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<br />e <br /> <br />e <br /> <br />FORM OF STATEMENT OF INSURANCE <br /> <br />[TO COME] <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 />I <br /> <br />I <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 />The following abbreviations, when used in the Assignment above or on the face of the <br />within Bond, shall be construed as though they were written out in full according to applicable <br />laws or regulations: . <br /> <br />TEN COM - as tenants in common <br />TEN ENT - as tenants by the entireties <br />JT TEN - as joint tenants with right of survivorship and not as tenants in common <br /> <br />UNIF GIFT MIN ACT- <br /> <br />Custodian <br /> <br />(Cust) (Minor) <br />under Uniform Gifts to Minors Act <br /> <br />(State) <br /> <br />10 <br />