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LPAN Completion Guidelines. Version 3 27 September 2006. 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:

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lpan completion guidelines

LPAN Completion Guidelines

Version 3

27 September 2006

slide2

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”

slide3

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

slide4

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

slide5

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)

slide6

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)

slide7

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)

slide8

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

slide9

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

slide10

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.

slide11

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.

slide12

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.

slide13

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

slide14

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

slide15

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)

slide16

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.

slide17

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).

slide18

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).

slide19

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.

slide20

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.

slide21

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).

slide22

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.

slide23

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.

slide24

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).

slide25

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)

slide26

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)

slide27

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.

slide28

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.

slide29

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.

slide30

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 SETTLEMENT CURRENCY, ONLY FOR MARINE BUSINESS (CONDITIONAL)

slide31

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)

slide32

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.

slide33

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.