# Canadian Premium

IT IS AGREED THAT THE CANADIAN PREMIUM FOR THIS POLICY 700.36 WILL BE PAID IN CANADIAN FUNDS.

IT IS FURTHER AGREED THAT AS RESPECTS SUCH CANADIAN PREMIUM THE BROKER OR RECORD IS JOHNSON & HIGGINS, WILLIS FARBER, LTD., PLACE VICTORIA, MONTREAL, QUEBEC, CANADA.

This endorsement, issued by one of the below named companies, forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein.
(The information below is required only when this endorsement is issued subsequent to preparation of policy.)

| Endorsement effective | Policy No. | Endorsement No. |
|----------------------|------------|-----------------|
| Named Insured         |            |                 |
| Additional Premium $  | Return Premium $ | BI PI1 |
|                       |             | In Advance $    | 1st Adv. $ | Total $ |
| The Aetna Casualty and Surety Company | Hartford, Connecticut | Countersigned by (Authorized Representative) |

(90455-B) 7-69