LPAN Completion Guidelines

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Presentation transcript:

LPAN Completion Guidelines Version 3 27 September 2006

Enter required processing LONDON PREMIUM ADVICE NOTE For Bureau Use Enter required processing PM/AP/RP (1) PM Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE THIS AREA OF THE LPAN SHOULD BE USED TO ADVISE THE NATURE OF PROCESSING REQUIRED. THE APPROPRIATE TEXT SHOULD BE CLEARLY SHOWN EG “DE-LINKED”, “NON CASH” OR “PAID BY CHEQUE”, “SIMULTANEOUS SETTLEMENT”

PM = Original Premium AP = Additional Premium LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) PM Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 1 = TYPE OF PREMIUM BEING PROCESSED (MANDATORY) YOU MAY ONLY ENTER: PM = Original Premium AP = Additional Premium RP = Return Premium FDO = For Declaration Only

BOX 2 = BUREAU INDICATOR. YOU MAY ONLY ENTER: LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) LPSO Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 2 = BUREAU INDICATOR. YOU MAY ONLY ENTER: LPSO = Lloyd’s ILU = ILU Company LIRMA = LIRMA Company

BOX 3 = YOUR THREE OR FOUR DIGIT LLOYD’S BROKER NUMBER (MANDATORY) LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) 123 Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 3 = YOUR THREE OR FOUR DIGIT LLOYD’S BROKER NUMBER (MANDATORY)

BOX 4 = ENTER YOUR THREE CHARACTER LLOYD’S PSEUDONYM (MANDATORY) LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) ABC Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 4 = ENTER YOUR THREE CHARACTER LLOYD’S PSEUDONYM (MANDATORY)

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) MARK BARWICK 0207 397 0207 : SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 5 = YOU MUST ENTER NAME OF BROKER CONTACT AND THEIR FULL PHONE NUMBER (MANDATORY) THE E:MAIL ADDRESS OF THE BROKER CONTACT CAN ALSO BE SHOWN (CONDITIONAL)

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S & A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 6 = SPECIAL SETTLEMENT NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK

BOX 7 = THE TYPE OF BUSINESS (MANDATORY), YOU MUST ENTER: LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) NM Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S & A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 7 = THE TYPE OF BUSINESS (MANDATORY), YOU MUST ENTER: M = MARINE NM = NON-MARINE AV = AVIATION

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) 21439*23-05-06 Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S & A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 8 = BUREAU ORIGINAL REFERENCE OF THE ORIGINAL PREMIUM THE SIGNING ATTACHES TO (CONDITIONAL) I.E. THE SIGNING NUMBER AND DATE OF THE ORIGINAL PREMIUM. MUST BE USED ON ALL AP’S AND RP’S SIGNED SUBSEQUENT TO THE ORIGINAL PREMIUM.

 BOX 9 = PROCESSING REQUIRED (MANDATORY) LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A  No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 9 = PROCESSING REQUIRED (MANDATORY) TICK STAGE ONE WHERE ONLY PREMIUM IS BEING PROCESSED. TICK S & A WHERE PREMIUM AND POLICY BOTH TO BE SIGNED. DO NOT TICK BOTH BOXES.

BOX 10 = THE BROKER PRIME REFERENCE (MANDATORY) LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 10 = THE BROKER PRIME REFERENCE (MANDATORY) A MAXIMUM OF 12 ALPHA NUMERICS.

BOX 11 = FURTHER BROKER REFERENCE (OPTIONAL) LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 11 = FURTHER BROKER REFERENCE (OPTIONAL) A MAXIMUM OF 12 ALPHA NUMERICS

BOX 12 = NO. OF LINES NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 12 = NO. OF LINES NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK

BOX 13 = MARKET SHARE APPLICABLE TO THE TRANSACTION (MANDATORY) LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 13 = MARKET SHARE APPLICABLE TO THE TRANSACTION (MANDATORY)

BOX 14 = LINE TYPE NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK. LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 14 = LINE TYPE NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK.

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 15 = MUST SHOW DEF OR RES DEPENDING ON TYPE OF PREMIUM BEING PRESENTED, IE IF DEFERRED OR RESERVE BUSINESS . IF A COMBINATION OF DEFERRED AND RESERVE BUSINESS THEN SHOW RES. (CONDITIONAL).

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 16 = MUST SHOW THE NUMBER OF INSTALMENTS, INCLUDING CASH, DEFERRED AND RESERVE INSTALMENT ITEMS IF BOX 15 COMPLETED (CONDITIONAL).

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 17 = AMOUNT OF UK OR OVERSEAS PREMIUM TAX THAT IS DUE TO BE PAID TO UNDERWRITERS IF APPLICABLE (CONDITIONAL) I.E. ANY TAXES OR CHARGES THAT ARE PAYABLE BY THE INSURED IN ADDITION TO THE PREMIUM AND WHICH ARE TO BE COLLECTED AND/OR ADMINISTERED BY UNDERWRITERS. THE FIGURE SHOULD BE THE BUREAU AMOUNT IN THE SETTLEMENT CURRENCY.

BOX 18 = 100% GROSS PREMIUM IN ORIGINAL CURRENCY (MANDATORY). LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 18 = 100% GROSS PREMIUM IN ORIGINAL CURRENCY (MANDATORY). IN THE EVENT OF THERE BEING A SLIP ORDER THE FOLLOWING RULES APPLY: A) IF THE SIGNED LINES ON THE SLIP TOTAL 100% THE FIGURE IN THIS BOX MUST HAVE TAKEN THE ORDER INTO ACCOUNT B) IF THE SIGNED LINES ON THE SLIP TOTAL THE ORDER PERCENTAGE THEN THE ORDER MUST NOT BE USED WHEN CALCULATING THE 100% GROSS PREMIUM FIGURE.

