**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 106,544
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