 Dec 2015S.No. Line of Business



FORM NL-39 - Rural & Social Obligations (Quarterly Returns)

(Rs in Lakhs)

S.No. Line of Business Particular No. of Policies Issued Premium Collected Sum Assured

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - -

Rural - - -

Social - - - Others*

3

4

5 Engineering

9

10

11

Motor TP

Employer's Liability

Rural & Social Obligations (Quarterly Returns)

1 Fire

2 Cargo & Hull

Workmen's Compensation

Motor OD

Aviation

Personal Accident

Health

8

6

7



FORM NL-40 - Business Acquisition through different channels

(Rs in Lakhs)

No. of Policies Premium No. of Policies Premium No. of Policies Premium No. of Policies Premium

1 Individual agents 140 27 - - 140 27 - -

2 Corporate Agents-Banks - - - - - - - -

3 Corporate Agents -Others 4 0 - - 4 0 - -

4 Brokers 96 3,317 - - 96 3,317 - -

5 Micro Agents - - - - - - - -

6 Direct Business 23 9 - - 23 9 - -

Total (A) 263 3,353 - - 263 3,353 - -

1 Referral (B) - - - - - -

Grand Total (A+B) 263 3,353 #VALUE! #VALUE! 263 3,353 #VALUE! #VALUE!

S.No.Channels

Current Quarter Same quarter Previous Year Up to the period

Business Acquisition through different channels

Same period of the previous year



FORM NL-41 - GREIVANCE DISPOSAL

(Rs in Lakhs)

Fully Accepted Partial Accepted Rejected

1 Complaints made by customers - - - - - -

a) Proposal Related - - - - - -

b) Claims - - - - - -

c) Policy related

d) Premium - - - - - -

e) Refund - - - - - -

d) Coverage - - - - - -

f) Cover note related - - - - - -

g) Product - - - - - -

h) Others - - - - - -

Total Number of Complaints - - - - - -

2 Total number of policies during previous year - - - - - -

3 Total number of claims during previous year - - - - - -

4 Total number of policies during current year

5 Total number of claims during current year - - - - - -

6Total number of policy complaints (current year) per 10,000 policies

(current year)

- - - - - -

7Total number of claims complaints (current year) per 10,000 policies

(current year)

- - - - - -

8 Duration wise Pending StatusComplaints made by

customers

Complaints made by

intermediariesTotal

a) Upto 7 Days - - -

b) 7 - 15 Days - - -

c) 15 - 30 Days

d) 30 - 90 Days - - -

e) 90 Days and beyond - - -

Total Number of Complaints - - -

Opening Balance * Additions Complaints Pending

-------------------------Nil--------------------------------

-------------------------Nil--------------------------------

-------------Nil-----------

GRIEVANCE DISPOSAL

Complaints ResolvedS No. Particulars

aditya birla health insurance co. limited registration no ... · aditya birla health insurance co....

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