Schedule III Authorisation forms referred to in Article 7

Regulation 7.

CENTRAL BANK AND FINANCIAL SERVICES AUTHORITY OF IRELAND

CERTIFICATE OF AUTHORISATION

INSURANCE UNDERTAKING WITH ITS HEAD OFFICE IN IRELAND

Subject to the provisions of the Insurance Acts, 1936 to 1983 and in accordance with the European Communities (Life Assurance) Regulations, 1984 (S.I. 57 of 1984), implementing the First E.E.C. Life Assurance Coordination Directive (79/267/EEC of 5th March, 1979), theCentral Bank and Financial Services Authority of Ireland hereby authorises............................................................ .....................................................

............................................................ ............................................................ ............................................................ ........

............................................................ ............................................................ ..........................................................