# Chubb Global Casualty

## Proposal Conditions

- This proposal may be withdrawn at any time prior to its acceptance.
- Unless accepted or extended by the Company in writing, this proposal expires automatically thirty days after the date on the cover page or by the proposed effective date, whichever is first.
- This proposal has been developed and drafted in reliance upon the statements and information made and provided in the underwriting submission and any application connected thereto (collectively "the Submission"). The statements and information provided are material to the acceptance of this risk and hazard assumed by the Insurer under this proposal and any policy (ies) issued therewith. This proposal is issued in reliance upon the truth and accuracy of the Submission and in reliance that all relevant information affecting the pricing and underwriting of this risk and hazard has been provided, that there are no material omissions or material nondisclosures, and that all information is current and effective at the time of the Submission. In the event that the Submission contains any material misrepresentation, material omissions or material nondisclosure, this proposal and any policy (ies) issued therewith are, subject to applicable law, invalid from the outset.
- Binding any Chubb company under the terms of this proposal is conditioned upon compliance with the proposal's terms, and the following conditions:
  - Receipt of properly executed Notice of Election 06/21/2018.
  - Receipt of properly executed state coverage selection forms prior to the effective date. If you have not provided us with your executed selection and rejection forms prior to the effective date, we will not issue your policies for a period of thirty days unless we receive properly executed UM/UIM selection and rejection forms. However, if you do not return fully completed selection and rejection forms within thirty days after the policies have incepted, We will issue the policies as though coverage for UM, UIM, and PIP are rejected wherever possible and minimum limits in all other states, in accordance with this proposal and/or your submission. In the event of a claim, a court may construe coverage where none was expected or intended. Any policy deductible, retention, retrospective premium obligation, or loss limitation will apply in such a case.
- The premiums in the Notice of Election are contingent upon the Claims Administrator and the Claims Administration Expenses shown in the Notice of Election. If the Claims Administrator or the Claims Administration Expenses are changed the premiums including taxes and non-premium surcharges are subject to change.

## US FATCA Compliance Notification

The U.S. Foreign Account Tax Compliance Act, commonly known as "FATCA", became the law in the U.S. in March of 2010 and became effective July 1, 2014. Pursuant to FATCA, brokers, producers, agents and/or clients may need to obtain withholding certificates, such as Forms W-8 or W-9, from insurance companies. For information on how to obtain the applicable withholding certificate from Chubb U.S. insurance companies, please go to [http://www2.chubb.com/us-en/u-s-foreign-account-tax-compliance-act-fatca.aspx](http://www2.chubb.com/us-en/u-s-foreign-account-tax-compliance-act-fatca.aspx)