Jun 3 2004 DEPARTMENT OF FINANCIAL SERVICES TOM GALLAGHER CHIEF FINANCIAL OFFICER > 4-2 LOEY IN THE MATTER OF: CASE NO.: 76113-04-AG EBEN COETZEE ADMINISTRATIVE COMPLAINT TO: EBEN COETZEE 1199 East Fowler Drive Deltona, Florida 32725-6311 You, EBEN COETZEE, license 1.D. #4050091, are hereby notified that the Chief Financial Officer of the State of Florida has caused to be made an investigation of your activities while licensed as an insurance agent in this state, as a result of which it is alleged: GENERAL ALLEGATIONS 1. Pursuant to Chapter 626, Florida Statutes, you, EBEN COETZEE, are currently licensed in this state as a Life Agent (2-16), Life & Health Agent (2-18), and Health Agent (2- 40). 2. At all times pertinent to the dates and occurrences referred to herein, you, EBEN COETZEE, were licensed in this state as an insurance agent. 3. Pursuant to Chapter 626, Florida Statutes, the Department of Financial Services (hereinafter the “Department”) has jurisdiction over your licenses and appointments. FILED Docketed by_. ML COUNT 1 4. The above general allegations are hereby realleged and fully incorporated herein by reference. 5. On or about June 12, 2002, you, EBEN COETZEE, solicited D.D. of Ormond Beach, Florida to cance} her existing annuity with Conseco Annuity Assurance Company (f/k/a American Life and Casualty) and purchase two new annuities with Allianz Life and Casualty Company being solicited by you. 6. You, EBEN COETZEE, failed to inform D.D. at any time tha: she would be charged approximately $8,698.14 as a surrender charge for canceling her existing Conseco early. D.D. would not have surrendered the Conseco annuity and purch ased the Allianz annuities if she had been so informed of the surrender charge. 7. The Allianz annuities each had a thirty-day free look period from the delivery date in which the applicant could return the policy and obtain a penalty free refund of her payment. You, EBEN COETZEE, represented to Allianz in writing that you delivered the annuities to D.D. on June 20, 2002. However, in fact, you, EBEN COETZEE, did not deliver the annuities to D.D. until August, 2002, in an attempt to deprive D.D. of her opportunity to retum the annuities. Your representations to Allianz and to D.D. were false and a material misstatement of fact. It IS THEREFORE CHARGED that you, EBEN COETZEE, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your licenses and appointments: (a) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising. [Section 626.611(5), Florida Statutes]; (b) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; (c) Willful violation of any provision of the Insurance Code. [Section 626.61 1(13), Florida Statutes]; (d) Violation of the provision against twisting, as defined in s. 625.9541(1)(). [Section 626.621(5), Florida Statutes]; (e) Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. [Section 626.621(2), Florida Statutes]; (f) Causing, directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public, any false material statement. [Section 626.9541(1)(e) 1, Florida Statutes] WHEREFORE, you, EBEN COETZEE, are hereby notified that the Chief Financial Officer intends to enter an Order suspending or revoking your licenses and appointments as an insurance agent or to impose such penalties as may be provided under the provisions of Sections 626.611, 626.621, 626.681, 626.691, and 626.9521, Florida Statutes, and under the other referenced sections of the Florida Statutes as set out in this Administrative Complaint. NOTICE OF RIGHTS You have the right to request a proceeding to contest this action by the Department pursuant to sections 120.569 and 120.57, Florida Statutes, and Rule 28-1C7, Florida Administrative Code. The proceeding request must be in writing, signed by you, and must be filed with the Department within twenty-one (21) days of your receipt of this notice. Completion of the attached Election of Proceeding form and/or a petition for administrative hearing will suffice as a written request. The request must be filed with the General Counsel as acting Agency Clerk, at the Florida Department of Financial Services, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333. Your written response must be received by the Department no later than 5:00 p.m. on the twenty-first day after your receipt of this notice. Mailing the response on the twenty-first day will not preserve your right to a hearing. YOUR FAILURE TO RESPOND IN WRITING WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THIS NOTICE WILL CONSTITUTE A WAIVER OF YOUR RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF REVOCATION WILL BE ENTERED AGAINST YOU. If you request a proceeding, you must provide information that complies with the requirements of Rule 28-107.004, Florida Administrative Code. As noted above, completion of the attached Election of Proceeding form conforms to these requirements. Specifically, your response must contain: (a) The name and address of the party making the request, for purpose of service: (b) A-statement that the party is requesting a hearing involving disputed issues of material fact, or a hearing not involving disputed issues of material fact; ard (c) A teference to the notice, order to show cause, administrative complaint, or other communication that the party has received from the agency. Ifa hearing of any type is requested, you have the right to be represented by counsel or other qualified representative at your expense, to present evidence and argument, to call and cross-examine witnesses, and to compel the attendance of witnesses and the production of documents by subpoena. If a proceeding is requested and there is no dispute of material fact, the provisions of section 120.57(2), Florida Statutes, apply. In this regard, you may submit oral or written evidence in opposition to the action taken by the Department or a written statement challenging the grounds upon which the Department has relied. While a hearing is normally not required in the absence of a dispute of fact, if you feel that a hearing is necessary, ore will be conducted in Tallahassee, Florida, or by telephonic conference call upon your request. However, if you dispute material facts that are the basis for the Department’s action, you must request an adversarial proceeding pursuant to sections 120.569 and 120.57(1), Florida Statutes. These proceedings are held before a State administrative law judge of the Division of Administrative Hearings. Unless the majority of witnesses are located elsewhere, the Department will request that the hearing be conducted in Tallahassee, Florida. Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied. All prior oral communication or correspondence in this matter shall be considered freeform agency action, and no such oral communication or correspondence shall operate as a valid request for an administrative proceeding. Any request for an administrative proceeding received prior to the date of this notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. Mediation of this matter pursuant to section 120.573, Florida Statutes, is not available. No Department attorney will discuss this matter with you until the response has been received by the Department of Financial Services. DATED and SIGNED this __ ATS dayof_ June _, 2004. “holies KAREN CHANDLER Deputy Chief Financial Officer CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF PROCEEDING has been furnished to: EBEN COETZEE, at 1199 E. Fowler Drive, Deltona, Florida 32725 by Certified Mail this. 3° ¢ day of Dine, 2004. ‘WO | 3. Service Type CERT! } ; ) Nowe A Kon Y JAMES A. BOSSART, ESQ. Division of Legal Services 200 East Gaines St. 612 Larson Building Tallahassee, Florida 32399-0 ULBIUT 10} OST] TON OC. Papiroig eSeiencg eouesuy os. THEW Pels4ed 410) }diaoay 3Vd HO HYVANLSOd BIIAISS eISOd SN —. yy. soreness ie “GOMPLETE THIS SECTION ON DELIVER : Date of Delivery C104 Ptease Print Clearly) Ciagent TAaddresses Cives from iter 1? = sArery addytss different 1 Jove {Aya ° tIYES. enter elivery 4 fess bel TED 3) WHY 2b 08! FIED MAIL r i very? (Extra Fee) } 4.R stricted Delivery’ . re reseneee Reference Information i CS sQ) HY G-ai 40 ETZEE Wp g TSSENS a DRIVE. 76113- 04-AG 1199 EAST FOWL! DELTONA, FL 32725 {June 3 3, , 2004 Bossart — — ee ar Demestic Return Receipt —————7 . ann

Docket for Case No: 04-002283PL