Ill. Admin. Code tit. 50, pt. 3113, exh. A

Current through Register Vol. 48, No. 37, September 13, 2024

Exhibit A - Consent and Authorization Form

I	_______________________	hereby give	___________________	written (or)
principal	licensee

permission and authorization to place on deposit with any Federal or State chartered bank(s) money which represents premium to be held or held on my behalf pursuant to 50 Ill. Adm. Code 3113 for interest or income producing purposes. I further waive any right to ownership in any interest or revenue produced from this deposit.

I agree and consent to the above	____________________		_______________
principal		licensee
Date: _______________________________

Ill. Admin. Code tit. 50, pt. 3113, exh. A

Amended at 8 Ill. Reg. 25007, effective January 1, 1985