“ OPEN MARKET” PROPERTY APPLICATION

TO: ROBERT FLEMING INSURANCE FAX: 011 44 20 7623 6175 BROKERS LTD., LONDON. (Or 011 44 20 7626 0400)

ATTN: Roger Wardale DATE:

FROM: ……………………………………………. FAX:

______

1) NAME OF ASSURED:......

2) LOCATION(S) OF RISK:......

3) DESCRIPTION OF OPERATIONS:......

4) EFFECTIVE DATE......

5) SUM INSURED REQUIRED VALUE $ CO-INSURANCE %

BUILDING ...... CONTENTS ...... LOSS OF EARNINGS ...... ANY OTHER INTERESTS______...... (please specify) ______......

6) R.C.V./A.C.V. BASIS OF VALUATION 7) PERILS REQUIRED......

8) TOTAL VALUE (if first loss) $......

9) CONSTRUCTION...... AGE......

10) CONDITION OF BUILDINGS ……………………..UPDATES......

11) PRIVATE PROTECTIONS......

12) PROTECTION CLASS......

13) % OCCUPANCY (apartments)...... % HUD/Subsidized......

14) FINANCIAL STATUS......

15) HOUSEKEEPING/MANAGEMENT......

16) TYPE OF NEIGHBOURHOOD (RE CRIME/VMM)......

17) TYPE OF CLIENTELE......

18) NUMBER OF YEARS IN BUSINESS......

19) DETAILS OF ADJACENT EXPOSURES......

20) PROPERTY LOSS RECORD PAST 5 YEARS......

21) ANY OTHER PERTINENT INFORMATION......

22) TARGET PRICE...... ………......