NetGuard Select (5-2018) - 0

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NetGuard® SELECT Cyber Protection for Today’s Digital Lifestyle

As your life gets more connected, you need better protection. While the increasing usage of computers, smart phones, and media-streaming devices have enabled you to connect to a variety of essential online services, they have also increased your vulnerabilities to cyberattacks and fraud. In the event of a cyber security incident, you need more than credit monitoring and identity theft support. You need the expertise and experience of a cyber response team to react quickly when security fails.

Introducing NetGuard™ SELECT from NAS Insurance More than just a great insurance policy, NetGuard™ SELECT provides state-of-the-art cyber security services and expertise to protect you and your family from emerging cyber threats including:

• Cyber Extortion

• Cyber Crime

• Identity Theft Expenses and Online Fraud

• Cyber Bullying

• Personal Data Exposure and Loss With NetGuard™ SELECT, you will have essential insurance coverage to help you recover quickly from a cyber incident. Beyond the insurance, NAS offers a host of services and support should you have any questions or need to report a claim. Our expert claims team and network of cyber security specialists work together to restore your systems, your identity, and your confidence. Professional. Proactive. Prevention. As a NetGuard™ SELECT policyholder, you also have access to PrivacyArmor™ – leading-edge security services that provide identity protection, fraud detection and social media monitoring to stop cyber threats before they turn into problems. In addition, you will have access to a Personal Privacy Advocate that will be your single-point-of-contact if you have any questions about ID theft, fraud detection or identity restoration. And in the event you become a victim, your Privacy Advocate will coordinate your recovery from start to finish.

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NAS Insurance – The Specialty Cyber Insurance Leader

NAS Insurance Services has been leading specialty insurance product development and distribution for over 40 years. Having developed some of the earliest privacy and network security insurance solutions, NAS has extensive experience in creating and underwriting cyber liability policies and managing a broad range of cyber claims. Today, NAS has over 500,000 commercial cyber policyholders, handles over 2,000 claims each year and has an expert staff of 20 in-house cyber claims specialists to support you in the event of a cyber incident.

As a Lloyd’s, London coverholder, NAS benefits from being a part of the Tokio Marine Group, one of the world’s largest insurance groups, which gives us the financial strength to keep you confident and secure.

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NetGuard® SELECT Cyber Liability for Individuals

NAS Insurance is now pleased to offer NetGuard® SELECT, a new and state of the art personal cyber solution with a streamlined application process. Individuals who meet the program qualifications can simply complete the Program Application, choose a limit, request to bind coverage, and pay the applicable premium.

COVERAGE COMPONENTS

▪ Security and Privacy Liability – Duty to defend coverage for third party claims alleging liability resulting from a security breach or privacy breach.

▪ Breach Event Costs – Covers your reasonable and necessary mitigation costs and expenses incurred as a result of a privacy breach or security breach, including legal expenses and IT forensic expenses, as well as the cost to provide call centers, credit monitoring and identity theft assistance to affected individuals.

▪ Data Recovery – Covers your reasonable and necessary data recovery expenses due to (1) accidental damage or destruction of electronic media or computer hardware, (2) administrative or operational mistakes in the handling of electronic data, or (3) computer crime/attacks, including malicious code, denial of service attacks, and acts of cyber terrorism.

▪ Cyber Extortion – Covers extortion expenses incurred and extortion monies paid as a direct result of a credible cyber extortion threat.

▪ Cyber Crime – Covers your loss of money or securities due to wire transfer fraud or a phishing attack.

▪ Identity Theft Expenses – Covers attorneys’ fees to remove, contest, or challenge tax, legal or financial liabilities resulting from identity theft, as well as the cost to obtain credit reports and credit monitoring.

▪ Cyber Bullying – Covers therapy fees, childcare expenses, temporary relocation expenses, and the fees of digital forensic analysts or cyber security consultants, if you or a member of your household is a victim of cyber bullying. Also covers private tutoring expenses, unreimbursed tuition, or the increase in tuition to relocate your child to another school, if he or she is a victim of cyber bullying.

PROGRAM HIGHLIGHTS

▪ Coverage included for trusts ▪ Personal LLC’s can be scheduled to the policy ▪ Broad coverage for data that is stored with outsourced IT providers ▪ Worldwide coverage ▪ Data Recovery covers accidental damage or destruction, administrative and operational mistakes as

well as computer crimes, including acts of cyber terrorism ▪ Proactive identity protection and fraud remediation services

Please note: coverage does not extend to any of the Applicant’s business ventures.

