SUPPLEMENT 3       SECURITIES LAW   FULL NAME OF APPLICANT               1.  What percentage of Applicant's securities practice for past fiscal year involved   % of Total Gross Billings       A.  Securities registered under the Securities Act of 1933   %       B.  Municipal Bonds   %       C.  Private Placements and State Registrations   %       D.  Representations of clients as to compliance with proxy and reporting requirements under the Securities Exchange Act of 1934 other than takeovers or mergers of publicly held companies.   %       E.  Representations of clients as to compliance with proxy and reporting requirements under the Securities Exchange Act of 1934 in relation to takeovers or mergers of publicly held companies   %       F.  Syndications, Tax Shelters, Limited Partnerships.   %       G.  Other Securities work - Please describe:   %               2.  A.  Does the Applicant conduct what is commonly referred to as a "Due Diligence" investigation when representing clients as to the offering or sale of securities? Yes   No       B.  If Yes, does the Applicant make routine use of checklists in its investigations? Yes   No     3.  During the past five (5) years has the Applicant been involved in or had the knowledge of any facts which would indicate that they may be included in an investigation of administrative action by the SEC or any state agency regulating securities? Yes   No       If yes, please give details on a separate addendum.           Please Note: The Policy for which you are applying, if issued, will not afford coverage for Securities Activities     4.  Does the Applicant have a cold review performed on all offerings by an attorney not involved in the project? Yes   No     5.  Please list representation in the past two years in a hostile or contested takeover of merger and the target company.       Name of Acquiring Company Client Name of Target Company Client Value of Transaction $ $ $ $                 ISSUER The name of the organization issuing the securities. BUSINESS The Business activity of the Issuer e.g. Electronics, Real Estate. $ OFFERING SIZE The Maximum dollar amount sold or anticipated to be sold. DATE If filed, the date of filing otherwise an estimated date. UNDERWRITER The name of the organization Underwriting the securities. ACCOUNTANT The name of the Accountant involved in the issue. INVESTMENT GRADE Please name grade and source if applicable. SECURITY TYPE Form of security offered e.g. common stock, municipal bonds, bonds, Ltd partnership. CLIENT Please place a ring to indicate your client as I - Issuer/U - Underwriter / P - Purchaser / S - Special counsel such as work on a tax opinion which is referred to or relied upon in the preparation of a prospectus or other offering document.                       ISSUER BUSINESS $ OFFERING SIZE DATE UNDERWRITER ACCOUNTANT SECURITY INVESTMENT GRADE CLIENT $ IUPS  Narrative: $ IUPS  Narrative: $ IUPS  Narrative: $ IUPS  Narrative: $ IUPS  Narrative: $ IUPS  Narrative: $ IUPS  Narrative: $ IUPS  Narrative:           Applicant hereby warrants that the statements set forth herein are true, complete and accurate and that there has been no attempt at suppression or misstatement of any material facts which are known, or should be known. Applicant agrees that this Supplemental Application shall become the basis for any coverage and part of any policy that is issued by the Company.             Date:  Signature: Title: