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Property Address:

Unless you provide us w ith evidence of the insurance coverage required by your agreement w ith us, w e maypurchase insurance at your expense to protect our interests in your collateral. This insurance may, but need not,protect your interests. The coverage that w e purchase may not pay any claim that you make or any claim that ismade against you in connection w ith the collateral. You may later cancel any insurance purchased by us, but onlyafter providing us w ith evidence that you have obtained insurance as required by our agreement. If w e purchaseinsurance for the collateral, you w ill be responsible for the costs of that insurance, including interest and any othercharges w e may impose in connection w ith the placement of the insurance, until the effect ive date of thecancellat ion or expirat ion of the insurance. The costs of the insurance may be added to your total outstandingbalance or obligation. The costs of the insurance may be more than the cost of insurance you may be able to obtainon your ow n.

Borrow er

IL COLLATERAL PROTECTION INSURANCE DISCLOSURE

Date:

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Borrow er Borrow er Date

Borrow er Date

Lender:

I/We have read the above disclosure and acknow ledge receiving a copy by signing below .

Date

Borrow er Date

Borrow er Borrow er Date

Borrow er Date

IL - Collateral Protection Insurance Disclosure.pdf Rev. 7/1/2004