Irrevocable Letter of Credit

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MISSOURI DEPARTMENT OF INSURANCE,

FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION


CAPTIVE INSURANCE COMPANY Save Print Reset
IRREVOCABLE LETTER OF CREDIT
LETTER OF CREDIT NUMBER DATE

BANK

ADDRESS CITY STATE

Director of Insurance, Financial Institutions and Professional Registration


State of Missouri
P.O. Box 690
Jefferson City, MO 65102

Director:

1. We hereby establish our IRREVOCABLE LETTER OF CREDIT in your favor for the account of ___________________________ up to the
aggregate amount of _____________ available by your draft(s) drawn on us, at sight, bearing the number of this IRREVOCABLE LETTER
OF CREDIT. This LETTER OF CREDIT shall expire at our Letter of Credit Department, ______________________, at our close of business
on ___________________ unless as hereinafter extended.

2. This LETTER OF CREDIT is issued pursuant to the provisions of Section 379.1306 of the Revised Statutes of Missouri, and on behalf of
the above mentioned _____________________ (name of captive) which is applying for a certificate of authority to engage in the insurance
business in the State of Missouri as a captive insurance company. We understand and agree that ___________________ (name of captive)
has no obligation to reimburse us and we have no right of set off against any funds held by us for ______________________ (name of
captive) in the event this LETTER OF CREDIT is drawn down, in whole or in part. By issuing this LETTER OF CREDIT, we waive any common
law, statutory or contractual right of reimbursement or set off against ___________________ (name of captive) that may arise in the event
this LETTER OF CREDIT is drawn down, in whole or in part.

3. It is a condition of the LETTER OF CREDIT that it shall be automatically extended for additional periods, each of one year, unless at least
ninety calendar days prior to the then relevant expiration date we have advised you in writing, by certified mail, that we elect not to extend. In
that event, you may draw hereunder on or prior to the then relevant expiration date, up to the full amount then available hereunder, against
your sight draft(s) on us, bearing the number of this LETTER OF CREDIT.

4. It is a further condition of this LETTER OF CREDIT that each automatic extension shall be measured from the then relevant expiration date,
even though such date is not a business day in Jefferson City, Missouri for this Bank. It is also a condition of this LETTER OF CREDIT that,
for the purpose of drawing hereunder, if the then relevant expiration date is a nonbusiness day for our Bank, drawing may be made not later
than our next immediately following business day.

5. This LETTER OF CREDIT sets forth in full the terms of our undertaking, and such undertaking shall not in any way be modified, amended
or amplified by reference to any note, document, instrument, statute, regulation or agreement referred to herein or in which this LETTER OF
CREDIT is referred to or to which this LETTER OF CREDIT relates and any such reference shall not be deemed to incorporate herein by
reference any note, document, instrument, statute, regulation, or agreement.

6. Each sight draft so drawn and presented shall be promptly honored by us if presented on or prior to the above stated expiration date or
any extension thereof as above provided. Presentation under this LETTER OF CREDIT must be made at _________________ located at
_____________ during normal banking hours.

7. Unless otherwise expressly stated, this undertaking is issued subject to the International Standby Practices 1998 (ISP 98), ICC
Publication No. 590.

Very truly yours,

MO 375-0591 (2-11)

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