STATEMENT of the estimated liability in respect of outstanding claims arising in the year of account, and in the preceding year or years; computed as at the end of the year in which the claims arose, and as at the end of the year of account; with particulars as to the number and amount of the claims actually paid in the intervening period.
I. Claims arising during the year of account ending _________ 19_________
(a) Particulars as to claims arising and settled during the year of account.
|
Class of Claim |
No. of Claims |
TOTAL AMOUNT PAID |
||
|---|---|---|---|---|
|
By Sums Insured |
By Costs and expenses |
Total of columns (3) and (4) |
||
|
(1) |
(2) |
(3) |
(4) |
(5) |
|
£ |
£ |
£ |
||
|
(i) Third Party |
||||
|
(ii) All other claims |
||||
|
Total |
||||
Notes.-
1. All claims arising under one policy and out of a single occurrence shall be treated as one claim for the purposes of this Schedule.
2. Under the headings "By costs and expenses" (column (4) of t