15-12G 1 a2052826z15-12g.txt 15-12G 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: 0-15946 EBIX.COM, INC. (Exact name of registrant as specified in its charter) 1900 E. GOLF ROAD, SUITE 1200 SCHAUMBURG, IL 60173 847-789-3047 (Address, including zip code, and telephone number, including area code, of registrant's principal executive offices) PARTICIPATION INTERESTS IN THE CASH OPTION PROFIT SHARING PLAN (Title of each class of securities covered by this Form) COMMON STOCK (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)(ii) [ ] Rule 12g-4(a)(1)(ii) [ ] Rule 12h-3(b)(2(i) [ ] Rule 12g-4(a)(2)(i) [ ] Rule 12h-3(b)(2)(ii) [ ] Rule 12g-4(a)(2)(ii) [ ] Rule 15d-6 [X] Rule 12h-3(b)(1)(i) [X] Approximate number of holders of record as of the certification or notice date: [0] SIGNATURE Pursuant to the requirements of the Securities Exchange Act of 1934, ebix.com, Inc. has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person. Date: JUNE 28, 2001 EBIX.COM, INC. By: /s/ Richard J. Baum Name: RICHARD J. BAUM Title: CHIEF FINANCIAL OFFICER