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Financial Services Board > Departments > Insurance > Forms: Applications, Notifications and Returns :

Forms: Applications, Notifications and Returns

Application Forms

Notification Forms

  • Notification Forms
    • Document Icon
      Notification form (Information Request 5 of 2016 (LTST)).zip
      Notification form: New cell arrangements entered into from 1 October 2016 to Information Request 5 of 2016 (LT&ST). The Notification form must be submitted to the Registrar’s office per email to FSB.INSCellCaptiveConduct@FSB.co.za.
    • Document Icon
      NotifyLTRegulation5-8.doc
      NOTIFICATION IN TERMS OF REGULATION 5.8 OF THE REGULATIONS ISSUED UNDER THE LONG-TERM INSURANCE ACT (“ACT”): AMENDMENTS TO ACTUARIAL BASIS AND VALUES OF LONG-TERM INSURANCE POLICIES
    • Document Icon
      General Notification-Parts 3 and 4 BN 158 of 2014(Final).doc
      Notification form: General notifications under Part 3 (Composition, Governance and Structure of the Board of Directors) and Part 4 (Risk Management System) of Board Notice 158 of 2014
    • Document Icon
      NotifyLT38Transfer.doc
      NOTIFICATION OF THE TRANSFER OF THE BUSINESS OF A LONG-TERM INSURER IN TERMS OF SECTION 38 OF THE LONG-TERM INSURANCE ACT (“ACT”)
    • Document Icon
      NotifyLT29(3)ST28(3)FinancialCondition2.doc
      NOTIFICATION OF FAILURE TO MAINTAIN A FINANCIALLY SOUND CONDITION IN TERMS OF SECTION 29(3) OF THE LONG-TERM INSURANCE ACT OR SECTION 28(3) OF THE SHORT-TERM INSURANCE ACT (“ACT”)
    • Document Icon
      NotifyLT43ST42VoluntaryWinding-up.doc
      NOTIFICATION OF A SPECIAL RESOLUTION RELATING TO THE WINDING-UP OF A LONG-TERM OR SHORT-TERM INSURER IN TERMS OF SECTION 43 OF THE LONG-TERM INSURANCE ACT OR SECTION 42 OF THE SHORT-TERM INSURANCE ACT
    • Document Icon
      NotifyLTST3(2)(b)(ii)MaterialInfoChangesDirectors2.doc
      NOTIFICATION OF A MATERIAL CHANGE AFTER A DIRECTOR, MANAGING EXECUTIVE OR PUBLIC OFFICER HAS SUBMITTED A PERSONAL QUESTIONNAIRE OR A DECLARATION TO THE REGISTRAR OF LONG-TERM OR SHORT-TERM INSURANCE IN TERMS OF SECTION 3(2)(b)(ii) READ WITH SECTIONS 9(3)(b)(ii)7,16(1)(b), (c) AND (d) AND 18 OF THE LTIA OR STIA
    • Document Icon
      MIE Personal Credentials Form.pdf
      MIE PERSONAL CREDENTIAL VERIFICATION FORM
    • Document Icon
      NotifyLTST3(2)(b)(ii)PersonalquestDirectors2.doc
      PERSONAL QUESTIONNAIRE FOR AN INDIVIDUAL WHO IS PROPOSING TO BECOME A DIRECTOR, MANAGING EXECUTIVE OR PUBLIC OFFICER OF A LONG-TERM OR SHORT-TERM INSURER REQUIRED IN TERMS OF SECTION 3(2)(b)(ii) READ WITH SECTIONS 9(3)(b)(ii), 16(1)(b), (c) AND (d) AND 18
    • Document Icon
      NotifyLTST13(2)(b)CessationNewPolicies2.doc
      NOTIFICATION OF INTENTION TO CEASE TO ENTER INTO ANY MORE LONG-TERM OR SHORT-TERM POLICIES IN TERMS OF SECTION 13(2)(b) OF THE LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT (“ACT”)
    • Document Icon
      NotifyLTST16(1)(c)(d)HeadOfficeAddress.doc
      NOTIFICATION OF A CHANGE OF ADDRESS OF THE HEAD OFFICE TO THE REGISTRAR OF LONG-TERM OR SHORT-TERM INSURANCE IN TERMS OF SECTION 16(1)(c) AND (d) OF THE LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT (“ACT”)
    • Document Icon
      NotifyLTST16(1)(b)(c)(d)PublicOfficer.doc
      NOTIFICATION OF A CHANGE OF A PUBLIC OFFICER OR OF A CHANGE OF A NAME OF A PUBLIC OFFICER TO THE REGISTRAR OF LONG-TERM OR SHORT-TERM INSURANCE IN TERMS OF SECTION 16(1)(b), (c) AND (d) OF THE LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT (“ACT”)
    • Document Icon
      NotifyLTST18AppointTerminateResignDirectors2.doc
      NOTIFICATION OF THE APPOINTMENT OR TERMINATION OF THE APPOINTMENT OR RESIGNATION OF A DIRECTOR OR MANAGING EXECUTIVE BY A LONG-TERM OR SHORT-TERM INSURER TO THE REGISTRAR OF LONG-TERM OR SHORT-TERM INSURANCE IN TERMS OF SECTION 18(1) OF THE LONG-TERM INSUNCE ACT OR THE SHORT-TERM INSURANCE ACT
    • Document Icon
      NotifyLTST19(2)Auditor2.doc
      INFORMATION REQUIRED BY THE REGISTRAR OF LONG-TERM OR SHORT-TERM INSURANCE IN CONSIDERING THE APPROVAL OF THE APPOINTMENT OF AN AUDITOR OF A LONG-TERM OR SHORT-TERM INSURER IN TERMS OF SECTION 19(2) OF THE LONG-TERM INSURANCE ACT OR THE SHORT-TERM INSURANCE ACT
    • Document Icon
      2012.11.30_Notification_form_(as_amended)-_Outsourcing_(as_approved_and_posted)[2].doc
      Notification of the outsourcing of a control, management or material function

Returns Forms

​Download Conduct of Business Return under the LTI Act and STI Act

​Download Returns for Short-term Insurers

Download Returns for Long-term Insurers

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