Illinois Administrative Code
Title 50 - INSURANCE
Part 1705 - CONSTRUCTION AND FILING OF FORMS
Exhibit A - Certificate of Compliance
Current through Register Vol. 48, No. 12, March 22, 2024
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STATE OF |
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COUNTY OF |
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___(Official's name)___________, being first duly sworn, deposes and says that:
1. He is the _____(Official title)_____________ of the ____(Name of fraternal benefit society) ___________, a fraternal benefit society formed under the laws of the State of;
2. He is the duly appointed official custodian of the Articles of Incorporation or Association, Constitution, By-laws, Rules and Regulations of said Society; and
3. The certificate(s) rider(s) or endorsement(s) hereto and filed for approval herewith are in full compliance with the provisions and requirements of those Articles of Incorporation or Association, Constitution, By-laws, Rules and Regulations.
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________________________________ (Official Title) |
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Subscribed and sworn to |
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before me this |
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day of |
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19 |
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________________________ |
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Notary Public ____________________________ |
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My Commission expires _________, 19 ___ . |
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