# Excess Overlayer Indemnity Policy

## Interpretive Endorsement (Data Processing)

**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.**

**Endorsement effective:** [Date]
**Named Insured:** [Name]
**Additional Premium:** $[Amount]
**SPECIAL NO.: 5**
**Policy No.:** [Policy Number]
**Endorsement No.:** 5

**The information below is required only when this endorsement is issued subsequent to preparation of policy:**

| Return Premium $ | In Advance $ | 1st Analv. $ | 2nd Analv. $ |
|------------------|--------------|--------------|--------------|
| $                | $            | $            | $            |

**Counter-signed by:** [Authorized Representative]

**The Aetna Casualty and Surety Company**  
**The Standard Fire Insurance Company**  
**Hartford, Connecticut**

**CAT. 4399**  
**PRINTED IN U.S.A.**