**Policy Number:** CSUSA2407557

| PREMIUM | GROSS PREMIUM: | USD 434,460.00 | (100%) Annual |
| --- | --- | --- | --- |
| Including 1% (one percent) allocation in respect of TRIA. |

**PREMIUM PAYMENT TERMS**

45 days as stated in Condition 10 of the Policy.

**TAXES PAYABLE AND ADMINISTERED BY (RE)INSURED OR THEIR AGENT**

Premiums paid to Underwriters by U.S. Insureds may be subject to State and/or Federal tax(es) which (if applicable) are in addition to the premium.

The Insured is responsible for reporting and remitting this tax to the appropriate authorities (if applicable).

Please refer to <http://www.aon.com/ipforms> to obtain the applicable tax forms.

**TAX(ES) PAYABLE BY THE (RE)INSURED AND ADMINISTERED BY THE (RE)INSURERS**

Underwriters acknowledge that the exposure on this risk may be Worldwide. However, for rating purposes only they consider the exposure for this layer of insurance to be all United States of America based, and therefore no other taxes apply.

**TAX(ES) PAYABLE BY THE (RE)INSURERS AND ADMINISTERED BY (RE)INSURED OR THEIR AGENT**

None

**(RE)INSURER CONTRACT DOCUMENTATION**

This Market Reform Contract details the contract terms entered into by the (Re)Insured(s) and (Re)Insurer(s) and constitutes the contract document.

The endorsement(s) or e-endorsement(s) signed by (Re)Insurers shall form the evidence of changes agreed.