# COLOGNE REINSURANCE COMPANY OF AMERICA

**FACULTATIVE ENDORSEMENT**

**CERTIFICATE NO.** A-0000179  
**ENDORSEMENT NO.** 3  

**INTERMEDIARY AND ADDRESS**  
NATIONAL FACULTATIVE SERVICE  
5 Marineview Plaza  
Hoboken, NJ 07030  

**ATTENTION:** Mr. Leon F. Gonzalez  

**NAME OF INSURED**  
9910310 CE 364 0505  

**CEDING COMPANY POLICY NO.**  
May 21, 1980  

**EFFECTIVE DATE OF ENDORSEMENT**  

**FROM May 21, 1980 to May 21, 1981**  
**CEDING COMPANY POLICY PERIOD**  
**FROM May 21, 1980 to May 21, 1981**  
**REINSURERS CERTIFICATE PERIOD**  

It is hereby understood and agreed that the Ceding Company Policy Number is amended to read as follows:

9910310  
CE 3640505  

Nothing herein contained shall vary, alter or extend any agreement, provision, general condition or declaration of the certificate other than as stated above.

In Witness Whereof, COLOGNE REINSURANCE COMPANY OF AMERICA has caused this endorsement of reinsurance to be signed by its President and by its Vice President and Secretary at Stamford, Connecticut, but the same shall not be binding upon the Reinsurer unless countersigned by an authorized representative of the Reinsurer.

**J.J. Davis**  
Vice President and Secretary  

**Countersigned at** Stamford, Ct. **this** 9th **day of** June **, 1981**  

COLOGNE REINSURANCE COMPANY OF AMERICA  
by: **James W. McCaig**  
AUTHORIZED SIGNATURE  

CRA F2 01/80