SUMMIT INVESTMENT TRUST
485BPOS, EX-99.O1, 2000-09-28
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<PAGE>   1
                                                                Exhibit 99(o)(1)


                             SUMMIT INVESTMENT TRUST
                             -----------------------
                                 CODE OF ETHICS
                                 --------------

1.       Definitions

         1.1 Access Person. As used in this Code of Ethics, the term "Access
Person" shall mean any Trustee, officer or Advisory Person of the Trust, except
for any such person who is an employee of the Trust's investment adviser (the
"Adviser"), investment sub-adviser (the "Sub-Adviser") or principal
underwriter,(1) or any company in a control relationship to the Trust, Adviser,
Sub-Adviser or the principal underwriter of the Trust, and who is subject to a
code of ethics of such Adviser, Sub-Adviser or principal underwriter of the
Trust that complies with the requirements of Rule 17j-1 adopted under the
Investment Company Act of 1940, as amended (the "Act").

         1.2 Active Consideration. A Security will be deemed under "active
consideration" when a recommendation to purchase or sell a Security for the
Trust has been made and communicated to the person or persons ultimately making
the decision to buy or sell the Security, which includes when a client has a
pending "buy" or "sell" order with respect to the Security. A Security will also
be deemed under "active consideration" whenever an Advisory Person focuses on a
specific Security and seriously considers recommending purchase or sale of the
Security for the Trust.

----------
(1) With respect to the principal underwriter of the Trust, Access Person means
any officer, director or general partner of the principal underwriter who, in
the ordinary course of business, makes, participates in or obtains information
regarding, the purchase or sale of Securities by the Trust for which the
principal underwriter acts in, or whose functions or duties in the ordinary
course of business relate to the making of, any recommendation to the Trust
regarding the purchase or sale of Securities.

<PAGE>   2
         A Security will be deemed under "active consideration" until the Trust
implements or rejects the recommendation or until the proper Advisory Person
decides not to recommend the purchase or sale of the Security for the Trust.

         A Security will not be deemed under "active consideration" if the
Security is being reviewed only as part of a general industrial survey or other
broad monitoring of the securities market.

         1.3 Advisory Person. As used in this Code of Ethics, the term "Advisory
Person" shall mean (i) any employee of the Trust, Adviser or Sub-Adviser or any
company in a control relationship to the Trust, Adviser or Sub-Adviser, who, in
connection with his/her regular functions or duties, makes, participates in, or
obtains information regarding the purchase or sale of a Security by the Trust,
or whose functions relate to the making of any recommendation with respect to
such purchases or sales; and (ii) any natural person in a control relationship
to the Trust, Adviser or Sub-Adviser who obtains information concerning
recommendations made to the Trust with regard to the purchase or sale of a
Security.

         1.4 Beneficial Ownership. "Beneficial ownership" shall be interpreted
in the same manner as it would be in determining whether a person is considered
a "beneficial owner" as defined in Rule 16a-1(a)(2) under the Securities
Exchange Act of 1934, as amended (the "Exchange Act"), which, generally
speaking, encompasses those situations where the beneficial owner has the right
to enjoy some economic benefit from the ownership of the Security. For purposes
of this Code of Ethics, the determination of direct or indirect beneficial
ownership shall apply to all securities which an Access Person has or acquires.

         1.5 Control. "Control" shall have the same meaning as that set forth in
Section 2(a)(9) of the Act.

                                     - 2 -

<PAGE>   3
         1.6 Disinterested Trustee. "Disinterested Trustee" means a Trustee of
the Trust who is not an "interested person" of the Trust within the meaning of
Section 2(a)(19) of the Act.

         1.7 Investment Personnel. "Investment Personnel" means any employee,
including, but not limited to, any securities analyst or securities trader, of
the Trust, Adviser or Sub-Adviser (or of any company in a control relationship
to the Trust, Adviser or Sub-Adviser) who, in connection with his or her regular
functions or duties, makes or participates in the making of recommendations
regarding a Trust's purchase or sale of Securities, or (b) any natural person
who controls the Trust, Adviser or Sub-Adviser and who obtains information
concerning recommendations to the Trust regarding the purchase or sale of
Securities by the Trust.

         1.8 Purchase or sale of a Security. "Purchase or sale of a Security"
includes, among other things, the writing of an option to purchase or sell the
Security.

