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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) <br />Policy Number: Endorsement Number: <br />Effective Date: Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: <br />This policy is subject to the following additional <br />Conditions: <br />A. If this policy is cancelled by the Company, other <br />than for non-payment of premium, notice of such <br />cancellation will be provided at least thirty (30) <br />days in advance of the cancellation effective <br />date to the certificate holder(s) with mailing <br />addresses on file with the agent of record or the <br />Company. <br />B. If this policy is cancelled by the Company for <br />non-payment of premium, or by the insured, <br />notice of such cancellation will be provided <br />within ten (10) days of the cancellation effective <br />date to the certificate holder(s) with mailing <br />addresses on file with the agent of record or the <br />Company. <br />Form WC 99 03 94 Printed in U.S.A. <br />Process Date: <br />If notice is mailed, proof of mailing to the last known <br />mailing address of the certificate holder(s) on file <br />with the agent of record or the Company will be <br />sufficient proof of notice. <br />Any notification rights provided by this endorsement <br />apply only to active certificate holder(s) who were <br />issued a certificate of insurance applicable to this <br />policy's term. <br />Failure to provide such notice to the certificate <br />holder(s) will not amend or extend the date the <br />cancellation becomes effective, nor will it negate <br />cancellation of the policy. Failure to send notice <br />shall impose no liability of any kind upon the <br />Company or its agents or representatives. <br />© 2011, The Hartford <br />Policy Expiration Date: <br />