Forms required by Regulation 41.

February 26, 1981 SUBJECT: INSURANCE Circular Letter No. 7 (1981) WITHDRAWN TO: ALL LICENSED EXCESS LINE BROKERS AND ALL PROPERTY AND CASUALTY INSURANCE COMPANIES RE: FORMS REQUIRED BY REGULATION 41 Circular Letter No. 5 (1981) dated February 23, 1981, contained copies of forms (EL-1 and EL-2) required by Regulation 41. Please be advised that Form EL-2 contained a misspelling. The word "Intentially" in the "Note" on the bottom of the form should be "Intentionally". Attached please find a corrected EL-2 Form which should be reproduced as needed. Very truly yours, [SIGNATURE] Albert B. Lewis Superintendent of Insurance ATTACHMENT (This form must be completed by the submitting broker or excess line broker and signed and dated by the company representative.) I, _______________________ (Name), submitting broker or excess line broker, whose business address is _____________________ (Street) ____________ (City) _________ (Zip) has submitted the risk hereinbelow described, to ______________________________ (Name) _______________________________ (Address) an underwriter or agent having underwriting authority for the _________________________________ (Name of Company) an insurance company authorized to do an insurance business in the State of New York, hereby declares that on __________________, 19_____, said risk was declined by the above-named underwriter or agent. The reason for declining said risk was:__________________________________________________ ____________________________________________________________________ Name of Insured: ___________________________________________________ Address of Insured: __________________________________Zip_____________ Type of Coverage Requested ________________________________________ ___________________________________________________________________ ___________________________________________________________________ (If more space is required attach additional sheets)____________________ Dated: _________________________ Signed: ___________________________ submitting broker or excess line broker I, the underwriter or agent having underwriting authority for the above-named company, confirm that the above information is correct. Dated: ___________________ Signed: _________________________________ underwriter or agent having underwriting authority NOTE: INTENTIONALLY GIVING FALSE INFORMATION ON THIS FORM IS TANTAMOUNT TO COMMITTING A PERJURY.