         1.9 Security. "Security" shall have the meaning set forth in Section
2(a)(36) of the Act except that it shall not include direct obligations of the
United States government, bankers' acceptances, bank certificates of deposit,
commercial paper, high-quality short-term debt instruments (including repurchase
agreements), and shares of registered open-end investment companies (i.e.,
mutual funds).

         1.10 Security held or to be acquired. A "Security held or to be
acquired" by the Trust is defined to include: (a) any Security that within the
most recent fifteen (15) days (i) is or has been held by the Trust, or (ii) is
under active consideration by the Trust, Adviser or Sub-Adviser for purchase or
sale by the Trust; and (b) any option to purchase or sell, and any Security
which is convertible into or exchangeable for, a Security described in subparts
(a)(i) or (a)(ii) of this Sub-paragraph 1.10.

                                     - 3 -

<PAGE>   4
         1.11 Trust and Trustees. As used in this Code of Ethics, "Trust" shall
mean Summit Investment Trust, a Massachusetts business trust registered as an
open-end investment company under the Act and "Trustees" shall mean the persons
who are trustees of the Trust.

         1.12 Additional Definitions. All other terms used in this Code of
Ethics shall be defined by reference to the Act or the Exchange Act.

2.       Purpose of the Code of Ethics

         This Code of Ethics is designed to prevent certain practices by Access
Persons in connection with the purchase or sale of a Security held or to be
acquired by the Trust. These include:

                  (a)      employing any device, scheme or artifice to defraud
                           the Trust;

                  (b)      making any untrue statement of a material fact or
                           omitting to state a material fact that renders
                           statements made to the Trust misleading;

                  (c)      engaging in any act, practice, or course of business
                           that acts as a fraud or deceit upon the Trust; or

                  (d)      engaging in any manipulative practice with respect to
                           the Trust.

3.       Prohibited Purchases and Sales

         3.1 No Access Person shall purchase or sell, directly or indirectly,
any Security in which he/she has, or by reason of such transaction acquires, any
direct or indirect beneficial ownership, and that such Access Person knew or, in
the course of fulfilling his or her official duties, should have known, at the
time of such purchase or sale, is held or to be acquired by the Trust, until a
period of five business days has elapsed from the date the Security no longer is
held or to be acquired by the Trust.

                                     - 4 -

<PAGE>   5
         3.2 No Investment Personnel shall directly or indirectly acquire
beneficial ownership in any Security in a limited offering ("private placement")
or initial public offering ("IPO") without prior approval from the appropriate
compliance officer. (In determining whether to grant such prior approval, the
appropriate officer shall determine (among other factors) whether the investment
opportunity should be reserved for the Trust and its shareholders, and whether
the opportunity is being offered to the individual by virtue of his or her
position with the Trust. Any Investment Personnel who has been authorized to
acquire Securities in a private placement, must disclose that investment when he
or she is involved in any subsequent consideration of an investment by the Trust
in that issuer. In such circumstances, Investment Personnel with no personal
interest in the particular issuer shall independently review the Trust's
decision to purchase that issuer's Securities.)

         3.3 The prohibitions of Sections 3.1 and 3.2 of this Code of Ethics
shall not apply to purchases and sales specified in Section 4 of this Code of
Ethics.

4.       Exempted Transactions

         The prohibitions in Sections 3.1 and 3.2 of this Code of Ethics shall
not apply to the following transactions:

                  (a)      purchases or sales of any Security effected in any
                           account over which an Access Person or Investment
                           Personnel have no direct or indirect influence or
                           control;

                  (b)      purchase or sales of Securities which are not
                           eligible for purchase or sale by the Trust;

                  (c)      purchases of Securities effected upon the exercise of
                           rights issued by an issuer pro rata to all holders of
                           a class of its Securities, to the extent the

                                     - 5 -

<PAGE>   6
                           rights were acquired from the issuer, and the sales
                           of the rights so acquired;

                  (d)      purchases or sales of any Security that are
                           non-volitional(2) on the part of either the Access
                           Person, Investment Personnel or the Trust;

                  (e)      purchases of any Security that are part of an
                           automatic dividend reinvestment plan;

                  (f)      purchases or sales of any Security that are approved
                           by a majority vote of those Trustees having no
                           interest in the transaction upon a showing of good
                           cause ("good cause" will be deemed to exist where
                           unexpected hardship occasions the need for additional
                           funds, but a change in investment objectives will not
                           be deemed "good cause"); and

                  (g)      purchases or sales of any Security that are approved
                           by a majority vote of those Trustees having no
                           interest in the transactions where the purchases and
                           sales have only a remote potential of harming the
                           Trust because (1) such transactions are in a highly
                           institutionalized market and would have little effect
                           on the market; or (2) the transactions clearly are
                           not related economically to Securities held or to be
                           acquired by the Trust.

