OR ALTA Leasehold Owner's Policy Schedule A 1

SCHEDULE A

Order No.: _____________________ Policy No.: ___________________

Date of Policy: __________________ Amount of Insurance: $ _________

1.Name of Insured: ____________________________

2.The estate or interest in the land which is covered by this policy is the leasehold estate, as leasehold estate is defined in section 1(h) of the Conditions and Stipulations of this policy, created by the instrument herein referred to as the Lease which is identified as follow:

____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________

3.The leasehold term insured is:

______________________________________________________________ ______________________________________________________________ ______________________________________________________________

4.Title to the estate or interest in the land is vested in:

______________________________________________________________ ______________________________________________________________ ______________________________________________________________

5.The land referred to in this policy is described as follows:

______________________________________________________________ ______________________________________________________________ ______________________________________________________________

No guidelines are available for this form at this time.