BOX 19 = TOTAL BROKERAGE AND COMMISSION PERCENTAGE (MANDATORY). LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 19 = TOTAL BROKERAGE AND COMMISSION PERCENTAGE (MANDATORY).

CAN BE EITHER A PERCENTAGE OR AN AMOUNT. LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 20 = TAXES OR CHARGES THAT ARE TO BE DEDUCTED FROM THE PREMIUM PAID TO UNDERWRITERS IF APPLICABLE (CONDITIONAL) CAN BE EITHER A PERCENTAGE OR AN AMOUNT.

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 21 = ANY OTHER DEDUCTIONS USED TO ARRIVE AT THE NET PREMIUM (CONDITIONAL) MUST BE EXPRESSED AS A PERCENTAGE AND AN INDICATION AS TO WHETHER TO BE DEDCUCTED FROM GROSS OR NET.

(I.E. THE CURRENCY IN WHICH THE CLIENT IS PAYING THE PREMIUM). LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 22 = ISO CURRENCY ABBREVIATION FOR THE ORIGINAL CURRENCY OF THE PREMIUM (MANDATORY) (I.E. THE CURRENCY IN WHICH THE CLIENT IS PAYING THE PREMIUM).

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 23 = RATE OF EXCHANGE USED TO CONVERT THE ORIGINAL CURRENCY TO THE SETTLEMENT CURRENCY, IF APPLICABLE (CONDITIONAL)

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 24 = ISO CURRENCY ABBREVIATION OF THE SETTLEMENT CURRENCY (MANDATORY)

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 25 = SIGNED LINE PROPORTION OF THE NET PREMIUM IN SETTLEMENT CURRENCY TO TWO DECIMAL PLACES. SHOW “0.00” WHERE NIL PREMIUM BEING SETTLED (MANDATORY) THIS FIGURE MUST NOT INCLUDE UK IPT BUT SHOULD INCLUDE THE BUREAU AMOUNT FOR OVERSEAS TAXES AS SHOWN IN BOX 17 OF THE LPAN.

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 26 = PLANNED SETTLEMENT DATE WHERE THE ITEM IS TO BE SIGNED IN FLEXIBLE SETTLEMENT SCHEME (OPTIONAL) THE DATE CANNOT BE LATER THAN THE SETTLEMENT DUE DATE SHOWN ON THE SLIP.

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 27 = 100% WAR GROSS PREMIUM IN ORIGINAL CURRENCY, ONLY FOR MARINE BUSINESS (CONDITIONAL) IN THE EVENT OF THERE BEING A SLIP ORDER THE FOLLOWING RULES APPLY: A) IF THE SIGNED LINES ON THE SLIP TOTAL 100%, THE FIGURE SHOWN IN THIS BOX MUST HAVE TAKEN THE ORDER INTO ACCOUNT. B) IF THE SIGNED LINES ON THE SLIP TOTAL THE ORDER PERCENTAGE, THIS ORDER MUST NOT BE USED WHEN CALCULATING THE 100% GROSS PREMIUM FIGURE.

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 28 = SIGNED LINE PROPORTION OF THE NET WAR PREMIUM IN ORIGINAL CURRENCY, ONLY FOR MARINE BUSINESS (CONDITIONAL)

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 29 = UNIQUE MARKET REFERENCE, FORMAT OF “B” FOR BROKER, THE FOUR CHARACTER BROKER CODE AND UP TO TWELVE CHARACTER REFERENCE (MANDATORY)

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 30 = MANDATORY FOR DEFERRED ITEMS AND MUST SHOW PAYMENT DATES OF INSTALMENTS AS FOLLOWS: A) FIRST INSTALMENT – ENTER THE SETTLEMENT DUE DATE OR “CASH” IF DUE NOW, B) FOR SUBSEQUENT INSTALMENTS ENTER A DATE WHICH IS CALCULATED BY ADDING THE TERMS OF TRADE CREDIT (AS SHOWN ON THE SLIP) TO THE CLIENT DUE DATE.

LONDON PREMIUM ADVICE NOTE For Bureau Use PM/AP/RP (1) Bureau (2) Broker No. (3) Broker (4) Broker Contact: (5) Name: Ext. No.: SPECIAL SETTLEMENT (6) YES/NO Signed: Title: M/NM/AV (7) Bureau Original Ref. (8) Separation (9) Broker Reference 1 (10) Broker Reference 2 (11) Stage 1 S&A No. of Lines (12) Bureau Total Line (13) Line Type (14) Def/Res (15) No of Insts (16) For Future Use (17) DEFERRED INSTALMENTS Month/Year (30) NA Instalment Premium (31) 100 % Gross Premium (18) Brokerage (19) Tax (20) Other Deductions (21) Orig. Ccy (22) Rate of Exchange (23) Sett. Ccy (24) Bureau NA Premium (25) PSD (26) 100% Gross War Premium (27) Bureau NA War Premium (28) For Future Use (29) FOR BUREAU USE BOX 31 = MANDATORY FOR DEFERRED ITEMS AND MUST SHOW THE BUREAU PROPORTION OF THE NET PREMIUM FOR EACH DEFERED INSTALMENT INCLUDING ANY UK IPT OR OVERSEAS TAXES.