**FORM-CUBL- BSF02 (07/09)**

**POLICY NO.: IBM-141/CUBLBSF02-10**
**RENEWAL OF: IBM-064/CUBLBSF01-09**

**DECLARATIONS, cont’d**

b) USD200,000,000 Aggregate

Which in turn is in excess of various insurances and/or retentions as more fully set forth in the Followed Policy

**Item 7 Notice to:**
(Conditions 3 & 5)

a) All Notices of Occurrences; Claims or Loss

To:
Canopius Underwriting Bermuda Limited
Atlantic House
11 Par-La-Ville Road
Hamilton, HM11 Bermuda
Facsimile: (441) 294-9459
E-Mail: claims@canopius.bm

b) All other Notices:

To:
Aon (Bermuda) Ltd.
Cumberland House
1 Victoria Street
Hamilton, HM11 Bermuda

**Item 8**
a) Premium
USD78,795 (For 100% Flat Annual)
b) Minimum Earned Premium
USD27,578
c) Commission
Net

**Item 9 The Company:**
Canopius Underwriting Bermuda Limited
At the address stated in Item 7 (a)

**Item 10 Policy Form: Endorsements**
The Bermuda Shorts Form – 02 (Ed. 07/09)
1-9 at Policy Issuance

**Signature:**
Jeremy J. Wright, VP
Canopius Underwriting Bermuda Limited
Underwriting on behalf of
Syndicate 4444 at Lloyd's

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