**ARGO RE**

Member Argo Group

Page 3 of 10

Form ARGO-BSF-03 (Ed. 03/14) POLICY NO.: ARGO-CAS-OCC-000888.1 NEW BUSINESS

DECLARATIONS (Cont'd.)

ITEM 8.
(a) Premium: USD 48,750 (for 100% Flat Annual)
(b) Minimum Earned Premium: Not Applicable
(c) Commission Nil

ITEM 9. The Company: Argo Re Ltd. At the address stated at the bottom of the Declarations Page

ITEM 10. Policy Form: The Bermuda Shorts Form – 03 (Ed. 03/14) Endorsements at Policy Issuance: 1 - Schedule of Excess Policy(ies) 2 - Several Liability Notice 3 - Premium Payment Condition

This Policy is made and accepted subject to the above statement together with the provisions, stipulations and agreements contained in the form(s) and endorsement(s) made a part of this Policy.

**TIM HADLER**
CUO CASUALTY

Dated: JULY 19, 2016

Argo House
110 Pitts Bay Road
Pembroke, Bermuda HM08
T 441 206 5858
F 441 296 6162
www.argore.com