0000009346-21-000086.txt : 20210614 0000009346-21-000086.hdr.sgml : 20210614 20210614105434 ACCESSION NUMBER: 0000009346-21-000086 CONFORMED SUBMISSION TYPE: 15-12G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20210614 DATE AS OF CHANGE: 20210614 EFFECTIVENESS DATE: 20210614 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Protective Insurance Corp CENTRAL INDEX KEY: 0000009346 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 350160330 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 15-12G SEC ACT: 1934 Act SEC FILE NUMBER: 000-05534 FILM NUMBER: 211013704 BUSINESS ADDRESS: STREET 1: 111 CONGRESSIONAL BLVD STREET 2: STE 500 CITY: CARMEL STATE: IN ZIP: 46032 BUSINESS PHONE: 317-452-7426 MAIL ADDRESS: STREET 1: 111 CONGRESSIONAL BLVD STREET 2: STE 500 CITY: CARMEL STATE: IN ZIP: 46032 FORMER COMPANY: FORMER CONFORMED NAME: BALDWIN & LYONS INC DATE OF NAME CHANGE: 19930908 FORMER COMPANY: FORMER CONFORMED NAME: BALDWIN H C AGENCY INC DATE OF NAME CHANGE: 19720309 15-12G 1 ptvcb20210611_1512g.htm PROTECTIVE INSURANCE CORPORATION - 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: 000-05534
PROTECTIVE INSURANCE CORPORATION
(Exact name of registrant as specified in its charter)


111 Congressional Boulevard, STE 500
Carmel, Indiana 46032
(317) 636-9800
(Address, including zip code, and telephone number, including area code, of registrant’s
principal executive offices)

Class A Common Stock, no par value
Class B Common Stock, no 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)          ☒
Rule 12g-4(a)(2)          ☐
Rule 12h-3(b)(1)(i)      ☒
Rule 12h-3(b)(1)(ii)     ☐
Rule 15d-6                   ☐
Rule 15d-22(b)            ☐
 
Approximate number of holders of record as of the certification or notice date:      1             
 
Pursuant to the requirements of the Securities Exchange Act of 1934, Protective Insurance Corporation has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.

Protective Insurance Corporation



 Date: June 14, 2021  By:  /s/ Jeremy D. Edgecliffe-Johnson
       Name: Jeremy D. Edgecliffe-Johnson
       Title: Chief Executive Officer