PROGRAM QUALIFICATIONS

□ No privacy or security claims/incidents in the past 5 years

□ Net worth must not exceed $1,000,000,000 (Larger risks can be submitted to NAS for further consideration)

Coverage cannot be bound under the terms and conditions of this program for Applicants who do not fall within the program qualifications; however, Applicants may be considered for coverage outside of the program.

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PROACTIVE PRIVACY PROTECTION NetGuard® SELECT policyholders have access to state-of-the-art identity protection, fraud detection and social media monitoring services to fight evolving cyber risks. This comprehensive suite of risk management services includes:

• Internet surveillance and identity monitoring

• Financial transaction monitoring and alerts

• CreditArmor monitoring and alerts

• SocialArmor reputational monitoring and notifications

• WalletArmor proactive monitoring and alerts for documents in your wallet that may be lost or stolen (e.g., driver’s licenses, ATM cards, insurance cards, etc.)

• Solicitation Reduction to opt out of unwanted direct marketing campaigns

NetGuard® SELECT Personal Privacy Advocate

With your NetGuard® SELECT policy, you’ll have access to expert advice and consultation on a range of cyber security and identity management concerns. Should you become a victim of identity theft or fraud, your personal Privacy Advocate acts as your dedicated case manager and will investigate, follow up, and escalate procedures to ensure a rapid restoration of your personal information.

Additionally, policyholders have access to secure, easy-to-use online tools that include:

• Personalized guides to protect you from identity theft and cyber bullying

• Account management tools to review credit alerts and a personalized ‘digital exposure report’

• Tools to manage and update your online identity

• Essential contact information for support in the event you suspect a breach or fraudulent activity

Expert Breach Response and Claims Handling

NAS claims team is at your side every step of the way. Our team of experts works in close coordination with nationally-recognized privacy & security experts to respond quickly and get you back on track. Our team of breach response experts are leaders in their field. From legal services to IT forensics to breach notification, your NAS policy gives you access to top tier national providers including:

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NAS Insurance and InfoArmor® together offer PrivacyArmor® to help safeguard your finances, reputation and credit against theft and abuse. Included in your NetGuard™ SELECT policy is a portfolio of products, services and support to help protect your identity and assist in fraud remediation and identity restoration. Your Identity Belongs

to You

PrivacyArmor® helps detect identity theft and minimize damages by actively monitoring and notifying you of suspicious activity. Data sources and proactive alerts include account applications for: credit cards, wireless carriers, loans, utility accounts and non-credit accounts. PrivacyArmor monitors high-risk identity activity such as password resets, fund transfers, unauthorized account access, compromised credentials, address changes and public record alerts. The CreditArmor® solution goes beyond the capabilities of “free” services, providing you with proactive alerts on any changes to your credit. CreditArmor also provides access to monthly credit scores and annual credit reports so you can stay on top of your credit and finances.

Protect the Contents of

Your Wallet

With WalletArmor™ you can quickly replace the contents of lost or stolen wallets. Your credit card numbers, driver’s licenses, gaming credentials, passports, professional license numbers, DEA numbers and insurance card data are stored in a secure online vault. Your wallet contents are proactively monitored for use in the underground Internet and can be accessed on-the-go in the event of loss or misuse.

Strengthen Your

Financial Wellness

PrivacyArmor helps you achieve financial wellness by monitoring and notifying you of suspicious activities associated with your financial accounts. With Threshold Monitoring, you are able to monitor your financial transactions from your online accounts, including checking, debit and savings, all in one place. Additionally, with Financial Transaction Monitoring you are able to take greater control of your finances with alerts that are triggered from additional data sources on credit, debit and checking accounts. These proactive alerts can help eliminate stolen funds and multiple transactions from occurring, giving you peace of mind your finances are secure.

Reduce Unwanted

Solicitations

Credit applications through the mail are not only wasteful and annoying, but they pose a risk for identity and credit theft. PrivacyArmor’s solicitation opt-out tool allows you to reduce and eliminate email and direct marketing campaigns for pre-approved credit offers. It also provides a single portal for managing the Do Not Call Registry, coupon opt-out, mail filtering and more.

