TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER ii: INSURANCE PRODUCERS, LIMITED INSURANCE REPRESENTATIVES AND BUSINESS ENTITIES
PART 3113 PREMIUM FUND TRUST ACCOUNT
SECTION 3113.EXHIBIT A CONSENT AND AUTHORIZATION FORM

Section 3113.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:

 

 

(Source:  Amended at 8 Ill. Reg. 25007, effective January 1, 1985)