1
================================================================================
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 NO. 000-22142
OMNI INSURANCE GROUP, INC.
(Exact name of Registrant as specified in its Charter)
1000 PARKWOOD CIRCLE
ATLANTA, GEORGIA 30339
(770) 952-4500
(Address, including zip code and telephone number,
including area code, of registrant's principal
executive offices)
COMMON STOCK, PAR VALUE $.01 PER SHARE
(Title of each class of securities covered by this Form)
NONE
(Title 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)(i) [ X ] Rule 12h-3(b)(1)(ii) [ ]
Rule 12g-4(a)(1)(ii) [ ] Rule 12h-3(b)(2)(i) [ ]
Rule 12g-4(a)(2)(i) [ ] Rule 12h-3(b)(2)(ii) [ ]
Rule 12g-4(a)(2)(ii) [ ] Rule 15d-6 [ ]
Rule 12g-3(b)(1)(i) [ ]
Approximate number of holders of record as of the certification or notice
date: 1
================================================================================
Page 1 of 2
2
Pursuant to the requirements of the Securities Exchange Act of 1934, Omni
Insurance Group, Inc. has caused this certification/notice to be signed on its
behalf by the undersigned duly authorized person.
OMNI INSURANCE GROUP, INC.
Date: February 12, 1998 /s/ J. Paul Kennedy
--------------------------
J. Paul Kennedy
President and Chief Operating Officer
-2-