**FISCAL AND REGULATORY**

- **TAX PAYABLE BY (RE)INSURER(S):** None.
- **COUNTRY OF ORIGIN:** United States of America
- **REGULATORY RISK LOCATION:** 100% United States of America
- **OVERSEAS BROKER:** Aon Risk Services Northeast Inc
  - One Liberty Plaza
  - 165 Broadway
  - Suite 3201
  - New York 10006
  - United States of America
- **SURPLUS LINE BROKER:** One Liberty Plaza
  - 165 Broadway
  - Suite 3201
  - New York
  - United States of America
  - 10006
  - Licence Number: 1037562
- **STATE OF FILING:** New York
- **US CLASSIFICATION:** Surplus Lines
- **NAIC CODES:** Not Applicable
- **ALLOCATION OF PREMIUM TO CODING:** Not Applicable.
  - In respect of electronic lines, please refer to the Settlement Information shown under Security Details herein which is deemed to supersede the above
- **ALLOCATION OF PREMIUM TO YEARS OF ACCOUNT:** Not Applicable.
- **REGULATORY CLIENT CLASSIFICATION:** Commercial - Large Risk

**Page 17 of 22**
**CEBBS 20/5/2021 10:11 AM**