EFTA00787679.pdf

SWORN STATEMENT IN PROOF OF LOSS TO THE AIG Property Casualty Company Agency at: Insurance Office Central Ohio Amount S 39,611,905 Policy No. PCG 0021940015 Date of Exp. July 15'h, 2018 BY YOUR POLICY OF INSURANCE ABOVE DESCRIBED, YOU INSURED Jeffrey Epstein according to the terms and conditions therein the below mentioned property against loss from the following cases: Property Insured as Per Policy No. PCG (The "Property") Against Loss From "All Risk" A loss to certain of the property occurred on the island of Little Saint James. USVI on the days of September 6th, 19i°, & 20th of 2017 about the hours of -- o'clock --M., which, upon the best of my knowledge and belief, was caused as follows: Hurricane damage and destruction of fine art from Hurricane Irma, (CAT 1744) and Hurricane Maria (CAT 1745). Upon the best of my knowledge and belief, the actual cash value of the property described by aforesaid policy, the actual amount of the loss, the total insurance thereon at the time of said the loss as shown by annexed schedule, amount of the loss named in this policy, and the amount claimed under IS policy are as follows: CASH VALUE WHOLE LOSS WHOLE. INSURANCE. AMOUNT NAMED IN AMOUNT CLAIMED UNDER Tills POLICY Tills POLICY - $1,468,006.00 $ 39,611,905.00 $ 39,611,905.00 $1,000,000.00 Except as noted below the Property belonged at the time of the loss , to Jeffrey Epstein and no other person or persons had any interest therein; no assignment or transfer, or encumbrance of the Property subject to the Loss has been made and no change in the title, use, or possession of said Property has occurred since the issuance of this policy and will accept IN FULL SATISFACTION AND COMPROMISE SETTLEMENT of the loss under this policy the sum of One million dollars and zero cents and demand no more AND in respect of the Loss HEREBY AUTHORIZE PAYMENT TO Jeffrey Epstein. In consideration of the payment to be made hereunder, I hereby assign and transfer to the said Insurers each and all claims and demands against any person, persons, corporation or property, arising from or connected with the loss , (and the said Insurers is subrogated in the place of and to the claims and demands of the undersigned against said person, persons, corporation or property) to the extent of the amount above named; and agree to immediately notify McLARENS YOUNG INTERNATIONAL., (for account of the Underwriters) in case of any recovery of any of the Property for which claim is being made hereunder. In connection with the loss, I also agree to either turn over to said McLARENS YOUNG INTERNATIONAL for account of the Insurers, any such recovery which may be made, or reimburse said McLARENS YOUNG INTERNATIONAL for account of the Insurers, any such recovery which may be made, or reimburse said McLARENS YOUNG INTERNATIONAL. to the extent of the payment for any of such Property which may be recovered, or market value at the time of recovery (whichever is the greater), subject to the decision of the Insurer. The said Loss was not caused by design or procurement on my part; nothing has been done by or with my privity or consent, to violate the conditions of the policy, or render it void, no articles are mentioned herein or in annexed schedules but such as were interested the Loss and insured under this policy, and belonged to me at the time of the Loss ; no Property subject to the Loss had been saved from the Loss and in any manner concealed, and no attempt to deceive the said Insurers as to the extent of the Loss , has in any manner been made. SPECIAL CONDITIONS: Compromised net loss amount. No deductible applies. Any other information that may be required will be furnished upon request and considered a part of this proof. It is expressly understood and agreed that the furnishing of this blank to the assured or the preparing of Proofs by an adjuster, or any agent of the Insurers named in the policy is not a waiver of any rights of said Insurers. "ANY PERSON KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURANCE COMPANY FILE A STATEMENT OR A CLAIM CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF TILE THIRD DEGREE." WITNESS hand at this day of 20 State of Signature of Assured County of Personally appeared before me, the day and date above written signer of the foregoing statements, who made solemn oath to the truth of same, and that no material fact is withheld of which said Insurers should be advised. (SEAL) NOTARY PUBLIC EFTA00787679  LOSS SUMMARY DESCRIPTION LOSS SUBMITTED PORTION OF SUBMITTED BY INSURED LOSS ACCEPTED BY INSURERS Scheduled Jewelry $471,125 nil Less: Withdrawn claim $471,125 nil Sub-total for Scheduled Jewelry nil nil Unscheduled Jewelry nil nil Scheduled Fine Art $521,055 $521,055 Less: Loss Adjustment $63,714 Sub-Total for Scheduled Fine Art $457,341 Unscheduled Fine Art $946,951 $946,951 Less: Loss Adjustment $531,523 Sub-Total for Unscheduled Fine Art $415,428 Net Adjusted Loss $872,769 Less: Deductible Nil Adjusted Net Loss $1,468,006 $872,769 Compromised Net Loss and Claim $1,000,000 EFTA00787680