(Letter to be re-typed on your Company Letterhead)




APPOINTMENT
of
AGENT-OF-RECORD


RE: Policy Number _________________________________________________

       Policyholder __________________________________________________


	This letter appoints            MICHAEL E. REICHEK, CFP  (TDI # 757026)

as Exclusive Agent of Record  to service this Policy/Contract and perform all the 

normal functions required of a Servicing Agent/Broker by the policy/contract 

holder.  Further, it is my understanding that this appointment will not affect my 

present rates, rights or benefits whatsoever. 

	This letter rescinds any and all previous agent of record letters for this 

company and will remain in effect until revoked, in writing, by an authorized 

officer of this firm..

	I request this change be effective as of today.



____________________________________
            Policyholders Signature


Date:________________________________