1. LPAN Completion Guidelines
Version 3
27 September 2006

2. Enter required processing
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
Enter required processing
PM/AP/RP (1) PM
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
THIS AREA OF THE LPAN SHOULD BE USED TO ADVISE THE NATURE OF PROCESSING REQUIRED. THE APPROPRIATE TEXT SHOULD BE CLEARLY SHOWN EG “DE-LINKED”, “NON CASH” OR “PAID BY CHEQUE”, “SIMULTANEOUS SETTLEMENT”

3. PM = Original Premium AP = Additional Premium
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1) PM
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 1 = TYPE OF PREMIUM BEING PROCESSED (MANDATORY) YOU MAY ONLY ENTER:
PM = Original Premium AP = Additional Premium
RP = Return Premium FDO = For Declaration Only

4. BOX 2 = BUREAU INDICATOR. YOU MAY ONLY ENTER:
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
LPSO
Broker No (3)
Broker (4)
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 2 = BUREAU INDICATOR. YOU MAY ONLY ENTER:
LPSO = Lloyd’s ILU = ILU Company LIRMA = LIRMA Company

5. BOX 3 = YOUR THREE OR FOUR DIGIT LLOYD’S BROKER NUMBER (MANDATORY)
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
123
Broker (4)
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 3 = YOUR THREE OR FOUR DIGIT LLOYD’S BROKER NUMBER (MANDATORY)

6. BOX 4 = ENTER YOUR THREE CHARACTER LLOYD’S PSEUDONYM (MANDATORY)
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
ABC
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 4 = ENTER YOUR THREE CHARACTER LLOYD’S PSEUDONYM (MANDATORY)

7. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
MARK BARWICK :
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 5 = YOU MUST ENTER NAME OF BROKER CONTACT AND THEIR FULL PHONE NUMBER (MANDATORY) THE E:MAIL ADDRESS OF THE BROKER CONTACT CAN ALSO BE SHOWN (CONDITIONAL)

8. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S & A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 6 = SPECIAL SETTLEMENT NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK

9. BOX 7 = THE TYPE OF BUSINESS (MANDATORY), YOU MUST ENTER:
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7) NM
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S & A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 7 = THE TYPE OF BUSINESS (MANDATORY), YOU MUST ENTER:
M = MARINE NM = NON-MARINE AV = AVIATION

10. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
21439*
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S & A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 8 = BUREAU ORIGINAL REFERENCE OF THE ORIGINAL PREMIUM THE SIGNING ATTACHES TO (CONDITIONAL)
I.E. THE SIGNING NUMBER AND DATE OF THE ORIGINAL PREMIUM. MUST BE USED ON ALL AP’S AND RP’S SIGNED SUBSEQUENT TO THE ORIGINAL PREMIUM.

11.  BOX 9 = PROCESSING REQUIRED (MANDATORY)
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name:
Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A 
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 9 = PROCESSING REQUIRED (MANDATORY)
TICK STAGE ONE WHERE ONLY PREMIUM IS BEING PROCESSED. TICK S & A WHERE PREMIUM AND POLICY BOTH TO BE SIGNED. DO NOT TICK BOTH BOXES.

12. BOX 10 = THE BROKER PRIME REFERENCE (MANDATORY)
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 10 = THE BROKER PRIME REFERENCE (MANDATORY)
A MAXIMUM OF 12 ALPHA NUMERICS.

13. BOX 11 = FURTHER BROKER REFERENCE (OPTIONAL)
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 11 = FURTHER BROKER REFERENCE (OPTIONAL)
A MAXIMUM OF 12 ALPHA NUMERICS

14. BOX 12 = NO. OF LINES NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 12 = NO. OF LINES NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK

15. BOX 13 = MARKET SHARE APPLICABLE TO THE TRANSACTION (MANDATORY)
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 13 = MARKET SHARE APPLICABLE TO THE TRANSACTION (MANDATORY)

16. BOX 14 = LINE TYPE NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK.
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 14 = LINE TYPE NO LONGER EXISTS. THIS BOX MUST BE LEFT BLANK.

17. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 15 = MUST SHOW DEF OR RES DEPENDING ON TYPE OF PREMIUM BEING PRESENTED, IE IF DEFERRED OR RESERVE BUSINESS . IF A COMBINATION OF DEFERRED AND RESERVE BUSINESS THEN SHOW RES. (CONDITIONAL).

18. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 16 = MUST SHOW THE NUMBER OF INSTALMENTS, INCLUDING CASH, DEFERRED AND RESERVE INSTALMENT ITEMS IF BOX 15 COMPLETED (CONDITIONAL).

19. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 17 = AMOUNT OF UK OR OVERSEAS PREMIUM TAX THAT IS DUE TO BE PAID TO UNDERWRITERS IF APPLICABLE (CONDITIONAL)
I.E. ANY TAXES OR CHARGES THAT ARE PAYABLE BY THE INSURED IN ADDITION TO THE PREMIUM AND WHICH ARE TO BE COLLECTED AND/OR ADMINISTERED BY UNDERWRITERS. THE FIGURE SHOULD BE THE BUREAU AMOUNT IN THE SETTLEMENT CURRENCY.

20. BOX 18 = 100% GROSS PREMIUM IN ORIGINAL CURRENCY (MANDATORY).
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 18 = 100% GROSS PREMIUM IN ORIGINAL CURRENCY (MANDATORY).
IN THE EVENT OF THERE BEING A SLIP ORDER THE FOLLOWING RULES APPLY: A) IF THE SIGNED LINES ON THE SLIP TOTAL 100% THE FIGURE IN THIS BOX MUST HAVE TAKEN THE ORDER INTO ACCOUNT B) IF THE SIGNED LINES ON THE SLIP TOTAL THE ORDER PERCENTAGE THEN THE ORDER MUST NOT BE USED WHEN CALCULATING THE 100% GROSS PREMIUM FIGURE.

