# ASPEN INSURANCE LIMITED

## THE BERMUDA SHORT FORM DECLARATIONS

**Policy Number:** ECA1KFW11A0W  
**New**

**ITEM 7 NOTICES TO THE INSURER:**

- (a) All notices of Occurrence or Claim:
  - Electronically: excesscasualtyclaims@aspen.bm
  - Via Courier: Aspen Insurance Limited Claims Department Maxwell Roberts Building 1 Church Street Hamilton HM11 Bermuda

- (b) All other notices: Aon Group (Bermuda) Ltd

**ITEM 8**

- (a) PREMIUM: USD 105,000
- (b) MINIMUM EARNED PREMIUM: 36%
- (c) COMMISSION: 0%

**IMPORTANT:** The premium payable to the Insurer does not include any amount with respect to insurance premium taxes or excise taxes. It is the obligation of the Insured to be liable for and pay any insurance premium taxes or excise taxes either itself or through its broker. Aspen Insurance Limited will be indemnified and fully reimbursed by the Insured for any premium taxes (and cost associated with collection, including legal costs) in the event the Insured or its broker fail pay.

**ITEM 9 THE COMPANY:**
Aspen Insurance Limited Maxwell Roberts Building 1 Church Street Hamilton HM11 Bermuda

**ITEM 10 POLICY FORM:**
The Bermuda Shorts Form – Aspen (05/09)

**Endorsement No**
1. Schedule of Followed Policy, Primary Policies and Underlying Policies
2. Minimum Earned Premium Endorsement
3. Arbitration Endorsement
4. Choice of Law Endorsement - II
5. Non Followed Endorsement

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