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 PENN-AMERICA GROUP, INC. ------------------------ (Exact name of registrant as specified in its charter) Pennsylvania 0-22316 23-2731409 ---------------- -------------------- ------------------ (State or other (Commission File (I.R.S. Employer jurisdiction of Number) Identification No.) incorporation) 420 S. York Road, Hatboro, 19040 Pennsylvania ------------------------------------- ------------------------------------- (Address of principal executive offices) (Zip Code) (215) 443-3600 ------------------------ (Registrant's telephone number, including area code) Common Stock ------------------------ (Title of each class of securities covered by this form) N/A ------------------------ (Titles of all other classes of securities for which a duty to file reports under Section 13(a) or 15(d) remains) 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: /X/ Rule 12g-4(a)(l)(i) / / Rule 12g-4(a)(2)(ii) / / Rule 12h-3(b)(2)(i) / / Rule 12g-4(a)(l)(ii) / / Rule 12h-3(b)(l)(i) / / Rule 12h-3(b)(2)(ii) / / Rule 12g-4(a)(2)(i) / / Rule 12h-3(b)(l)(ii) / / Rule 15d-6 Approximate number of holders of record as of the certification or notice date: 2 Pursuant to the requirements of the Securities Exchange Act of 1934, Penn-America Group, Inc. has duly caused this Certification/Notice to be signed on its behalf by the undersigned duly authorized person. January 25,2004 PENN-AMERICA GROUP, INC /s/ Garland P. Pezzuolo -------------------------------- Garland P. Pezzuolo Vice President, Secretary & General Counsel