# General Change Endorsement

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**Policy No:** XL 98512  
**Issued To:** [Blank]  
**Effective Date of This Endorsement:** [Blank]

**And Conditions remain unchanged except:**

- Return premium due now $ [Blank]
- (pro rata of $) [Blank]
- Premium subject to audit [Blank]

## E.R.I.S.A. Exclusion

It is agreed that such coverage as is afforded by this policy does not apply to any claim or suit for loss or damage arising out of any duty imposed upon the insured by virtue of the provisions of public law 93-406, The Employee Retirement Income Security Act of 1974.