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<br />e <br /> <br />e <br /> <br />rFORM OF STATEMENT OF INSURANCE <br />STATEMENT OF INSURANCE] <br /> <br />FORM OF ASSIGNMENT <br /> <br />ASSIGNMENT <br /> <br />FOR VALUE RECEIVED, the undersigned registered owner of this Bond, or duly authorized <br />representative or attorney thereof, hereby assigns this Bond to <br /> <br />I I <br />(Assignee's Social Security or Tax Payer <br />Identification number) <br /> <br />(Print or type Assignee's name and address, including zip code) <br /> <br />and <br /> <br />hereby irrevocably constitutes and appoints <br />attorney to transfer the registration of this Bond on the Paying AgentlRegistrar's Registration Books with full power <br />of substitution in the premises. <br /> <br />Dated <br /> <br />Signature Guaranteed: <br /> <br />NOTICE: Signature(s) must be guaranteed by a <br />member firm of the New York Stock Exchange or a <br />commercial bank or trust company. <br /> <br />NOTICE: The signature above must correspond with <br />the name of the Registered Owner as it appears upon <br />the front of this Bond in every particular, without <br />alteration or enlargement or any change whatsoever. <br /> <br />The following abbreviations, when used in the assignment above or on the face of the within Bond, shall be <br />construed as though they were written out in full according to applicable laws or regulations: <br /> <br />TEN COM - as tenants in common <br />TEN ENT - as tenants by the entireties <br />JT TEN - as joint tenant with right of survivorship and not as tenants in common <br />UNIF GIFT MIN ACT - Custodian <br /> <br />under Uniform Gifts to Minor Act <br /> <br />(Cust) <br />(State) <br /> <br />(Minor) <br /> <br />Additional abbreviations may also be used though not in the list above. <br /> <br />FORM OF REGISTRATION CERTIFICATE OF THE COMPTROLLER OF PUBLIC ACCOUNTS' <br />'To be printed or attached to Initial Bond only <br /> <br />COMPTROLLER'S REGISTRATION CERTIFICATE: REGISTER NO. <br /> <br />I hereby certify that this Bond has been examined, certified as to validity, and approved by the Attorney <br />General of the State of Texas, and that this Bond has been registered by the Comptroller of Public Accounts of the <br />State of Texas. <br /> <br />9 <br />