Application

PTO Form 1478 (Rev 9/2006)

OMB No. 0651-0009 (Exp 12/31/2014)

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PTO Form 1478 (Rev 9/2006)

OMB No. 0651-0009 (Exp 12/31/2014)

Trademark/Service Mark Application, Principal Register

Serial Number: 85859140

Filing Date: 02/25/2013

To the Commissioner for Trademarks:

MARK: HOSPITAL INDEMNITY PRO (Standard Characters, see mark)
The literal element of the mark consists of HOSPITAL INDEMNITY PRO.
The mark consists of standard characters, without claim to any particular font, style, size, or color.

The applicant, Assurity Life Insurance Company, a corporation of Nebraska, having an address of
      2000 Q Street
      Lincoln, Nebraska 68503
      United States


requests registration of the trademark/service mark identified above in the United States Patent and Trademark Office on the Principal Register established by the Act of July 5, 1946 (15 U.S.C. Section 1051 et seq.), as amended, for the following:

       International Class 036:  insurance services, namely, insurance underwriting for individual and worksite products in the field of hospital indemnity insurance.
Intent to Use: The applicant has a bona fide intention to use or use through the applicant's related company or licensee the mark in commerce on or in connection with the identified goods and/or services. (15 U.S.C. Section 1051(b)).


The applicant's current Attorney Information:
      Michael L. Sullivan of Baird Holm LLP
      1500 Woodmen Tower, 1700 Farnam Street
      Omaha, Nebraska 68102
      United States

The applicant's current Correspondence Information:

Michael L. Sullivan

Baird Holm LLP

1500 Woodmen Tower, 1700 Farnam Street

Omaha, Nebraska 68102

402-344-0500(phone)

402-344-0588(fax)

msullivan@bairdholm.com (authorized)

A fee payment in the amount of $325 has been submitted with the application, representing payment for 1 class(es).

Declaration

The undersigned, being hereby warned that willful false statements and the like so made are punishable by fine or imprisonment, or both, under 18 U.S.C. Section 1001, and that such willful false statements, and the like, may jeopardize the validity of the application or any resulting registration, declares that he/she is properly authorized to execute this application on behalf of the applicant; he/she believes the applicant to be the owner of the trademark/service mark sought to be registered, or, if the application is being filed under 15 U.S.C. Section 1051(b), he/she believes applicant to be entitled to use such mark in commerce; to the best of his/her knowledge and belief no other person, firm, corporation, or association has the right to use the mark in commerce, either in the identical form thereof or in such near resemblance thereto as to be likely, when used on or in connection with the goods/services of such other person, to cause confusion, or to cause mistake, or to deceive; and that all statements made of his/her own knowledge are true; and that all statements made on information and belief are believed to be true.

Declaration Signature

Signature: /Michael L. Sullivan/   Date: 02/25/2013
Signatory's Name: Michael L. Sullivan
Signatory's Position: Attorney of record, NE bar member
RAM Sale Number: 85859140
RAM Accounting Date: 02/26/2013

Serial Number: 85859140
Internet Transmission Date: Mon Feb 25 15:04:18 EST 2013
TEAS Stamp: USPTO/BAS-XXX.XXX.XX.XXX-201302251504186
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2bd01c23cc3c2d365d16f517a218888f19c9e33a
3-CC-15473-20130225145841155469