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<br />e <br /> <br />e <br /> <br />FORM OF STATEMENT OF INSURANCE <br /> <br />STATEMENT OF INSURANCE <br /> <br />Municipal Bond Guaranty Insurance Policy No. (the "Policy") with respect to <br />payments due for principal of and interest on this Bond has been issued by AMBAC Indemnity <br />Corporation ("AMBAC Indemnity"). The Policy has been delivered to the United States Trust <br />Company of New York, New York, New York, as the Insurance Trustee or any successor trustee. <br />The Policy is on file and available for inspection at the principal office of the Insurance Trustee <br />and a copy thereof may be secured from AMBAC Indemnity or the Insurance Trustee. All <br />payments required to be made under the Policy shall be made in accordance with the provisions <br />thereof. The owner of this Bond acknowledges and consents to the subrogation rights of AMBAC <br />Indemnity as more fully set forth in the Policy. <br /> <br />FORM OF ASSIGNMENT: <br /> <br />* ASSIGNMENT <br /> <br />FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers unto <br /> <br />Please insert Social Security or Taxpayer <br />Identification Number of Transferee <br /> <br />/ <br /> <br />/ <br /> <br />(Please print or typewrite name and address, including zip code of Transferee) <br />the within Bond and all rights thereunder, and hereby irrevocably constitutes and appoints <br /> <br />attorney to register the transfer of the within Bond on the books kept for registration thereof, with <br />full power of substitution in the premises. <br /> <br />Dated: <br /> <br />Signature Guaranteed: <br /> <br />NOTICE: Signature(s) must be guaranteed <br />by a member firm of the New York Stock <br />Exchange or a commercial bank or trust <br />company. <br /> <br />NOTICE: The signature above must correspond <br />with the name of the Registered Owner as it <br />appears upon the front of this Bond in every <br />particular, without alteration or enlargement <br />or any change whatsoever. <br /> <br />10 <br />