AUDITED FINANCIAL STATEMENTS

EXEMPTION AFFIDAVIT

Section 624.424(8)(b), Florida Statutes

(Filing Deadline - March 1, 2001)

 

 

I, the undersigned, hereby certify that

_______________________________________________________________

(Name of Company)

_______________________________________________________________

(Address)

__________________________________________

(Federal ID Number)

is automatically exempt from filing audited financial statements as permitted by Section 624.424(8)(b), Florida Statutes.

I further certify the amount of direct premiums written during the calendar year in the State of Florida for 1998 was $____________ and the number of policyholders or certificate holders of directly written policies nationwide at the end of the calendar year was

_______________.

 

 Signature                                                                                                    (Date)

 

__________________________________                                           ______________                                                     

    

 

__________________                                                                       ____________________    

Notary Public                                                                                          (Officer's Title)