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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
7.75% Bonds due 2008 | (1) (2) (3) (4) | 01/26/2008 | J(1)(2)(3)(4) | 774,149,000 | 01/26/2008 | 01/26/2008 | Assurant Common Stock | (1) (2) (3) (4) | $ 1,000 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
FORTIS INSURANCE N.V. ARCHIMEDESLAAN 6 3584 BA UTRECHT, P7 |
Former 10% Owner |
/s/ Joost Hermans, Attorney-in-Fact, on behalf of Fortis Insurance N.V. | 01/29/2008 | |
**Signature of Reporting Person | Date | |
/s/ Pierre-Henri Bagon, Attorney-in-Fact, on behalf of Fortis Insurance N.V. | 01/29/2008 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | On 26 January 2005, Fortis Insurance N.V. issued US$774,149,000 aggregate principal amount of 7.75% bonds due 2008 mandatorily exchangeable for shares of common stock of Assurant, Inc. (the "Bonds"). |
(2) | Each Bond in the principal amount of $1,000 obligated Fortis Insurance N.V. to deliver on January 26, 2008, referred to as the maturity date, the following number of shares of Assurant, Inc. ("Assurant") common stock, subject to anti-dilution adjustments: if the applicable market value of Assurant common stock, as determined pursuant to the terms of the Bonds (the "Applicable Market Value") equals or exceeds the threshold appreciation price of $41.0652, 24.3515; if the Applicable Market Value is less than the threshold appreciation price of $41.0652 but is greater than the adjusted initial price of $33.6600, between 24.3515 and 29.7089; and if the Applicable Market Value is less than or equal to the adjusted initial price, 29.7089. |
(3) | On 26 January 2008, the Bonds matured and the Applicable Market Value was in excess of $41.0652. On 28 January 2008, Fortis Insurance N.V. delivered 24.3515 shares of common stock of Assurant, Inc. per $1,000 principal amount of Bonds in satisfaction of its obligations under the Bonds. |
(4) | After the settlement of the Bonds, Fortis Insurance N.V. owns less than 10% of the common stock of Assurant, Inc. The member of the board of directors of Assurant, Inc. appointed by Fortis Insurance N.V. resigned from the Assurant, Inc. board effective January 25, 2008. |