# General Change Endorsement

This endorsement forms a part of and is for attachment to the following designated policy:

- **Affiliated FM Insurance Company**
  - **Policy No:** XL 96794
  - **End. No.:** 4
- **Appalachian Insurance Company**
  - **No Binder**

**All Terms and Conditions remain unchanged except:**

- Additional premium due now $ (pro rata of $)
- Return premium due now $ (pro rata of $)
- Premium subject to audit.

It is agreed that such coverage as is afforded by this policy shall not apply to any Errors and Omissions.