**American International Companies**

**EXECUTIVE OFFICES:**
30 E STREET, NEW YORK, N.Y. 10270

**AMERICAN HOME ASSURANCE CO.**
THE INS CO OF THE STATE OF PENNA.
COMMERCE & INDUSTRY INS CO
NATIONAL UNION FIRE INS CO OF PITTS. PA
BIRMINGHAM FIRE INS CO OF PA

**NOTICE OF PREMIUM DUE**

This premium is due and payable to the company 15 days from the date of this bill or 30 days from inception of the contract, whichever is later. If payment is not received within the time stated, this policy will be cancelled.

**RETURN REMITTANCE TO:**

[Address]

**PREMIUM DUE**

* **Policy Number:** [Policy Number]
* **Effective Date:** [Effective Date]
* **Date Due:** [Date Due]
* **Premium Due:** [Premium Due]

**COVERAGE**

* [Coverage Details]

**REMITTANCE INVOICE AND CHANGE IN ADDRESS**

**BANK INFORMATION**

[Bank Information]