Digital Identity Report The Internet is a lot deeper than what can be found with a Google search, and unless you frequent the deep and dark web, you might not realize that your identity, credit or credentials have been compromised. Our deep Internet searches root out your potential exposure to fraud before you feel its detrimental effects. With a Digital Identity Report, you can review your digital footprint across websites, social media and online directories with an easy-to-read snapshot of your exposed information online. You can then secure your personal information through actionable tips contained in your personal Privacy Grade.

Personal Privacy

Advocate

In the unfortunate event that you fall victim to identity theft or fraud, a dedicated Privacy Advocate™ will guide and manage your full recovery process, restoring credit, identity, accounts, finance, and your sense of security. Privacy Advocates are available 24 hours a day, 7 days a week so you can receive help right when you need it.

Once you receive your policy, just visit www.myprivacyarmor.com/netguardselect and

register using the sign-up code you will be provided with your policy documentation.

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LIMIT OPTIONS

Limits are subject to and in excess of a self-insured retention.

$500,000 LIMIT

I. Security and Privacy Liability $ 500,000

II. Breach Event Costs $ 500,000

III. Data Recovery $ 500,000

IV. Cyber Extortion $ 500,000

V. Cyber Crime $ 100,000

VI. Identity Theft Expenses $ 500,000

VII. Cyber Bullying $ 50,000

Maximum Policy Aggregate Limit of Liability: $ 500,000

$1,000,000 LIMIT

I. Security and Privacy Liability $1,000,000

II. Breach Event Costs $1,000,000

III. Data Recovery $1,000,000

IV. Cyber Extortion $1,000,000

V. Cyber Crime $ 250,000

VI. Identity Theft Expenses $1,000,000

VII. Cyber Bullying $ 100,000

Maximum Policy Aggregate Limit of Liability: $1,000,000

RATES Rates do not include applicable state taxes, policy fee, and broker fee.

Rates are valid through June 30, 2018

Total Net Worth Retention Premium

$500K Limit Premium $1M Limit

Retroactive Date

$0 -$10,000,000 $5,000 $1,500 $2,100 None. Unknown Prior Acts Are Covered.

$10,000,001 - $50,000,000 $5,000 $1,700 $2,380 None. Unknown Prior Acts Are Covered.

$50,000,001 - $100,000,000 $5,000 $2,200 $3,080 None. Unknown Prior Acts Are Covered.

$100,000,001 - $200,000,000 $5,000 $2,800 $3,920 None. Unknown Prior Acts Are Covered.

$200,000,001 - $300,000,000 $10,000 $3,200 $4,480 None. Unknown Prior Acts Are Covered.

$300,000,001 - $400,000,000 $10,000 $3,600 $5,040 None. Unknown Prior Acts Are Covered.

$400,000,001 - $500,000,000 $10,000 $3,950 $5,530 None. Unknown Prior Acts Are Covered.

$500,000,001 - $600,000,000 $10,000 $4,300 $6,020 None. Unknown Prior Acts Are Covered.

$600,000,001 - $700,000,000 $10,000 $4,600 $6,440 None. Unknown Prior Acts Are Covered.

$700,000,001 - $800,000,000 $10,000 $4,900 $6,860 None. Unknown Prior Acts Are Covered.

$800,000,001 - $900,000,000 $10,000 $5,150 $7,210 None. Unknown Prior Acts Are Covered.

$900,000,001 - $1,000,000,000 $10,000 $5,400 $7,560 None. Unknown Prior Acts Are Covered.

$1,000,000,000+ Refer to NAS

* Add 10% additional premium if there are more than 10 individuals that have access to the Applicant’s personal bank accounts.

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POLICY & ENDORSEMENT LINKS

Rates apply to the NetGuard® Select Program, written by NAS on the NetGuard® Select Policy Form P1856NGSLT-0418 and endorsed with:

Nuclear Incident Exclusion Clause (E1856A-0710) U.S. Treasury Department’s Office of Foreign Assets Control (OFAC) Advisory Notice to Policyholders

(E1856US-0315) Policyholder Disclosure Notice of Terrorism Insurance Coverage (E1856J-1117) Additional Insured Amendatory (E1856NGSM-0518)

HOW TO PURCHASE THIS INSURANCE

1. Fully complete the enclosed NetGuard® Select Cyber Liability for Individuals Program Application, including the attached Surplus Lines form (if non-CA risk) or D1 Disclosure Notice (if CA risk).

