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<br />e <br /> <br />e <br /> <br />[FORM Of{ STATEMENT OF INSURANCE] <br /> <br />STATEMENT OF INSURANCE <br /> <br />[FORM OF ASSIGNMENT] <br /> <br />ASSIGNMENT <br /> <br />FOR Y ALUE RECEIVED, the undersigned registered owner of this bond or duly authorized representative <br />or attorney thereof, hereby assigns this bond to <br /> <br />I <br />(Assignee's Social <br />Security or Taxpayer <br />Identification Number) <br /> <br />I <br /> <br />(print or typewrite Assignee's name <br />and address, including zip code) <br /> <br />and hereby irrevocably constitutes and appoints <br /> <br />attorney to transfer the registration of this bond on the Bond Registration Books with full power of substitution <br />in the premises. <br /> <br />Dated: <br /> <br />Signature Guaranteed: <br /> <br />NOTICE: The signature of the <br />Registered Owner must be gua- <br />ranteed. by a member of the <br />New York Stock Exchange or a <br />commercial bank or trust <br />company. <br /> <br />Registered Owner <br />NOTICE: This signature <br />must correspond with the <br />name of the Registered <br />Owner appearing on the face <br />of this bond in every <br />particular way without alteration or enlargement or any <br />change whatsoever. <br /> <br />The following abbreviations, when used in the assignment above or on the face of the within <br />Bond, shall be 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 tenants with right of survivorship <br />and not as tenants in common <br /> <br />UNIF GIFT MIN ACT - Custodian <br />(Cust) (Minor) <br />under Unifonn Gifts to Minors Act <br /> <br />(State) <br /> <br />Additional abbreviations may also be used though not in the list above. <br />