5.       Prohibited Business Conduct

         5.1      No Access Person shall, either directly or indirectly:

----------
(2)      Non-volitional purchases or sales include those transactions which do
         not involve a willing act or conscious decision on the part of the
         employee. For example, shares received or disposed of in a merger,
         recapitalization or similar transaction are considered non-volitional.


                                     - 6 -

<PAGE>   7
                  (a)      engage in any business transaction or arrangement for
                           personal profit based on confidential information
                           gained by way of employment with the Trust, Adviser
                           or Sub-Adviser;

                  (b)      communicate non-public information about security
                           transactions of the Trust whether current or
                           prospective to anyone unless necessary as part of the
                           regular course of the Trust's business (non-public
                           information regarding particular securities,
                           including reports and recommendations of the Adviser
                           or Sub-Adviser, may not be given to anyone who is not
                           an officer or Trustee of the Trust, a Representative,
                           director or officer of the Adviser or an officer or
                           director of the Sub-Adviser, without prior approval
                           of the President of the Trust;

                  (c)      buy or sell any security or any other property from
                           or to the Trust, provided that this item shall not be
                           construed to prohibit a person from being a
                           shareholder of the Trust or a policy owner of a
                           variable annuity policy that is funded in whole or in
                           part by shares of the Trust; or

                   (d)     accept a gift, favor, or service of significant value
                           from any person or company which, to the actual
                           knowledge of such Access Person, does business or
                           might do business with the Trust, Adviser,
                           Sub-Adviser or The Union Central Life Insurance
                           Company.

6.       Reporting, Disclosure and Certification Requirements

         6.1 Initial Holdings Reports. All Access Persons (excluding
Disinterested Trustees who would be required to make a report solely by reason
of being a Trustee) shall disclose all personal Securities holdings to the
appropriate compliance officer upon commencing

                                     - 7 -

<PAGE>   8
employment. The Initial Report shall be made on the form attached as Exhibit A
and shall contain the following information:

                  (a)      the title, number of shares and principal amount of
                           each Security in which the Access Person had any
                           direct or indirect beneficial ownership when the
                           person became an Access Person;

                  (b)      the name of any broker, dealer or bank with whom the
                           Access Person maintained an account in which any
                           Securities were held for the direct or indirect
                           benefit of the Access Person as of the date the
                           person became an Access Person; and

                  (c)      the date that the report is submitted by the Access
                           Person.

         All Access Persons currently employed by the Trust shall submit an
Initial Report to the appropriate compliance officer within ten days of the date
of this Code of Ethics. All other Initial Reports shall be made no later than
ten days after the person becomes an Access Person.

         6.2      Quarterly Reports.

                  (a)      All Access Persons (excluding Disinterested Trustees
                           who would be required to make a report solely by
                           reason of being a Trustee) shall report to the
                           appropriate compliance officer, the information
                           described below in Sub-paragraph 6.2(c) of this
                           Section with respect to transactions in any Security
                           in which such person has, or by reason of such
                           transaction acquires, any direct or indirect
                           beneficial ownership in the Security; provided, that
                           all Access Persons shall not be required to make a
                           report with respect to transactions effected for any
                           account over which such

                                     - 8 -

<PAGE>   9
                           person does not have any direct or indirect influence
                           or Security transactions which are not eligible for
                           purchase or sale by the Trust.

                  (b)      Each Disinterested Trustee, who would be required to
                           make a report solely by reason of being a Trustee,
                           need submit a Quarterly Report only if such Trustee
                           knew or, in the ordinary course of fulfilling his or
                           her official duties as a Trustee, should have known
                           that during the 15-day period immediately before or
                           after the Trustee's transaction in a Security that
                           the Security was held or to be acquired by the Trust.

