# Reinsurance Layoff Sheet

## Assured
- Name: [Name]
- Policy Number: 2610302
- Effective Date of Reinsurance: 5-21-85
- Policy Limit: $1,000,000
- Participating/Quota Share: 10% (10% x $1,000,000 = $100,000)

## Type of Coverage
- Underlying Layer: X5 Unit Liab
- Policy Premium: $71,000
- Policy Period: From 5/24/85 to 5/23/86
- Premium: $6,272.50

## Reinsurer Information
| Reinsurer | Reinsurance Broker/Direct | Percent of Participation | % of Change | Total Comm to Company | Closing Cert Number | Ceded Premium Annual | Pro-Rata |
|-----------|--------------------------|-------------------------|-------------|-----------------------|--------------------|----------------------|-----------|
| N.V.      |                         | 70%                     | +10%        |                       |                    |                      |           |
| Tengen    | N.F.S.                   | 10%                     | Same        |                       |                    |                      |           |
| Metra     |                         | 10%                     | Same        |                       |                    |                      |           |
| St Paul   |                         | 10%                     | Same        |                       |                    |                      |           |

## Excess of Loss or Section II Casualty
- Limits: 10% of $1,000,000 = $100,000
- Premium: $19,300

## Remarks
- Branch: N
- Underwriter: [Underwriter Name]
- Date: 1/6/86