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<br />14-02-14230 (05/2008) Page 1 <br />ENDORSEMENT/RIDER <br /> <br /><COVSECT> <br /> <br />Effective date of <br />this endorsement/rider: <TRXEFFDATE> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /><CARRNAME> <br /> <br />Endorsement/Rider No. <EN> <br /> <br />To be attached to and <br />form a part of Policy No. <POLICYNO> <br /> <br />Issued to: <ACCTNAME> <br />__________________________________________________________________________________________ <br />___ <br /> <br />NORTH CAROLINA AMENDATORY ENDORSEMENT <br />REGARDING THE APPLICATION <br /> <br />In consideration of the premium charged, it is agreed that the section of the Application that deems the <br />Application attached to and part of the policy is inapplicable unless the Application is physically attached <br />to the policy. <br /> <br />The Policy will be deemed to have been amended to the extent necessary to effect the purposes of this <br />Amendatory Endorsement. <br /> <br />The regulatory requirements set forth in this Amendatory Endorsement shall supersede and take precedence over any provisions <br />of the Policy or any endorsement to the Policy, whenever added, that are inconsistent with or contrary to the provisions of t his <br />Amendatory Endorsement, unless such Policy or endorsement provisions comply with the applicable insurance laws of the state <br />of North Carolina. <br /> <br />The title and any headings in this endorsement/rider are solely for convenience and form no part of the <br />terms and conditions of coverage. <br /> <br />All other terms, conditions and limitations of this Policy shall remain unchanged. <br /> <br /> <br /> <br /> <br /> <br /><ENDSIG> <br /> <br />Authorized Representative <br />DocuSign Envelope ID: 010D91E2-5C66-4610-B0AF-F96D7E61B6C5