**Canadian Schedule**

Johnson & Higgins
Willis Faber Ltd.
Place Victoria, Suite 21000
Montreal, Canada
10010
881
$480.00

All premiums and losses payable under this endorsement in Funds.

**Total Additional Premium**
- Pro Rate of

**Total Return Premium**
- Pro Rate or Short Rate of

**The Premium is Payable in Installments**

| INSTALLMENT | INCREASE | DECREASE | REMANDED INSTALLMENT |
|-------------|----------|----------|----------------------|
| $           | $        | $        | $                    |
| $           | $        | $        | $                    |
| $           | $        | $        | $                    |
| $           | $        | $        | $                    |