
STATE OF ARKANSAS
DEPARTMENT OF INSURANCE
FINANCE DIVISION
1200 West Third Street
Little Rock, Arkansas 72201
(501) 371-2665
I, _________________________________, ____________________hereby certify that to the best of my
(Name of Authorized Officer) (Title)
knowledge, information and belief, the advertisements (if any) pertaining to life insurance, which were disseminated by :
__________________________________________________________
(Name of Company)
during the period of January 1, 2007 through December 31, 2007, complied or were made to comply in all respects with the provisions of these Rules and Regulations and the laws of the State of Arkansas as implemented and interpreted by these Rules.
Dated at ________________________ in the State of _______________________ this ______ day of _________________, 2______.
___________________________________
Authorized Officer of the Company