Commonwealth Numbered Regulations

1995 No. 141 LIFE INSURANCE REGULATIONS - SCHEDULE 4

SCHEDULE 4
FORMS
                                  FORM 1        Subregulation 6.01 (1)

Life Insurance Act 1995 STATEMENT OF PECUNIARY INTERESTS OF APPOINTED ACTUARY
(full name of actuary) of (address), the appointed actuary of the (name of
life company) under the Life Insurance Act 1995 has, in respect of the
company:

* no pecuniary interest.

* the pecuniary interest(s) set out in the Schedule. SCHEDULE Pecuniary
interests of appointed actuary Dated Signature of appointed actuary (NOTE:
Regulation 6.01 specifies the kinds of interests that are required to be set
out in this form.)

* Omit whichever is inapplicable
                                     FORM 2         Regulation 10.01