**Item 7. Notice to: (Conditions 3 and 4)**

a) All Notices of Occurrence, Claim or Loss:

To:
- The Company as shown in the attached Individual Security Details;
- Aon Bermuda Ltd.
  - 30 Woodbourne Ave.
  - Pembroke, Bermuda
  - HM08
- Email: debbie.brown@aon.com and nedia.williams@aon.com

b) All other Notices:

Via:
- Aon Bermuda Ltd.
  - 30 Woodbourne Ave.
  - Pembroke, Bermuda
  - HM08
To:
- The Company

**Item 8. a) Premium:** USD 235,000 (100%)

b) Minimum Earned Premium: 35%

c) Commission: Net

**Item 9. The Company:**
- Name: As per Individual Security Details
- Address: As per Individual Security Details

**Item 10. Policy Form:** The Bermuda Shorts Form – 03 (Ed. 03/14)

**Endorsements:**
- Number One – Schedule of Underlying Policy(ies)
- Number Two – Premium Payment Condition
- Number Three – Following Form Policy Issuance

Any Additional Endorsements to those shown above will be shown on Individual Security Details (if applicable)

Page | 2 Declarations