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Additional Premium Due For This Transaction



                   Payment of the premium as specified below will be deemed acceptance by the public authority
                   of the policy terms.


                     Minimum and Deposit                      GBP

                     Insurance Premium Tax at 12%             GBP

                     Total Payable in this Transaction        GBP




               Future Annual Premium



                   Payment of the premium as specified below will be deemed acceptance by the public authority
                   of the policy terms.

                     Minimum and Deposit                      GBP

                     Insurance Premium Tax at 12%             GBP

                     Total Payable                            GBP










               Signed on behalf of the insurer
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