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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-365834

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1. NAMIC PAC

    3601 Vincennes Road
    PO Box 68700
    Indianapolis, IN 46268
    Fax: 3178798408
    Email: fecnotices@namic.org

2. Date: 10/07/2008

3. FEC Committee ID #: C00170258 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Committee ID# C00170258
National Association of Mutual Insurance Companies
3601 Vincennes Road
PO Box 68700
Indianapolis, Indiana 46268

Custodian of Records:

Gregg Dykstra
3601 Vincennes Rd
PO Box 68700
Indianapolis, IN 46268
Title: Treasurer
Phone # (317) 875-5250

Treasurer:

Gregg Dykstra
3601 Vincennes Rd
PO Box 68700
Indianapolis, Indiana 46268
Title: Treasurer
Phone # (317) 875-5250

Designated Agent(s):

NAMIC Service Copora c/o Gregg Dykstra
3601 Vincennes Rd
PO Box 68700
Indianapolis, Indiana 46268
Title: Assistant Secretary
Phone # (317) 875-8250

Banks or Depositories

Chase Bank
8751 N Michigan Road
Indianapolis, Indiana 46268

Signed: Gregg Dykstra
Date Signed: 10/07/2008
Official Committee URL: http://www.namic.org/pac
Official Committee FAX: 3178798408

(End FEC FORM 1)

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