[Name of Designated Contract Party]

[Name of Appointed Broker] [address]

[Date]

Dear Sirs,

One [•] [Aircraft] [Engine], manufacturer’s serial number [•] (the Equipment): [Name of Airline]

[Insurance] [Reinsurance] Certificate No. [•] – Termination of AVN 67C Endorsement

We are the Designated Contract Party under the above certificate.

We hereby notify you that at [•] hours (GMT) on [•] 200[•], the Insured ceased to have any further obligation to insure the Equipment under the Contract(s), and that consequently the insurance provided by Endorsement AVN 67C for the benefit of the Contract Party(ies) terminated with effect from that date and time.

We request you to provide us with a certificate evidencing application of Continuing Liability Endorsement AVN 99 for the benefit of the Contract Party(ies), with effect from that date and time.

Yours faithfully,

……………………………………….. [Name of Designated Contract Party]

LON1546590/3 122287-0005 AL