23 CAR pt. 13, Appendix B
23 CAR pt. 13, Appendix B. Exhibit B - Custodian Affidavit
Length: 287 wordsOfficial source
EXHIBIT B
CUSTODIAN AFFIDAVIT
(For use in instances where a custodian bank maintains securities on deposit with a clearing institution
registered with the U.S. Securities and Exchange Commission.)
STATE OF
)
)
SS.:
COUNTY OF
)
_________________________, being duly sworn deposes and says that I am an officer of
_________________________, , a banking corporation organized under and pursuant to the laws of the.
_________________________, with its principal place of business at ____________________
(hereinafter called "bank");
That my duties involve supervision of activities of the bank as custodian and records relating
thereto;
That the bank is custodian for certain securities of _________________________,with a place of
business at _________________________ (hereinafter called "insurance company"), pursuant to an
agreement between the bank and the insurance company;
I
That the bank has caused certain of such securities to be deposited with (name and address)__
_________________________________________________________________________________
(hereinafter called "_________________________"); and that the schedule attached hereto is a true
and complete statement of the securities of the insurance company of which the bank was custodian as
of the close of business on ___________________________, and which were so deposited with
__________________________ at such date;
That the bank as custodian has the same responsibility for the safekeeping of such securities whether in
the possession of the bank or deposited with _________________________ as that responsibility is
specifically set forth in the agreement between the bank as custodian and the insurance company; and
That, to the best of my knowledge and belief, unless otherwise shown on the schedule, said
securities were the property of said insurance company and were free of all liens, claims or
encumbrances whatsoever.
Subscribed and sworn to
_________________________(L.S.)
before me this _____ day
of __________, 19_____
______________________________
TYPED NAME
______________________________
______________________________
NOTARY PUBLIC
TITLE