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Date Bank Name Attention Address City State Zip Re Bank Account Balance Confirmation The Delaware Department of Insurance is currently conducting an organizational examination on or about of your customer described below this date Name of Captive Insurance Company Solely for the purposes of verification please confirm below the balance in account. Attached is a letter from your client giving you permission to release the account information to the Delaware Department of Insurance. Please mail your reply to the address below and/or fax to 302 577-1212. Examiner for the Bureau of Captive and Financial Insurance Products Attn Jamie Bafundo 704 King Street Suite 602 Wilmington DE 19801 Fax 302 577-1212 For security purposes this form cannot be sent to our department via email. If you have any questions please contact Jamie Bafundo at jamie. Date Bank Name Attention Address City State Zip Re Bank Account Balance Confirmation The Delaware Department of Insurance is currently conducting an organizational examination on or about of your customer described below this date Name of Captive Insurance Company Solely for the purposes of verification please confirm below the balance in account. Attached is a letter from your client giving you permission to release the account information to the Delaware Department of Insurance. Please mail your reply to the address below and/or fax to 302 577-1212. Examiner for the Bureau of Captive and Financial Insurance Products Attn Jamie Bafundo 704 King Street Suite 602 Wilmington DE 19801 Fax 302 577-1212 For security purposes this form cannot be sent to our department via email* If you have any questions please contact Jamie Bafundo at jamie. bafundo state. de. us or by telephone at 302 577-1211. Thank you in advance for your assistance in this matter. Date Bank Name Attention Address City State Zip Re Bank Account Balance Confirmation The Delaware Department of Insurance is currently conducting an organizational examination on or about of your customer described below this date Name of Captive Insurance Company Solely for the purposes of verification please confirm below the balance in account. Attached is a letter from your client giving you permission to release the account information to the Delaware Department of Insurance. Attached is a letter from your client giving you permission to release the account information to the Delaware Department of Insurance. Please mail your reply to the address below and/or fax to 302 577-1212. Examiner for the Bureau of Captive and Financial Insurance Products Attn Jamie Bafundo 704 King Street Suite 602 Wilmington DE 19801 Fax 302 577-1212 For security purposes this form cannot be sent to our department via email* If you have any questions please contact Jamie Bafundo at jamie. Please mail your reply to the address below and/or fax to 302 577-1212. Examiner for the Bureau of Captive and Financial Insurance Products Attn Jamie Bafundo 704 King Street Suite 602 Wilmington DE 19801 Fax 302 577-1212 For security purposes this form cannot be sent to our department via email* If you have any questions please contact Jamie Bafundo at jamie. bafundo state. de. us or by telephone at 302 577-1211. Thank you in advance for your assistance in this matter.

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