23 CAR pt. 13, Appendix C
23 CAR pt. 13, Appendix C. Exhibit C - Custodian Affidavit
Length: 301 wordsOfficial source
EXHIBIT C
CUSTODIAN AFFIDAVIT
(For use where ownership is evidenced by book-entry at a Federal Reserve Bank.)
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 it has caused certain of such securities to be credited to its book-entry account with the
Federal Reserve Bank of ____________________ under the Federal Reserve book-entry procedure; 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 ____________________, which
were in a book-entry account maintained in the name of the bank on which the books and records of
the Federal Reserve Bank of ____________________ as such date;
That the bank has the same responsibility for the safekeeping of such securities whether in the
possession of the bank or in said book-entry account 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