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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1136306

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1. Essent US Holdings, Inc. Political Action Committee

    Two Radnor Corporate Center
    100 Matsonford Road
    Radford, PA 19087
    Email: essentpac@essent.us

2. Date: 12/29/2016

3. FEC Committee ID #: C00630350 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Essent US Holdings, Inc.
Two Radnor Corporate Center
100 Matsonford Road
Radnor, Pennsylvania 19087
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. Bryan D MacIntyre
Two Radnor Corporate Center
100 Matsonford Road
Radnor, PA 19087
Title: Secretary
Phone # (610) 225-1848

Treasurer:

Mr. Matthew D Tully
Two Radnor Corporate Center
100 Matsonford Road
Radnor, Pennsylvania 19087
Title: Treasuer
Phone # (610) 225-1848

Designated Agent(s):

Mr Peter A Simon
Two Radnor Corporate Center
100 Matsonford Road
Radnor, Pennsylvania 19087
Title: Assistant Treasuer
Phone # (610) 225-1848

Banks or Depositories

Branch Banking and Trust Company
110 South Stratford Road
Wintson-Salem, North Carolina 27104

Signed: Mr. Matthew D Tully
Date Signed: 12/29/2016

(End FEC FORM 1)

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