f New York Inc. Premium Acc City: State: Zip Ccde: Acct urst Type: DDA (1,1) 0 EFTA01589830 Swift Other Intermidiary Bank Account/Code: Intwrnediary Bank Name: Payment Details (Reference/ Advice Description/Addenda) Acc #: Invoice: 11133Al2 Reference: 12000081 05/14/13 Authorized By Date ID: 03