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         1    VIRGINIA:

         2                 COLONIAL INSURANCE COMPANY

         3    - - - - - - - -  - - - - - x
              IN RE:                     :
         4                               : CLAIM NO: XXXXXXXXXXX
              NAME OF CLAIMANT           :
         5                               :
              - - - - - - - -  - - - - - x
         6
                                    Fairfax, Virginia
         7
                                    Tuesday, January 11, 2000
         8

         9    Examination under oath of:

        10               NAME OF CLAIMANT 

        11              Called for examination by counsel for

        12    Colonial Insurance Company, pursuant to notice, at

        13    the Law Office of NAME OF ATTORNEY of the law firm of

        14    FIRM NAME, DEPOSITION LOCATION

        15    DEPO CITY, STATE, ZIP

        16    beginning at 10:54 p.m., before NAME OF REPORTER a

        17    Court Reporter and Notary Public in and for the

        18    Commonwealth of Virginia at Large, Notary No. XXXXXX when

        19    were present on behalf of the respective parties:

        20

        21

        22
                                                                 2



         1              FOR NAME OF INSURANCE COMPANY:

         2              NAME OF ATTORNEY, ESQ.

         3              FIRM NAME

         4              ADDRESS

         5              Suite XXX

         6              Fairfax, Virginia 22030

         7
                        ALSO PRESENT:
         8
                        NAME OF OTHER PERSON PRESENT
         9

        10                      - - - - - - - -

        11                      C O N T E N T S

        12    WITNESS:       EXAMINATION BY COUNSEL FOR:

        13    (None) OR NAME OF WITNESS IF THEY APPEAR

        14

        15                      E X H I B I T S

        16                (Marked prior to statement)

        17    DEPOSITION:

        18    1          DESCRIBE EXHIBIT

        19    2          DESCRIBE EXHIBIT

        20

        21

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