21. BOX 19 = TOTAL BROKERAGE AND COMMISSION PERCENTAGE (MANDATORY).
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 19 = TOTAL BROKERAGE AND COMMISSION PERCENTAGE (MANDATORY).

22. CAN BE EITHER A PERCENTAGE OR AN AMOUNT.
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 20 = TAXES OR CHARGES THAT ARE TO BE DEDUCTED FROM THE PREMIUM PAID TO UNDERWRITERS IF APPLICABLE (CONDITIONAL)
CAN BE EITHER A PERCENTAGE OR AN AMOUNT.

23. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 21 = ANY OTHER DEDUCTIONS USED TO ARRIVE AT THE NET PREMIUM (CONDITIONAL)
MUST BE EXPRESSED AS A PERCENTAGE AND AN INDICATION AS TO WHETHER TO BE DEDCUCTED FROM GROSS OR NET.

24. (I.E. THE CURRENCY IN WHICH THE CLIENT IS PAYING THE PREMIUM).
LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 22 = ISO CURRENCY ABBREVIATION FOR THE ORIGINAL CURRENCY OF THE PREMIUM (MANDATORY)
(I.E. THE CURRENCY IN WHICH THE CLIENT IS PAYING THE PREMIUM).

25. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 23 = RATE OF EXCHANGE USED TO CONVERT THE ORIGINAL CURRENCY TO THE SETTLEMENT CURRENCY, IF APPLICABLE (CONDITIONAL)

26. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 24 = ISO CURRENCY ABBREVIATION OF THE SETTLEMENT CURRENCY (MANDATORY)

27. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 25 = SIGNED LINE PROPORTION OF THE NET PREMIUM IN SETTLEMENT CURRENCY TO TWO DECIMAL PLACES. SHOW “0.00” WHERE NIL PREMIUM BEING SETTLED (MANDATORY)
THIS FIGURE MUST NOT INCLUDE UK IPT BUT SHOULD INCLUDE THE BUREAU AMOUNT FOR OVERSEAS TAXES AS SHOWN IN BOX 17 OF THE LPAN.

28. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 26 = PLANNED SETTLEMENT DATE WHERE THE ITEM IS TO BE SIGNED IN FLEXIBLE SETTLEMENT SCHEME (OPTIONAL)
THE DATE CANNOT BE LATER THAN THE SETTLEMENT DUE DATE SHOWN ON THE SLIP.

29. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 27 = 100% WAR GROSS PREMIUM IN ORIGINAL CURRENCY, ONLY FOR MARINE BUSINESS (CONDITIONAL)
IN THE EVENT OF THERE BEING A SLIP ORDER THE FOLLOWING RULES APPLY: A) IF THE SIGNED LINES ON THE SLIP TOTAL 100%, THE FIGURE SHOWN IN THIS BOX MUST HAVE TAKEN THE ORDER INTO ACCOUNT. B) IF THE SIGNED LINES ON THE SLIP TOTAL THE ORDER PERCENTAGE, THIS ORDER MUST NOT BE USED WHEN CALCULATING THE 100% GROSS PREMIUM FIGURE.

30. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 28 = SIGNED LINE PROPORTION OF THE NET WAR PREMIUM IN ORIGINAL CURRENCY, ONLY FOR MARINE BUSINESS (CONDITIONAL)

31. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 29 = UNIQUE MARKET REFERENCE, FORMAT OF “B” FOR BROKER, THE FOUR CHARACTER BROKER CODE AND UP TO TWELVE CHARACTER REFERENCE (MANDATORY)

32. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 30 = MANDATORY FOR DEFERRED ITEMS AND MUST SHOW PAYMENT DATES OF INSTALMENTS AS FOLLOWS: A) FIRST INSTALMENT – ENTER THE SETTLEMENT DUE DATE OR “CASH” IF DUE NOW, B) FOR SUBSEQUENT INSTALMENTS ENTER A DATE WHICH IS CALCULATED BY ADDING THE TERMS OF TRADE CREDIT (AS SHOWN ON THE SLIP) TO THE CLIENT DUE DATE.

33. LONDON
PREMIUM
ADVICE
NOTE
For Bureau Use
PM/AP/RP (1)
Bureau (2)
Broker No (3)
Broker (4)
Broker Contact: (5)
Name: Ext. No.:
SPECIAL SETTLEMENT (6)
YES/NO
Signed:
Title:
M/NM/AV (7)
Bureau Original Ref (8)
Separation (9)
Broker Reference (10)
Broker Reference (11)
Stage 1
S&A
No. of Lines (12)
Bureau Total Line (13)
Line Type (14)
Def/Res
(15)
No of Insts
(16)
For Future Use (17)
DEFERRED INSTALMENTS
Month/Year (30)
NA Instalment Premium (31)
100 % Gross Premium (18)
Brokerage (19)
Tax (20)
Other Deductions (21)
Orig. Ccy (22)
Rate of Exchange (23)
Sett. Ccy (24)
Bureau NA Premium (25)
PSD (26)
100% Gross War Premium (27)
Bureau NA War Premium (28)
For Future Use (29)
FOR BUREAU USE
BOX 31 = MANDATORY FOR DEFERRED ITEMS AND MUST SHOW THE BUREAU PROPORTION OF THE NET PREMIUM FOR EACH DEFERED INSTALMENT INCLUDING ANY UK IPT OR OVERSEAS TAXES.