UT Combination Guarantee 16

SCHEDULE A

Combination Guarantee

Order No.: ________________

Guarantee No.: ____________

Date of Guarantee: _________

Liability: __________________

A.Assured:

B.Assurances are set forth in Schedules attached named:

[list two or more appropriate schedules and identify by the common name found below the words - Schedule A of each guarantee]

For issuing guidelines on this form, see Guidelines