"Certification and Agreement by Financial Institution" - Oklahoma

Certification and Agreement by Financial Institution is a legal document that was released by the Oklahoma Insurance Department - a government authority operating within Oklahoma.

Form Details:

  • The latest edition currently provided by the Oklahoma Insurance Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Oklahoma Insurance Department.

ADVERTISEMENT
ADVERTISEMENT

Download "Certification and Agreement by Financial Institution" - Oklahoma

607 times
Rate (4.5 / 5) 36 votes
CERTIFICATION AND AGREEMENT BY FINANCIAL INSTITUTION
The undersigned financial institution (the “Institution”) does hereby certify and agree as follows:
1. The
____________________________________________
(the
“Insurer”)
has
deposited funds in the Institution and such funds are evidenced by the certificate of
deposit (the “Certificate”) numbered ____________________ in the amount of
$_______________ from (Bank)___________________________________________;
2. The records of the Institution reflect that the Certificate is pledged in favor of the
Oklahoma Insurance Commissioner and is classified as negotiable and transferrable;
3. Funds represented by the Certificate are subject to withdrawal by the Insurer only after
notice to, and approval from the Oklahoma Insurance Department is officially given on
the Oklahoma Insurance Department’s Withdrawal Form 31 along with the original
Certificate;
4. The Institution agrees to comply with instructions originated by the Oklahoma Insurance
Department directing the disposition of the funds in the Certificate without further
consent by the Insurer; and
5. The provisions of this certification and agreement will continue in full force and effect
and apply to any renewal or continuation of the Certificate, or to any other deposit funds
that may be proceeds of the Certificate.
______________________________________
Signature
______________________________________
Print Name
______________________________________
Title
______________________________________
Name of Financial Institution
______________________________________
Address
______________________________________
City, State, Zip
This instrument was acknowledged before me on___________________________________,
by ______________________________________________, Commission #______________
(Notary)
My Commission Expires:____________________
[seal]
CERTIFICATION AND AGREEMENT BY FINANCIAL INSTITUTION
The undersigned financial institution (the “Institution”) does hereby certify and agree as follows:
1. The
____________________________________________
(the
“Insurer”)
has
deposited funds in the Institution and such funds are evidenced by the certificate of
deposit (the “Certificate”) numbered ____________________ in the amount of
$_______________ from (Bank)___________________________________________;
2. The records of the Institution reflect that the Certificate is pledged in favor of the
Oklahoma Insurance Commissioner and is classified as negotiable and transferrable;
3. Funds represented by the Certificate are subject to withdrawal by the Insurer only after
notice to, and approval from the Oklahoma Insurance Department is officially given on
the Oklahoma Insurance Department’s Withdrawal Form 31 along with the original
Certificate;
4. The Institution agrees to comply with instructions originated by the Oklahoma Insurance
Department directing the disposition of the funds in the Certificate without further
consent by the Insurer; and
5. The provisions of this certification and agreement will continue in full force and effect
and apply to any renewal or continuation of the Certificate, or to any other deposit funds
that may be proceeds of the Certificate.
______________________________________
Signature
______________________________________
Print Name
______________________________________
Title
______________________________________
Name of Financial Institution
______________________________________
Address
______________________________________
City, State, Zip
This instrument was acknowledged before me on___________________________________,
by ______________________________________________, Commission #______________
(Notary)
My Commission Expires:____________________
[seal]