Exhibit 1
OAR 836-024-0115
INSIDER TRADING REPORTING FORMS AND INSTRUCTIONS
Note: These forms are patterned substantially after Forms 3 and 4 of the Securities and Exchange Commission.
STATE OF OREGON
Director of the Department of Consumer and Business Services
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed Pursuant to:
_____________________________________________________________________________
[Name of insurance company]
_____________________________________________________________________________
[Name of person whose ownership is reported]
_____________________________________________________________________________
[Business address of such person; street, city, zone, state]
Relationship of such person to company named above.
(See
instruction 5)___________________________________________________________________
Date of event that requires the filing of this state.
(See
instruction 6)___________________________________________________________________