**PROPERTY CODE SLIP**

**Jutil Business Machini**

| TYPE CARD | CO. | PROD STATE | PRODUCER | AGENCY OR BROKER | POLICY OR BINDER NUMBER |
|-----------|-----|------------|-----------|-------------------|------------------------|
| 1         | 2-3 | 4 5 6 7 8 9 10 11 12 13 14 15 16 17 | 18 19 20 21 22 23-24 25 | 26 27 28-29 30 |

**NAME OF INSURED**

| 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 |

**TAX STATE | RISK LOCATION | AUD | MAJOR CLASS | MAJOR PROD LINE | COMM. RATE | PREMIUM | CR |
|-----------|-------------|----|-------------|--------------|-----------|--------|---|
| 31-33     | 34-37       | 38 | 39          | 40-42        | 43-46      | 47-49   | 50-57 |
| 020       |             |    |             |              |            |         | 57  |

**TOTAL**

**FIRE AND ALLIED**

**FARMOWNER**

**SPECIAL MULTI-PERIL**

**REINSURANCE**

| REINS. CO. NAME | CHANGE | TOTAL |
|-----------------|--------|-------|
| QOBE            | 1st Layer |
| QO9E            | 2nd Layer |

**KIND | TRANS EFF. DATE | TAX STATE | REINS. CO. CODE | MAJOR CLASS | REINS. COMM. RATE | PREMIUM | CR |
|------|-----------------|-----------|---------------|-------------|------------------|--------|---|
| 1    | 4 5 21 0 070    | 0772 012  | 175           | 720 00      |
| 2    | 4 5 21 0 070    | 0650 012  | 175           | 480 00      |

**FORM NO. G 7733 6/70**