**Reinsurance Layoff Sheet**

**Assured:** [Name]
**Policy Number:** 18M
**Effective Date of Reinsurance:** 5-21-79
**Policy Limit:** $5,000,000

**Type of Coverage:** Excess Umbra Ms 1103
**Underlying Layer:** $19,000,000
**Policy Premium:** $12,066
**Policy Period:** From 5-21-79 to 5-21-80

**Participating/Quota Share:**

| Reinsurer | Reinsurance Broker/Direct | Percent of Participation | % of Change | Total Company | Closing Cert. Number | Ceded Premium Annual | Pro-Rata |
|-----------|--------------------------|-------------------------|-------------|---------------|----------------------|----------------------|------------|
| Net Union | Direct                   | 70%                     | -          | $5,000,000    | TBA                  |                      |            |
| INARO 205 | Direct                   | 30%                     | +54%        |               |                      |                      |            |

**Excess of Loss or Section II Casualty:**

| Reinsurer | Reinsurance Broker/Direct | Percent of Participation | % of Change | Total Company | Closing Cert. Number | Ceded Premium Annual | Pro-Rata |
|-----------|--------------------------|-------------------------|-------------|---------------|----------------------|----------------------|------------|
|           |                         |                         |             |               |                      |                      |            |

**Automatic Excess Treaty Reinsurance:**

| Remarks: | Branch | Underwriter | Date       |
|----------|--------|-------------|------------|
|          |        |             |            |

**Coding:** 3126 778