2. Calculate the applicable premium from the rate chart.

3. Sign and date (must be within 45 days prior to binding) and return the completed Application to your broker with your check for the premium, plus state taxes, policy issuance fee and any applicable broker fee.

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NetGuard® Select

Cyber Liability for Individuals Program Application Section One – Applicant Information

1. Name of Applicant: (as it should appear on the policy)

Mailing Address: City: State: Zip Code: Phone: Email: (To be used for PrivacyArmor registration)

2. Requested effective date (no backdating): 3. Limit desired: $500,000 $1,000,000 4. Applicant’s net worth: $0 -$10,000,000 $400,000,001 - $500,000,000

$10,000,001 - $50,000,000 $500,000,001 - $600,000,000

$50,000,001 - $100,000,000 $600,000,001 - $700,000,000

$100,000,001 - $200,000,000 $700,000,001 - $800,000,000

$200,000,001 - $300,000,000 $800,000,001 - $900,000,000

$300,000,001 - $400,000,000 $900,000,001 - $1,000,000,000

5. Number of individuals that have access to Applicant’s personal bank accounts: ___________________

* If more than 10 individuals, add 10% additional premium.

6. Does the Applicant have any personal LLCs? Yes No (To be scheduled via endorsement)

If “Yes”, please provide the name and full details for each personal LLC:

________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________

For Questions 7-9, if the answer is “Yes”, coverage cannot be bound under this program. If you desire an indication outside of the program, please provide details for any “Yes” answer.

7. In the past five (5) years, has the Applicant received any complaints or claims or experienced any losses relating to a privacy breach, security breach, identity theft, denial of service attack, computer virus infection (including malware or ransomware), theft of private information, cyber bullying, or damage to third party networks?

Yes No

8. Does the Applicant have knowledge of any acts, facts, events, circumstances or incidents which may give rise to complaints, claims or losses relating to a privacy breach, security breach, identity theft, denial of service attack, computer virus infection (including malware or ransomware), theft of private information, cyber bullying, or damage to third party networks?

Yes No

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9. Has the Applicant experienced a financial loss resulting from wire transfer fraud, telecommunications fraud or a phishing attack in the past three (3) years?

Yes No

Section Two – Acknowledgements and Representations

A. The Applicant represents that the statements, representations and information contained herein or attached to this Application are true and complete, and that reasonable efforts have been made to obtain sufficient information to facilitate the proper and accurate completion of this Application.

B. The undersigned acknowledges that the signing of this Application does not bind the undersigned to complete the insurance. The undersigned further acknowledges that the statements, representations, and information contained herein, or submitted with this Application (which shall be retained on file by the Underwriters and shall be deemed attached hereto, as if physically attached hereto), are material to the risk assumed by the insurer; that any policy will have been issued in reliance upon the truth thereof; and that this Application and all written statements and materials furnished to the Insurer in conjunction with this Application shall be deemed incorporated into and made a part of the policy, should a policy be issued.

C. The undersigned acknowledges and agrees that if the information supplied on this Application, or in any attachments, changes between the date of the Application and the effective date of the policy period, the Applicant will immediately notify the Underwriters of such change, and the Underwriters may withdraw or modify any outstanding quotations and/or agreement to bind the insurance.

D. For purposes of creating a binding contract of insurance by this Application, or in determining the rights and obligations under such a contract in any court of law, the parties acknowledge that a signature reproduced by either facsimile or photocopy shall have the same force and effect as an original signature, and that the original and any such copies shall be deemed one and the same document.

Signed: Print Name:

Must be signed no more than 45 days prior to binding

Date (Mo/Day/Yr):

Section Three – Payment Instructions

Premium: $ Taxes & Fees (3.2%): $ (Exact Amount will be confirmed at binding) Policy Issuance Fee: $ 175 Broker fee: $ TOTAL PAYMENT $

• Policy fee is fully earned. • Written Policies are subject to a minimum earned premium of 25%. • No Flat Cancellations.

