-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, PlymdqmCcC58MzUIFWTPpu6B0VMtaSV9dz6rtWo7h45y7mKD4OFQSzasDbCxSd/I I867/fsicgSfdsJxwSdc+g== 0000898080-03-000375.txt : 20030730 0000898080-03-000375.hdr.sgml : 20030730 20030730162952 ACCESSION NUMBER: 0000898080-03-000375 CONFORMED SUBMISSION TYPE: 15-15D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20030730 EFFECTIVENESS DATE: 20030730 FILER: COMPANY DATA: COMPANY CONFORMED NAME: INTEGON RE BARBADOS LTD CENTRAL INDEX KEY: 0001109711 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] STATE OF INCORPORATION: C8 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 15-15D SEC ACT: 1934 Act SEC FILE NUMBER: 333-34088 FILM NUMBER: 03811801 BUSINESS ADDRESS: STREET 1: ONE FINANCIAL PLACE STREET 2: COLLYMORE ROCK ST MICHAEL BARBADOS WI CITY: ST MICHAEL BUSINESS PHONE: 2464364895 MAIL ADDRESS: STREET 1: ONE FINANCIAL PL COLLYMORE ROCK STREET 2: ST MICHAELS BARBADOS WI CITY: ST MICHAELS STATE: C8 15-15D 1 form15-15da.txt FORM 15 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 15 CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934 OR SUSPENSION OF DUTY TO FILE REPORTS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934. Commission File Number 333-34088 ------------- INTEGON RE (BARBADOS), LIMITED - -------------------------------------------------------------------------------- (Exact name of registrant as specified in its charter) One Financial Place, Collymore Rock, St. Michaels, Barbados, W.I., (246) 436-4895 - -------------------------------------------------------------------------------- (Address, including zip code, and telephone number, including area code, of registrant's principal executive offices) Participating Stock, without nominal or par value - -------------------------------------------------------------------------------- (Title of each class of securities covered by this Form) None - -------------------------------------------------------------------------------- (Titles of all other classes of securities for which a duty to file reports under section 13(a) or 15(d) remains) Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports: Rule 12g-4(a)(1)(i) / / Rule 12h-3(b)(1)(i) /x/ Rule 12g-4(a)(1)(ii) / / Rule 12h-3(b)(1)(ii) / / Rule 12g-4(a)(2)(i) / / Rule 12h-3(b)(2)(i) / / Rule 12g-4(a)(2)(ii) / / Rule 12h-3(b)(2)(ii) / / Rule 15d-6 / / Approximate number of holders of record as of the certification or notice date: Six ----------------- Pursuant to the requirements of the Securities Exchange Act of 1934 Integon Re (Barbados), Limited has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person. Date: 28th July 2003 By: /s/ Vinston E. Hampden ------------------- --------------------------------------------- Name: Vinston E. Hampden Title: Vice-President, Finance and Principal Financial Officer -----END PRIVACY-ENHANCED MESSAGE-----