-----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, NQXBlpp2FCZJCaL8bmkeh9fS+RqgYWTOrGk3a1OAcANInbRYF2hmWDRZaISPfyNc id1Bs+DfSvYrR7ti6dPhoA== 0000703701-04-000027.txt : 20040326 0000703701-04-000027.hdr.sgml : 20040326 20040325184209 ACCESSION NUMBER: 0000703701-04-000027 CONFORMED SUBMISSION TYPE: 15-12G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040326 EFFECTIVENESS DATE: 20040326 FILER: COMPANY DATA: COMPANY CONFORMED NAME: ASCENT ASSURANCE INC CENTRAL INDEX KEY: 0000703701 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] IRS NUMBER: 731165000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 15-12G SEC ACT: 1934 Act SEC FILE NUMBER: 000-10873 FILM NUMBER: 04690874 BUSINESS ADDRESS: STREET 1: 3100 BURNETT PLAZA STREET 2: 801 CHERRY STREET, UNIT 33 CITY: FORT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: 8178783300 MAIL ADDRESS: STREET 1: 3100 BURNETT PLAZA STREET 2: 801 CHERRY STREET, UNIT 33 CITY: FORT WORTH STATE: TX ZIP: 76102 FORMER COMPANY: FORMER CONFORMED NAME: WESTBRIDGE CAPITAL CORP DATE OF NAME CHANGE: 19920703 15-12G 1 f152004.htm FORM 15 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 1-8538

Ascent Assurance, Inc.

(Exact name of registrant as specified in its charter)

3100 Burnett Plaza, Unit 33, 801 Cherry Street, Fort Worth, Texas 76102

(Address, including zip code, and telephone number, including area code, of registrant’s principal executive offices)

Ascent Assurance, Inc. Warrants

(Title of each class of securities covered by this Form)

Ascent Assurance, Inc. Common Stock

(Title 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 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 12g-4(a)(1)(ii)
Rule 12g-4(a)(2)(i)
Rule 12g-4(a)(2)(ii)

X
__
__
__

Rule 12h-3(b)(1)(i)
Rule 12h-3(b)(1)(ii)
Rule 12h-3(b)(2)(i)
Rule 12h-3(b)(2)(ii)
Rule 15d-6

X
__
__
__
__

Approximate number of holders of record as of the certificate or notice date: -0-

Pursuant to the requirements of the Securities Exchange Act of 1934 (Name of registrant as specified in charter) has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.

Date: March 25, 2004

By: /s/ Cynthia B. Koenig
        Cynthia B. Koenig, Sr. Vice President and
        Chief Financial Officer

Instruction: This form is required by Rules 12g-4, 12h-3 and 15d-6 of the General Rules and Regulations under the Securities Exchange Act of 1934. The registrant shall file with the Commission three copies of Form 15, one of which shall be manually signed. It may be signed by an officer of the registrant, by counsel or by any other duly authorized person. The name and title of the person signing the form shall be typed or printed under the signature.

SEC2069 (09-03)

Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMS control number.

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