Illinois Administrative Code (Last Updated: March 27, 2024)

§3113.EXHIBIT A. Consent and Authorization Form

Latest version.

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)

                    
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