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<br />e <br /> <br />e <br /> <br />Dated: <br /> <br />JPMORGAN CHASE BANK, <br />Paying Agent/Registrar <br /> <br />By <br /> <br />Authorized Signature <br /> <br />FORM OF STATEMENT OF INSURANCE <br /> <br />STATEMENT OF INSURANCE <br /> <br />[TO COME] <br /> <br />FORM OF ASSIGNMENT <br /> <br />ASSIGNMENT <br /> <br />FOR VALUE RECEIVED, th~ undersigned registere4 owner of this Bond, or duly authorized <br />representative or attorney thereof: hereby assigns this Bond to <br /> <br />/ <br /> <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 AgentJRegistrar's Registration Books with full power <br />of substitution in the premises. <br /> <br />D~ted <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 />Gonstrued as though the)' 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 />IT TEN - as joint tenant with right of survivorship and not as tenants in common <br />UNIt' GIFT MIN ACT - Custodian <br /> <br />(Cust) <br /> <br />(Minor) <br /> <br />under Uniform Gifts to Minor Act <br /> <br />(State) <br /> <br />Additional abbreviations may also be used though not in the list above. <br /> <br />Q63939.QQQl AUSTJN 2.803.48 v2. <br /> <br />8 <br />