All other terms and conditions of this Policy remain unchanged.

**Authorized Representative**

Date of Issuance: June 14, 2011

103281(11/09) Page 3 of 3
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