MARYLAND 10/6/2009 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 50.40 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 MARYLAND — MASSACHUSETTS 10/6/2009 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 MARYLAND — MICHIGAN 10/6/2009 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 49.00 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 MARYLAND — MINNESOTA 10/6/2009 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 50.40 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 MARYLAND — OKLAHOMA 10/6/2009 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 50.40 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 MARYLAND — RHODE ISLAND 10/6/2009 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 49.00 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.00 AVERAGE ANNUAL PREMIUM EMPLOYEE RATES: 51.
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APPLICATION FOR INSURANCE * UNITED AMERICAN INSURANCE COMPANY A LEGAL RESERVE STOCK COMPANY * ADMINISTRATIVE OFFICE: MCKINNEY, TX SS # Employee/Applicant First Name Last Name Child 4 First Name t
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