Attachment 3 - Audit Confirmation Sample.pdf
PDF 1 MB Posted
- Attached to
- Banking Safekeeping Depository Account Services
- Solicitation number
- 300000275177457
- Issued by
- Missouri
About this file
This is an Audit Confirmation Sample form issued by the Missouri Department of Commerce and Insurance, Division of Insurance Company Regulation, addressed to insurance companies maintaining securities on joint deposit with the Department. The document serves as a confirmation request for securities held at designated financial institutions as of December 31, 2025. Companies are required to verify the accuracy of listed securities, including par values and market values across capital accounts, reserve accounts, and special accounts, with a total deposit amount of $300,000.00. The form requests company signature, title, print name, and contact information, with responses due within 30 days of the notice date. Completed confirmations should be returned to the Securities Section at the Department's Jefferson City address or via email to DCIDeposit@insurance.mo.gov.
The document lists specific security details including a United States Treasury Note with a 2.500 percent coupon rate maturing on May 15, 2024, identified by CUSIP number and security type. Companies are instructed to report any discrepancies between the Department's records and their own company records. This confirmation process is part of the Department's oversight of banking safekeeping depository account services, ensuring accurate accounting and secure custodial arrangements for insurance company deposits and investments held in joint custody with authorized financial institutions.
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Text version
SAMPLE
The above amounts are correct and in agreement with the company records
Company
Signature Title
Print Name Phone Number and/or Email Address 301 West High Street, Room 530, P.O. Box 690 · Jefferson City, Missouri 65102-0690 ·
Telephone 573/751-4126 · RelayMo TTY Dial 711 or 1-800-735-2966 http://www.dci.mo.gov 01/01/2022 08:38:01 9999-99997 BAP094084 094 BAP0685
Governor Mike Kehoe State of Missouri
Department of Commerce & Insurance Angela L. Nelson, Director
DIVISION OF INSURANCE COMPANY REGULATION
John F. Rehagen, Division Director
DEC 31, 20259999-99999
INSURANCE COMPANY
1111 STREET
CITY, STATE, ZIP
ATTN: SECURITIES INVESTMENTS/TREASURER
The records of the Missouri Department of Commerce and Insurance (the Department) indicate your Company has securities on joint deposit with the Department at [FINANCIAL INSTITUTION] in [LOCATION] as of December 31, 2025, in the amounts listed below.
If these figures are correct, please print, sign, and return this letter to the Securities Section, Department of Commerce and Insurance, P.O. Box 690, Jefferson City, Missouri 65102-0690 or email the completed letter to: DCIDeposit@insurance.mo.gov. Should this amount differ in any way, please advise.
** Responses are due within 30 days of the date of this notice. **
REQUIRED PAR VALUE
CAPITAL ACCOUNTS XXXXXXXXX xxxxxxxxx
RESERVE ACCOUNTS XXX XXX
SPECIAL ACCOUNTS XXXXXXXXX XXXXXXXXX
TOTALS 300,000.00 300,000.00
SECURITY DESCRIPTION COUPON
RATE
MATURITY
DATE
SECURITY
TYPE
CUSIP LOC TYPE
(C,R,S)
PAR MARKET
00000000 UNITED STATES TREAS NTS 2.500 05/15/2024 010 XXXXXXXXXX F S XXXXXXXXXX XXXXXXXXXX
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