Fillable Printable SAMPLE COPY ESCROW AGREEMENT

SAMPLE COPY ESCROW AGREEMENT

SAMPLE COPY

ESCROW AGREEMENT

Agreement made this _____ day of _______, 19___, by and between ____________ and _______ as

Escrow Agent (the “Escrow Agent”).

WITNESSETH:

Pursuant to Section 513( ) of the Delaware Insurance Code, ________ is required to maintain on deposit in

the State of Delaware for the protection of all its policyholders wherever located, except the deposits

required by Delaware statute to be maintained solely for the benefit of Delaware policyholders, cash or cash

equivalents in an amount and in a manner specified by the said Code and the Insurance Commissioner of

the State of Delaware. It is intended that the deposit made and maintained pursuant to this Escrow

Agreement satisfy the requirements of said Code and said Insurance Commissioner.

Now, THEREFORE, in consideration of the premises and the covenants herein contained, the parties

hereto, intending to be legally bound, agree as follows:

(1) _______________hereby agrees to deposit with the Escrow Agent cash or cash equivalents of a

kind and of a value or amount sufficient to satisfy the applicable deposit requirements of the Delaware

Insurance Code. This deposit (hereinafter referred to as the “Escrow Deposit”) shall consist initially of the

cash or cash equivalents listed on Schedule A attached hereto. Thereafter, the Escrow Deposit shall consist

of such other cash or cash equivalents as ___________ may deliver to the Escrow Agent with written

instructions that the same shall be part of the Escrow Deposit. the Escrow Agent shall hold the Escrow

Deposit subject to the terms and conditions of this Escrow Agreement. In no event, shall the Escrow Agent

have any responsibility to ascertain whether the Escrow Deposit satisfies the applicable deposit

requirements of the Delaware Insurance Code.

(2) All cash or cash equivalents delivered by _________ as part of the Escrow Deposit shall be

registered in the name of ___________ and shall be accompanied by irrevocable transfer powers executed

in blank, sufficient to allow the Escrow Agent to sell or deliver such cash or cash equivalents in accordance

with this Escrow Agreement. The Escrow Agent may cause said cash or cash equivalents to be registered

in the name of the Escrow Agent or its nominee. The cash or cash equivalents so deposited shall at all

times be kept separate and distinct from all other deposits, so that at all times they may be identified as

belonging to _______________.

(3) ____________________ shall receive from time to time payments of any interest payments or

other distributions upon any government obligations, corporation obligations included as a part of said

Escrow Deposit, and the Escrow Agent shall collect interest payments or other distributions for the account

of ____________ and the same shall not constitute part of the Escrow Deposit.

(4) ____________________ shall have the right at any time and from time to time to withdraw from the

Escrow Deposit any cash or cash equivalents provided, however, that at the time of such withdrawal

_________________ shall replace the withdrawn cash or cash equivalents with cash or cash equivalents of

market value at least as great as the withdrawn cash or cash equivalents.

(5) The purpose of the Escrow Deposit shall be the protection of the policyholders of

_________________ wherever located, as determined by the Insurance Commissioner of the State of

Delaware, except the deposits required by Delaware statute to be maintained solely for the benefit of

Delaware policyholders. Except as set forth in Paragraph (4) above, the Escrow Agent shall deliver the

Escrow Deposit only in accordance with the written order of the Insurance Commissioner of the State of

Delaware and shall have no liability for any payment of delivery made by it in accordance with such written

order.

(6) The Escrow Agent’s responsibility hereunder is limited to the safe holding of the cash or cash

equivalents forming the Escrow Deposit, the collection of income there from and distribution with respect

thereto, and the delivery thereof as set forth in. this Escrow Agreement, and it shall be liable for its own

negligence, dishonesty, willful misconduct or lack of faith, and indemnify ________________ for any loss

resulting therefrom.

(7) The Escrow Deposit shall at all times be kept separate and apart from other deposits with the

custodian, so that the deposit may be identified as belonging solely to __________________.

(8) _________________ agrees to pay all reasonable costs of fees charged by the Escrow Agent for

acting as Escrow Agent hereunder.

1991-92 COMPILATION BULLETINS

DOMESTIC/FOREIGN INSURERS BULLETINS

IN WITNESS WHEREOF, the parties have executed this Escrow Agreement by their duly authorized

corporate officers the day and year first above written.

COMPANY NAME

(CORPORATE SEAL) BY:_______________________

TITLE:_____________________

ATTEST:___________________

BANK

(CORPORATE SEAL) BY:________________________

TITLE:______________________

ATTEST:____________________

Attachments: Schedule A Compensation Agreement for Services as Custodian

SCHEDULE A

ESCROW AGREEMENT BETWEEN

_____________________________

AND

_____________________________

ESCROW DEPOSIT

CASH OR CASH EQUIVALENTS MARKET VALUE AT DATE

Receipt of the above cash or cash equivalents is acknowledged this ___________ day of

_______________, 19____.

BANK

BY:_______________________

TITLE:_____________________

COMPENSATION AGREEMENT

FOR SERVICES AS CUSTODIAN

THE ANNUAL COMPENSATION IS SHOWN IN THE FOLLOWING SCHEDULES:

(1) ON EACH ISSUE OF _____________________:

$_____________ per $ ________________ on the first $ _______________

$_____________ per $ ________________ on the next $ _______________

$_____________ per $ ________________ all over $________________

MINIMUM CHARGE $___________________

(2) OTHERS:

MINIMUM CHARGE $___________________

(3) TRANSACTION FEE:

$_____________________ for cash purchase and/or sale or other conversions. Additions or withdrawals of

securities are not considered transactions.

(4) OUT-OF-POCKET EXPENSES SUBJECT TO REIMBURSEMENT.

(5) MINIMUM ANNUAL FEE: $________________________

DONNA LEE H. WILLIAMS

INSURANCE COMMISSIONER