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5. FOREIGN INSURERS SHOULD BE LICENSED BY A <br />STATE IN THE UNITED STATES AND YOU MAY <br />CONTACT THAT STATE'S DEPARTMENT OF INSURANCE <br />TO OBTAIN MORE INFORMATION ABOUT THAT <br />INSURER. <br />6. FOR NON -UNITED STATES (ALIEN) INSURERS, THE <br />INSURER SHOULD BE LICENSED BY A COUNTRY <br />OUTSIDE OF THE UNITED STATES AND SHOULD BE ON <br />THE NAIC'S INTERNATIONAL INSURERS DEPARTMENT <br />(IID) LISTING OF APPROVED NONADMITTED NON - <br />UNITED STATES INSURERS. ASK YOUR AGENT, <br />BROKER, OR "SURPLUS LINE" BROKER TO OBTAIN <br />MORE INFORMATION ABOUT THAT INSURER. <br />7. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE <br />SURPLUS LINE INSURERS. ASK YOUR AGENT OR <br />BROKER IF THE INSURER IS ON THAT LIST, OR VIEW <br />THAT LIST AT THE INTERNET WEB SITE OF THE <br />CALIFORNIA DEPARTMENT OF INSURANCE: <br />VV WW.INSURANCE. CA. GOV. <br />8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE <br />INSURANCE POLICY YOU HAVE PURCHASED BE <br />BOUND IMMEDIATELY, EITHER BECAUSE EXISTING <br />COVERAGE WAS GOING TO LAPSE WITHIN TWO <br />BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED <br />TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, <br />AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM <br />AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER <br />COVERAGE BECAME EFFECTIVE, YOU HAVE THE <br />RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS <br />OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL <br />COVERAGE, THE PREMIUM WILL BE PRORATED AND <br />ANY BROKER'S FEE CHARGED FOR THIS INSURANCE <br />WILL BE RETURNED TO YOU. <br />Applicant Signature Date <br />NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR tn.�Ra E Risk MayagemadDimsion <br />TERMS, CONDITIONS, OR LIMITATIONS OF THE POLICY TO WHICH THIS NOTIC] REVIEWED & APPROVED BY. - <br />THAN AS STATED ABOVE. Af, Acev44 <br />Risk Management Specialist <br />SL-17888 (Ed. 01/17) Page 2 of 2 <br />