Illinois Administrative Code
Title 50 - INSURANCE
Part 3113 - PREMIUM FUND TRUST ACCOUNT
Exhibit A - Consent and Authorization Form

Universal Citation: 50 IL Admin Code ยง A
Current through Register Vol. 48, No. 12, March 22, 2024

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: _______________________________

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