Date:_________________________ Fax To: 734-283-1197

Blue Cross Blue Shield of Michigan

Agent Sales Department - #L816

53200 Grand River

New Hudson, MI 48165

Re: Group #(s)_________________________________

Dear Sir or Madam:

Effective immediately, this is to authorize and instruct Blue Cross Blue Shield of Michigan to recognize John L. Daly as our exclusive Agent of Record for the above mentioned policies. Mr. Daly's Blue Cross agent number is 648-01355. We understand that our premiums will not change as a result of Mr. Daly’s involvement.

We are making this change in an effort to enjoy a higher level of professional service for our Blue Cross plans. We also appreciate the on-line capabilities of Daly Merritt, Inc.

Thank you for your assistance, meanwhile, if you have any questions you may contact Mr. Daly directly at Daly Merritt, Inc. at (734) 283-1400.

Sincerely,

Corporate Officer Signature: X_______________________________

Corporate Officer Name: _______________________________

Corporate Officer Title: _______________________________