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SURPLUS LINE FILING FORM By completing, you accept the responsibility of filing the policy with the state as well as collecting tax(es) and/or fee(s) from the insured, and will remit to the filing state along with any and all required affidavits or forms. Additionally, you will be responsible for providing to the insured and/or attaching to the policy, any state required forms or documents, and will apply any and all appropriate state wordings.

BY SIGNING THIS FORM, YOU ASSUME RESPONSIBILITY FOR

FILING THIS POLICY

AND

COLLECTION AND REMITTANCE OF SURPLUS LINE TAX(ES) AND FEE(S) Insured Name Filing State

If New Jersey, Transaction Number NAS Policy Number SL Filing Agency:

Name Address

SL Filer / Licensee:

Name

License Number (must be for filing state) Person Completing This Form: Name and Title

Signature Date Signed

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NOTICE: 1. THE INSURANCE POLICY THAT YOU ARE APPLYING TO PURCHASE IS BEING ISSUED BY AN

INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED “NONADMITTED” OR “SURPLUS LINE” INSURERS.

2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS.

3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED.

4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR “SURPLUS LINE” BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER: 1-800-927-4357 OR INTERNET WEB SITE WWW.INSURANCE.CA.GOV. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC’S INTERNET WEB SITE AT WWW.NAIC.ORG.

5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE’S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC’S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER, OR “SURPLUS LINE” BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: WWW.INSURANCE.CA.GOV.

8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER’S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU.

Date:

Insured: D-1 (Effective January 1, 2017)

All other terms and conditions of the Policy remain unchanged.

E1856J-1117 Page 1 of 1

POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE – E1856J-1117

COVERAGE FOR ACTS OF TERRORISM IS ALREADY INCLUDED IN THE POLICY (INCLUDING ANY QUOTATION FOR INSURANCE) TO WHICH THIS NOTICE APPLIES. YOU SHOULD KNOW THAT, UNDER THE POLICY, ANY LOSSES CAUSED BY CERTIFIED ACTS OF TERRORISM WOULD BE PARTIALLY REIMBURSED BY THE UNITED STATES UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. UNDER THIS FORMULA, THE UNITED STATES PAYS 85% THROUGH 2015; 84% BEGINNING ON JANUARY 1, 2016; 83% BEGINNING ON JANUARY 1, 2017; 82% BEGINNING ON JANUARY 1, 2018; 81% BEGINNING ON JANUARY 1, 2019 AND 80% BEGINNING ON JANUARY 1, 2020; OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURER PROVIDING THE COVERAGE. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS EXCLUSION FOR NUCLEAR EVENTS. THE TERM “ACT OF TERRORISM” MEANS ANY ACT THAT IS CERTIFIED BY THE SECRETARY OF THE TREASURY, IN CONSULTATION WITH THE SECRETARY OF HOMELAND SECURITY AND THE ATTORNEY GENERAL OF THE UNITED STATES, TO BE AN ACT OF TERRORISM; TO BE A VIOLENT ACT OR AN ACT THAT IS DANGEROUS TO HUMAN LIFE, PROPERTY, OR INFRASTRUCTURE; TO HAVE RESULTED IN DAMAGE WITHIN THE UNITED STATES, OR OUTSIDE THE UNITED STATES IN THE CASE OF AN AIR CARRIER OR VESSEL OR THE PREMISES OF A UNITED STATES MISSION; AND TO HAVE BEEN COMMITTED BY AN INDIVIDUAL OR INDIVIDUALS, AS PART OF AN EFFORT TO COERCE THE CIVILIAN POPULATION OF THE UNITED STATES OR TO INFLUENCE THE POLICY OR AFFECT THE CONDUCT OF THE UNITED STATES GOVERNMENT BY COERCION. THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES EXCEEDS $100 BILLION IN ANY ONE CALENDAR YEAR. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED. THE PORTION OF YOUR ANNUAL PREMIUM THAT IS ATTRIBUTABLE TO COVERAGE FOR CERTIFIED ACTS OF TERRORISM AS DEFINED IN THE TERRORISM RISK INSURANCE ACT OF 2002, AS AMENDED, IS 1%.

On behalf of certain underwriters at Lloyd’s 12 January 2015 LMA9105 (amended)

This endorsement is to take effect on «f4». Policy No.: «f1» Name: «f2» «f3» Policy Effective Date: «f4» Expiration: «f5» Endorsement No.: