**Reinsurance Layoff Sheet**

**Assured:** Onten Bus Machines

**Policy Number:** 19931601

**Eff. Date of Reinsurance:** 5/21/87

**Policy Limit:** 15 x 30

**Underlying Layer:** 30 m./l

**Policy Premium:** $91,510

**Policy Period:** From: 5/21/87; To: 8/8

**I Participating/Quota Share Limits:**
- **Net:** 15 x 30
- **Premium:** $91,510

**Reinsurer:** [Blank]
**Reinsurance Broker/Direct:** [Blank]
**Percent of Participation:** 40
**% of Change:** 20
**Total Comm to Company:** [Blank]
**Closing Cert. Number:** [Blank]
**Ceded Premium Annual Pro-Rata:** $116,604

**Treaty IO.:**
- **Net:** 600
- **Premium:** $174,906

**II Excess of Loss or Section II Casualty Limits:**
- **Premium:** [Blank]

**Reinsurer:** [Blank]
**Reinsurance Broker/Direct:** [Blank]
**Percent of Participation:** [Blank]
**% of Change:** [Blank]
**Total Comm to Company:** [Blank]
**Closing Cert. Number:** [Blank]
**Ceded Premium Annual Pro-Rata:** [Blank]

**III Automatic Excess Treaty Reinsurance:**
- **Limits:** [Blank]
- **Premium:** [Blank]

**Remarks:**
- **Branch:** [Blank]
- **Underwriter:** QBR
- **Date:** 5/21/87

**Coding:** [Blank]