**POLICY NO.:** 25413435  
**NEW BUSINESS/RENEWAL OF:** 21472589

**DECLARATIONS, cont’d**

**Item 7. Notice to: (Conditions 3 and 5)**

a) All Notices of Occurrence, Claim or Loss:
   - To: Chartis Excess Limited  
     29 Richmond Road  
     Pembroke HM08 Bermuda  

b) All other Notices:
   - To: Aon (Bermuda) Ltd.  
     Cumberland House,  
     1 Victoria Street,  
     Hamilton, HM 11  
     Bermuda  

**Item 8.**
a) Premium: USD 373,208 (for 100% Flat Annual)
b) Minimum Earned Premium: USD 130,622
c) Commission: 0%

**Item 9. The Company:**
Chartis Excess Limited  
At the address stated at the top of the Declarations Page  

**Item 10. Policy Form: Endorsements**
The Bermuda Shorts Form – 103271(11/09)  
1 - 7 at Policy Issuance  

**Authorized Representative**

**Date of Issuance:** June 24, 2010  
**Page 2 of 2**

103270(11/09)

**CHARTIS EXCESS LIMITED IS REGISTERED IN IRELAND AND REGULATED BY THE IRISH FINANCIAL SERVICES REGULATORY AUTHORITY.**  
**REGISTERED OFFICE:** 30 NORTH WALL QUAY, IFSC, DUBLIN 1, IRELAND. **REGISTRATION NO. 279452**