                  (c)      Reports required to be made under this Paragraph 6.2
                           shall be made not later than 10 days after the end of
                           the calendar quarter in which the transaction to
                           which the report relates was effected. All Access
                           Persons (excluding Disinterested Trustees who would
                           be required to make a report solely by reason of
                           being a Trustee) shall be required to submit a report
                           for all periods, including those periods in which no
                           Securities transactions were effected. A report shall
                           be made on the form attached hereto as Exhibit B or
                           on any other form containing the following
                           information:

                           (i)      the date of the transaction, the title of
                                    the Security, the interest rate and maturity
                                    date (if applicable), the number of shares,
                                    and the principal amount of each Security
                                    involved;

                           (ii)     the nature of the transaction (i.e.,
                                    purchase, sale or any other type of
                                    acquisition or disposition);

                           (iii)    the price at which the transaction was
                                    effected;

                                     - 9 -

<PAGE>   10
                           (iv)     the name of the broker, dealer or bank with
                                    or through whom the transaction was
                                    effected; and

                           (v)      the date the report is submitted.

                  (d)      All Access Persons (excluding Disinterested Trustees
                           who would be required to make a report solely by
                           reason of being a Trustee) shall direct their brokers
                           to supply duplicate copies of all monthly brokerage
                           statements for all Securities accounts maintained by
                           the Access Person to the appropriate compliance
                           officer, on a timely basis. An Access Person may
                           submit such a brokerage statement or a confirmation
                           in lieu of the Report contained in Exhibit B,
                           provided such statements or confirmations contain all
                           of the information required to be reported in Exhibit
                           B. In addition, with respect to any account
                           established by the Access Person in which any
                           Securities were held during the quarter for the
                           direct or indirect benefit of the Access Person, the
                           Access Person shall report the following information:

                           (i)      the name of the broker, dealer or bank with
                                    whom the Access Person established the
                                    account;

                           (ii)     the date the account was established; and

                           (iii)    the date the report is submitted.

         6.3 Annual Holdings Reports. All Access Persons (excluding any
Disinterested Trustee who would be required to make a report solely by reason of
being a Trustee) shall disclose all personal Securities holdings on an annual
basis on the Form attached as Exhibit C

                                     - 10 -

<PAGE>   11
within 30 days after the end of the calendar year. All Annual Reports shall
provide information on personal Securities holdings that is current as of a date
no more than 30 days before the Annual Report is submitted. Such Annual Reports
shall contain the following information:

                  (a)      the title, number of shares and principal amount of
                           each Security in which the Access Person had any
                           direct or indirect beneficial ownership;

                  (b)      the name of any broker, dealer or bank with whom the
                           Access Person maintains an account in which any
                           Securities are held for the direct or indirect
                           benefit of the Access Person; and

                  (c)      the date that the report is submitted by the Access
                           Person.

         6.4 Any of the foregoing reports may contain a statement that the
report shall not be construed as an admission by the person making such report
that he or she has any direct or indirect beneficial ownership in the Security
to which the report relates.

7.       Certification of Compliance with Code of Ethics. Every Access Person
(excluding Disinterested Trustees who would be required to make a report solely
by reason of being a Trustee) shall certify in their Annual Report (Attached as
Exhibit C) that:

         7.1 they have read and understand the Code of Ethics and recognize that
they are subject thereto;

         7.2 they have complied with the requirements of the Code of Ethics; and

         7.3 they have reported all personal securities transactions required to
be reported pursuant to the requirements of the Code of Ethics.

8.       Conflict of Interest. Every Access Person shall notify the compliance
officer of any personal conflict of interest relationship which may involve the
Trust, such as the existence of

                                     - 11 -

<PAGE>   12
any economic relationship between their transactions and Securities held or to
be acquired by the Trust.

9.       Reporting of Violations to the Board of Trustees

         9.1 Any person, including the compliance officer, shall promptly report
all violations and apparent violations of this Code of Ethics and the reporting
requirements thereunder to the Board of Trustees.

         9.2 The Board of Trustees, or a committee of Trustees created by the
Board of Trustees for that purpose, shall consider reports made to the Board of
Trustees hereunder and shall determine whether or not this Code of Ethics has
been violated and what sanctions, if any, should be imposed.

10.      Annual Reporting to the Board of Trustees

         10.1 The compliance officer shall prepare an annual report relating to
this Code of Ethics to the Board of Trustees. Such annual report shall:

                  (a)      summarize existing procedures concerning personal
                           investing and any changes in the procedures made
                           during the past year;

                  (b)      identify any violations requiring significant
                           remedial action during the past year;

                  (c)      identify any recommended changes in the existing
                           restrictions or procedures based upon the Trust's
                           experience under its Code of Ethics, evolving
                           industry practices or developments in applicable laws
                           or regulations; and

                  (d)      certify that the Trust has adopted procedures
                           reasonably necessary to prevent Access Persons from
                           violating this Code of Ethics.

