# IRON·STARR

## THE BERMUDA SHORTS FORM (cont'd)

**DECLARATIONS - attaching to and forming part of Policy No:** IS0000881

### Item 6. Underlying Limits:
- **(Insuring Agreement 2):**
  - a) USD 400,000,000 Each Occurrence, Claim or Loss
  - b) USD 400,000,000 Annual Aggregate
  - Which in turn is excess of various insurances and/or retentions as more fully set forth in the Followed Policy

### Item 7. Notice to:
- **(Conditions 3 and 5):**
  - a) All Notices of Occurrence, Claim or Loss:
    - To: Iron-Starr Excess Agency Ltd.
      Attention: Claims Manager
      141 Front Street
      Hamilton HM 19, Bermuda
      claims@ironstarrecess.com
  - b) All other Notices:
    - To: Iron-Starr Excess Agency Ltd.
      Attention: Underwriting Dept.
      141 Front Street
      Hamilton HM 19, Bermuda

### Item 8.
- a) Premium: USD (for 100% Flat Annual)
- b) Minimum Earned Premium: 35%
- c) Commission: NIL

### Item 9. The Company:
Iron-Starr Excess Agency Ltd. For and on behalf of subscribing Insurers as follows;
- 50% Ironshore Insurance Ltd.
- 50% Starr Insurance & Reinsurance Limited
at the address stated at the top of the Declarations Page

Date of Issuance: June 14, 2012
ISEABSF Declarations [01/12]