1. Hereby formally requests cover for themselves under Rule 7.1 effective October 1, 1998.
   
2. That the following be accepted and covered as a related employer as that term is defined in The Signal Mutual Indemnity Association Ltd. Bye-laws and Rules of the Association, effective October 1, 1998:
   
   <Related Employer 1>
   <Related Employer 2>
   <Related Employer 3>
   
   
3. That the following be covered under Rule 5.2:
   
   <Alternate Employer 1> <Address>
   <Alternate Employer 2> <Address>
   <Alternate Employer 3> <Address>

By jointly executing this application, both «Name» and the above named Related Employers acknowledge receipt of the current Bye-laws and Rules of The Signal Mutual Indemnity Association Ltd. and acknowledge that they have read them. Further, they agree to be bound by each and every one of those Bye-laws and Rules (including, but not without limitation, its joint and several liabilities under Rule 4.4).

Date:______________________