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QBE SPECIALTY INSURANCE COMPANY This endorsement, effective on, at 12:01 A.M. standard time at your mailing address shown in the Declarations, forms a part of and modifies insurance provided under

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What is this endorsement effective on?

This endorsement is effective on the date specified by the insurer.

Who is required to file this endorsement effective on?

The policyholder or the authorized representative of the policyholder is required to file this endorsement.

How to fill out this endorsement effective on?

The endorsement should be completed accurately and signed by the policyholder or authorized representative.

What is the purpose of this endorsement effective on?

The purpose of this endorsement is to make changes to the insurance policy.

What information must be reported on this endorsement effective on?

The changes to the insurance policy that are being made.

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