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SVO – VALUATION INFORMATION MEMORANDUM
FOR SECURITIES NOT RATED BY AN SVO RECOGNIZED RATING AGENCY
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If no Public Offering Statement or Private Placement Memorandum is available please
submit this form with a completed Securities Acquisition Report (SAR). If a Public
Offering or Private Placement Memorandum is available, this form is not necessary.
Application: (Must be an Insurer).____________________________________________
_________________________________________________________________________
Address:_________________________________________________________________
Contact Person:___________________________________________________________
(Print name of person who signed the Note Purchase Agreement or similar document.)
Phone Number:___________________________________________________________
_________________________________________________________________________
The undersigned represents and states that he or she:

is a responsible employee or officer of the nam