**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;

And:
Aon Bermuda Ltd.
30 Woodbourne Ave.
Pembroke, Bermuda
HM08

Email: debbie.brown@aon.com and media.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 105,478

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