                                     - 12 -

<PAGE>   13
11.      Annual Reporting of Investment Advisers, Investment Sub-Advisers and
Principal Underwriters to the Board(3)

         Any investment adviser, sub-adviser or principal underwriter to the
Trust shall also prepare an annual report to the Board which contains that
information described in Section 10 (as it pertains to their particular Code of
Ethics and compliance with Rule 17j-1).

12.      Sanctions

         Upon learning of a violation of this Code of Ethics, the Trustees may
impose any sanction as it deems appropriate under the circumstances, including,
but not limited to, letters of reprimand, suspension of employment, or
termination of employment.

13.      Retention of Records

         13.1 The Trust shall, at its principal place of business, maintain
records in the manner and to the extent set out below, as modified from time to
time by any amendments to Rule 17j-1, and shall make these records available to
the Securities and Exchange Commission ("SEC") or any representative of the SEC
at any time and from time to time for reasonable periodic, special or other
examination:

                  (a)      A copy of this Code of Ethics, or any Code of Ethics
                           which within the past five (5) years has been in
                           effect, shall be preserved in an easily accessible
                           place;

                  (b)      A record of any violation of this Code of Ethics, and
                           of any action taken as a result of such violation,
                           shall be preserved in an easily accessible place

----------
(3) The requirements of Section VII apply to principal underwriters only where:
         - the principal underwriter is an affiliated person of the Trust or the
Trust's investment adviser or investment sub-adviser; or
         - an officer, director or general partner of the principal underwriter
serves as an officer, director or general partner of the Trust or of the Trust's
investment adviser or investment sub-adviser.

                                     - 13 -

<PAGE>   14
                           for a period of not less than five (5) years
                           following the end of the fiscal year in which the
                           violation occurs;

                  (c)      A copy of each report made by an Access Person
                           pursuant to this Code of Ethics shall be preserved
                           for a period of not less than five (5) years from the
                           end of the fiscal year in which it is made, the first
                           two years in an easily accessible place;

                  (d)      A list of all persons who are, or within the past
                           five (5) years have been, required to make reports
                           pursuant to this Code of Ethics shall be maintained
                           in an easily accessible place;

                  (e)      A record of any decision, and the reasons supporting
                           the decision, to approve the acquisition by
                           Investment Personnel of securities in a private
                           placement or IPO, as described in Section 3.2 (a) of
                           this Code of Ethics, for at least five (5) years
                           after the end of the fiscal year in which the
                           approval is granted; and

                  (f)      A copy of each annual report required under Section
                           10 or 11 for at least five (5) years after the end of
                           the fiscal year in which it is made, the first two in
                           an accessible place.

Date Last Revised: _________________________, 2000


                                     - 14 -

<PAGE>   15
                                                                       Exhibit A


                             SUMMIT INVESTMENT TRUST

                                 CODE OF ETHICS

                                 INITIAL REPORT


To the Compliance Officer of SUMMIT INVESTMENT TRUST (the "Trust"):

         1. I hereby acknowledge receipt of a copy of the Code of Ethics for the
Trust.

         2. I have read and understand the Code of Ethics and recognize that I
am subject thereto in the capacity of an "Access Person."

         3. Except as noted below, I hereby certify that I have no knowledge of
the existence of any personal conflict of interest relationship which may
involve the Trust, such as any economic relationship between my transactions and
Securities held or to be acquired by the Trust or any of its series.

         4. As of the date below I had a direct or indirect beneficial ownership
in the following Securities:

<TABLE>
<CAPTION>
                                                       Dollar Amount        Type of Interest
Title of Security             Number of Shares        of Transaction      (Direct or Indirect)
-----------------             ----------------        --------------      --------------------
<S>                           <C>                     <C>                 <C>





</TABLE>

         5. I hereby represent that I maintain account(s) as of the date this
report is submitted in which Securities are held for my direct or indirect
benefit with the brokers, dealers or banks listed below.


                                       A-1
<PAGE>   16
<TABLE>
<CAPTION>
     Name of Broker, Bank or Dealer with Whom
                Account Maintained                     Date Established
                ------------------                     ----------------
<S>                                                    <C>



</TABLE>




Name:
     -------------------------------

Title:
      ------------------------------

Date Report Submitted:
                      --------------


                                      A-2

<PAGE>   17
                                                                       Exhibit B

                             SUMMIT INVESTMENT TRUST

                                 CODE OF ETHICS

                    Quarterly Securities Transactions Report
                    For the Calendar Quarter Ended: _________

To the Compliance Officer of the SUMMIT INVESTMENT TRUST (the "Trust"):

         During the quarter referred to above, the following transactions were
effected in Securities of which I had, or by reason of such transaction
acquired, direct or indirect beneficial ownership, and which are required to be
reported pursuant to the Code of Ethics adopted by the Trust.

