# Allied World Assurance Company

## Commission

**Item 9. The Company:** Allied World Assurance Company, AG

**Item 10. Policy Form:**
- **Endorsements**
- **The Bermuda Shorts Form – 03 (Ed. 07/13)**
- **1 - 4 at Policy Issuance**

**Authorized Representative**

**Date of Issuance:** July 11, 2014
**ACBSF-03 (07/13)**

**Page 3 of 10**