Please complete the form with as much detail as possible. Please remember to send copies of your annual report and accounts (PDF is acceptable).

Organisation
Name of organisation (in full):
Name known as:
Contacts
Senior management contacts (generic titles have been used, please replace with official titles)
Name	Title	Tel	Fax	Email
Formal contact (this is usually the CEO)
Organisation's address:
Organisation's Web site:
Constitutional form
What is the legal structure of the organisation? (eg, mutual)
Do you have a unitary or supervisory board? (explain)
How is the board of directors appointed?
Which other national, regional, and international group(s) is the organisation a member of?
History
When was the organisation formed and by whom?
Financial data
Please supply a copy of the organisation's most recent report and accounts.
Key statistics (all figures to be supplied in local currency).
			Last year	Previous year
Gross premiums:
Net written premiums:
Surplus/profit:
Total assets:
Invested assets:
Policyholder reserves:
Number of employees:
Analysis of gross premium income
	Type of business		Gross premium	Percentage
Life:
Non-life:
Total:				100%
Subsidiaries Please supply a list of subsidiaries together with percentage of ownership and businesses (this may be included in your annual report - if so, please refer to the page).
Name of subsidiary (annual report page)			% ownership	Type of business
Distribution methods
				% premiums
Agents:
Brokers:
Direct:
Internet:
				100%
Surplus/profit Please give a short description of the way in which surplus/profit is applied.
Type the characters shown in image below for verification:
Notes
Please remember to enclose copies of the organisation's annual report and accounts. Please forward this information to: Shaun Tarbuck, CEO, Association of Mutual Insurers PO Box 21, Altrincham, Cheshire, WA14 4PD, UK.
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