<TABLE>
<CAPTION>
================ ================= ======== =============== ============= ================ ======= ===============
                                             INTEREST RATE                   NATURE OF                 BROKER/
                                              AND MATURITY     DOLLAR       TRANSACTION                 DEALER
   TITLE OF          DATE OF        NO. OF      DATE (if      AMOUNT OF   (Purchase, Sale,         OR BANK THROUGH
   SECURITY        TRANSACTION      SHARES    applicable)    TRANSACTION       Other)       PRICE   WHOM EFFECTED
---------------- ----------------- -------- --------------- ------------- ---------------- ------- ---------------
<S>              <C>               <C>     <C>             <C>             <C>              <C>     <C>
---------------- ----------------- -------- --------------- ------------- ---------------- ------- ---------------

---------------- ----------------- -------- --------------- ------------- ---------------- ------- ---------------

---------------- ----------------- -------- --------------- ------------- ---------------- ------- ---------------

---------------- ----------------- -------- --------------- ------------- ---------------- ------- ---------------

---------------- ----------------- -------- --------------- ------------- ---------------- ------- ---------------

---------------- ----------------- -------- --------------- ------------- ---------------- ------- ---------------

---------------- ----------------- -------- --------------- ------------- ---------------- ------- ---------------

================ ================= ======== =============== ============= ================ ======= ===============
</TABLE>

         This report (i) excludes transactions with respect to which I had no
direct or indirect influence or control, (ii) other transactions not required to
be reported, and (iii) is not an admission that I have or had any direct or
indirect beneficial ownership in the Securities listed above.

         I hereby represent that I established the brokerage accounts listed
below, in which Securities were held during the quarter referenced above for my
indirect or direct benefit.


                                       B-1

<PAGE>   18

<TABLE>
<CAPTION>
     Name of Broker, Bank or Dealer with Whom
                Account Established                     Date Established
                -------------------                     ----------------
<S>                                                    <C>



</TABLE>


         Except as noted in this report, I hereby certify that I have no
knowledge of the existence of any personal conflict of interest relationship
which may involve the Trust, such as the existence of any economic relationship
between my transactions and Securities held or to be acquired by the Trust or
any of its series.


Name:
     -------------------------------

Title:
      ------------------------------

Date Report Submitted:
                      --------------


                                      B-2

<PAGE>   19

                                                                       Exhibit C


                             SUMMIT INVESTMENT TRUST

                                 CODE OF ETHICS
                                  ANNUAL REPORT

         To the Compliance Officer of the SUMMIT INVESTMENT TRUST (the "Trust"):

         1. I have read and understand the Code of Ethics and recognize that I
am subject thereto in the capacity of an "Access Person."

         2. I hereby certify that, during the year ended December 31, 200__, I
have complied with the requirements of the Code of Ethics and I have reported
all Securities transactions required to be reported pursuant to the Code of
Ethics.

         3. Except as noted below, I hereby certify that I have no knowledge of
the existence of any personal conflict of interest relationship which may
involve the Trust, such as any economic relationship between my transactions and
Securities held or to be acquired by the Trust or any of its series.

         4. As of December 31, 200__, I had a direct or indirect beneficial
ownership in the following Securities:

<TABLE>
<CAPTION>
                                          Principal Amount     Type of Interest     Broker/Dealer or Bank
Title of Security     Number of Shares   of Securities Sold  (Direct or Indirect)   Through Whom Effected
-----------------     ----------------   ------------------  --------------------   ---------------------
<S>                   <C>                <C>                 <C>                    <C>





</TABLE>

         5. I hereby represent that I maintain the account(s) with the brokers,
dealers or banks listed below in which Securities are held for my direct or
indirect benefit.

                                       C-1

<PAGE>   20

<TABLE>
<CAPTION>
     Name of Broker, Bank or Dealer with Whom
                Account Maintained                     Date Established
                ------------------                     ----------------
<S>                                                    <C>



</TABLE>

Name:
     -------------------------------

Title:
      ------------------------------

Date Report Submitted:
                      --------------


                                      C-2


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