# Reinsurance Continuation Sheet

## Premium

**Type Card**: 2-3
**Producer**: 4 5 6 7 8 9 10 11 12 13 14 15 16 17
**Policy or Binder No.**: 2 4 1 3 9 1 8 3 4 2 5 5 0 1 8 5 2 9 1
**Div./Dept.**: 1 8 5 2 9 1

**Name of Insured**: INTERNAT'L BUSIN. MA

**Coded By**: J.C. 6/1/77
**Keytape Date**: 

| Certificate Number | Reinsurance Co. Name | % Reins. | Change | Total |
|--------------------|---------------------|----------|---------|-------|
| 7756               |                      | 100.     |         |       |
| 7757               |                      | 100.     |         |       |
| No. Am.Re          |                      | 100.     |         |       |

**Line**: 20 21 22 23-24 25 26 27 28-29 30
**Kind**: 4 1 5 20 7 1 5 20 8
**Trans. Eff. Date**: Mo. Day Yr.
**Term**: Mo. Day Yr.

**Line**: 31-33 34-37
**Tax State**: 051 7756
**Reins. Co. No.**: 7757
**Major Class**: 012 0384
**Major Prod. Line**: 300 320 250
**Reins. Comm. Rate**: 625.00 1875.00 2500.00
**Premium or Return**: ER 50 50-57
**CR**: 76 76-83
**Final Exp. Yr.**: 84-85
**Reins. Source**: 93-97
**Line**: 0871
**Name of Insured**: 

**Form No.**: 10309 1/70