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n D. Black Insurance Trust #2 New York Life 4/28/1999 Leon D. Black Insurance Trust #2 Pacific Life 4/28/1999 Leon D. Black Insurance Trust #2 John Hancock 4/28/1999 Leon D. Black Insurance Trust #2 AXA Equitable 4/28/1999 Leon D. Black Insurance Trust #2 I T h TOTAL: i EFTA00616063 Page 8 o
Insurance Carrier Face Value Annual _ Cash Surrender I Beneficia ies _.._. Premium Prudential 9/1/1999 Leon D. Black Insurance Trust #1 AXA Equitable 9/1/1999 Leon D. Black Insurance Trust #1 Security Life of Denver 9/1/1999 Leon 0 Black Insurance Trust #1 Prudential 4/26/1999 Leon D. Black
0,000.00 $196,080.00 $3,395&24.00 Pacific Life VP 6089 7390 4/28/1999 Leon D. Black Insurance Trust #2 $5,000,000.00 $33.218.00 $495,683.00 John Hancock 20 039 301 4/28/1999 Leon D. Black Insurance Trust #2 $30,000,000.00 $359,022.00 $5,416,560.00 AXA Equitable 49 232 123 4/28/1999 Leon D. B
ber Issued Beneficiary(les) Value Prudential V1 016 844 9/1/1999 Leon D. Black Insurance Trust #1 $30,000.000.00 $502,335.00 $4.737,189.00 AXA Equitable 49 232 126 9/1/1999 Leon D. Black Insurance Trust #1 $15,000,000.00 $264.894.00 $2,191,174.00 Security Life of Denver 610014742.00 9/1/1999
00,000 S196.080 S3,081,046.27 $3,073,203.07 S 2,514,929 Pacific Life VP 6089 7390 $ 5.010.000 $ 33.218 $457,928.92 $457,928.92 S 424,480 John Hancock 20 039 301 $30.000,000 $359,022 $5,040,643.54 $5,040.643.54 S 4,622,974 AXA Equitable 49 232 123 664 9 4 2.638.569.80 2 627 947 Total Se
r Value 12-ii -12 Siffli-rtisthit ' AtkanCt" 112-31-12 Prudential VI 016 844 $30,000,000 $502,335 $4,504,232.62 $4.504,232.62 $6,108,212 AXA Equitable 49 232 126 $15.000,000 $264,894 $2,053,540.91 $2,019,619.09 $3,172,980 Security Life of Denver 610014742 £,000 000 96.380 $584.170.30 5_5
0,000.00 $196,080.00 4,139,064.14 Pacific Life VP 6089 7390 4/28/1999 Leon D. Black Insurance Trust /12 $5,000,000.00 $33,218.00 666.260.80 John Hancock 20 039 301 4/28/1999 Leon D. Black Insurance Trust N2 630,000,000.00 $359.022.00 7.780,251.83 AXA Equitable 49 232 123 4/28/1999 Leon D. Bl
000,000.00 $33,218.00 666.260.80 John Hancock 20 039 301 4/28/1999 Leon D. Black Insurance Trust N2 630,000,000.00 $359.022.00 7.780,251.83 AXA Equitable 49 232 123 4/28/1999 Leon D. Black Insurance Trust N2 $25.000.000.00 5205.246.00 3.948.483.29 TOTAL: S 20,496,495.85 EFTA_R1_02123393 EFTA0
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Pacific Life
LOCATIONLeon Black
PERSONPrudential
ORGANIZATION
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ORGANIZATIONMercedes Benz S 600
ORGANIZATIONSecurity Life
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ORGANIZATIONArt Collections
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ORGANIZATIONNew York Life
ORGANIZATIONLeon D. Black Insurance Trust
PERSON
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PERSONyour Dependent Children
ORGANIZATIONHamlet Holdings LLC
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PERSONIndividual Life Insurance Coverage
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