A trustee who contravenes any provision of these Regulations commits an offence and is liable on conviction to a fine not exceeding seventy five currency points and in case of a continuing contravention, an additional penalty of fifty currency points in respect of each day on which the offence continues.
One currency point is equivalent to twenty thousand Uganda shillings
2 Mailing address (if different)
3 Key officer Name Title Telephone number Fax number Email address
7 Auditor Name of auditor/ audit firm Managing partner Address Telephone number Fax number Email address
8 Actuary (if applicable) Name Address Tel Fax Email
________________________ _____________ Signature (on behalf of trustees) Signature (on behalf of trustees) Date: Date:
PARTICULARS OF MEMBERS OF SCHEME
Name of scheme………………………………
2 Members of scheme Female Male (a) Number of members at start of reporting period Number of members admitted to scheme during the period (b) Number of members retired during the period (c) Number of members deceased during the period Number of other members who leave scheme (d) during the period
Total number of members at end of period
3 Members of scheme who retire from employment Female Male Number of members who are retired from (a) employment at start of the period Number of members who retire from employment (b) during the period
Total number of members who are retired from employment at end of the period
_______________________________ __________________________ Signature (on behalf of trustees) Signature (on behalf of trustees) Date: Date:
STATEMENT OF INCOME AND EXPENDITURE OF SCHEME
Financial year ended …………………
1 Previous Year - 1 Previous Year
2 Income Employer contributions Employee contributions Additional voluntary contributions Insurance proceeds (including proceeds from death and disability) Other income (specify)
3 Benefits paid Death benefits paid Disability benefits paid Retirement benefits paid
Pensions payments made Withdrawal benefits paid Other benefits paid (specify)
4 Operational expenses Payments for salaries and benefits of employees Payments for remuneration for trustees Payments for other expenses of the trustees Payments for insurance premiums Administration fees paid Audit fees paid
Actuarial fees paid License fees paid Tax expenses Rental expenses Other payments (specify)
_______________________________ ______________________
Signature (on behalf of trustees) Signature (on behalf of trustees) Date: Date:
STATEMENT OF INVESTMENTS OF SCHEME
2 How asset are invested Yes No Investment by fund managers Collective investment schemes Insurance policies Other (specify)
Details of fund managers, 3 collective investment schemes and insurers
Address (including Value of assets email address and managed telephone number)
___________________________ ___________________
Signature (on behalf of Signature (on behalf of trustees) trustees) Date: Date:
STATEMENT OF INCOME FROM INVESTMENTS OF SCHEME
Name of scheme………. Financial year ended…
1 Previous year - 1 Previous year
2 Source of income Interest income Dividends Rental income Realized capital gains or loss Unrealized capital gains or loss Other (specify)
3 Expenses Professional fees Fund management fees Custody fees Transaction costs Bank charges Other (specify)
Net income from investments
________________________ ____________________ Signature (on behalf of trustees) Signature (on behalf of trustees) Date: Date:
FORM 6 Regulation 3 (3) STATEMENT OF FINANCIAL STATUS OF SCHEME
Name of scheme……... Financial year ended ………………………..
1 Previous year - 1 Previous year
2 Value of assets Value of investment property Value of plant and equipment Value of financial assets Value of contributions and other receivables Cash and cash equivalents Other (specify)
3 Value of liabilities Accounts payable Other (Specify)
4 Member accounts/reserves
Account/reserve 1 Account/reserve 2 Account/reserve 3
__________________________ ____________________ Signature (on behalf of trustees) Signature (on behalf of trustees) Date: Date:
SCHEDULE 3 Regulation 4(2) and 10(3)
REPORT ON CONTRIBUTIONS AND INVESTMENTS OF SCHEME
