1012005500 BfG Schweinfurt (Routing No. 79310111).

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Certificate of Insurance for Life Insurance     No. 174 596-00

Commercial Direct Insurance (salary conversion)

The insured party is irrevocably entitled to benefits, in the event of both death as well as survival.

In the event of death, the insurance benefit is to be paid to: his wife, Marie Theres, née Tebartz, if deceased, to his children, Felix, DOB 02/23/1984, and Meike, DOB 08/18/1985, if deceased, to his parents, if deceased, to the heirs of the insured party. The aforementioned surviving beneficiaries in the event of death have an irrevocable claim to the insurance benefits in the event of the death of the insured person. The entitlement to benefits also applies to the excess shares.

Certificate of Insurance for Life Insurance     No. 174 596-00

which we will debit from your account.

We will also have the subsequent premiums debited from your account No.:

We will not send premium statements on the individual due dates.

The insurance coverage commences upon receipt of this insurance policy, but not prior to the technical commencement of insurance. We assume that the initial premium can be debited from your account by the next debit date, and that the debit note will not be disputed. Otherwise the insurance coverage would be rendered invalid retroactively.

Certificate of Insurance for Life Insurance     No. 174 596-00

The right to choose an annuity is excluded for this agreement.

For the duration of employment, it is irrevocably agreed that a transfer of the capacity of policyholder and an assignment of rights arising from this agreement to the insured employee until the date at which the insured employee turns 59, is excluded, insofar as the premiums have been paid by the policyholder (employer).

The assignment or lending of the irrevocable entitlement against security is excluded.

Certificate of Insurance for Life Insurance     No. 174 596-00

Table of cash-in values and premium-free amounts insured

If this insurance is terminated or made premium-free, the following cash-in values (“RW”) or premium-free amounts insured (“bS”) will result without consideration for profit credits:

When comparing with your payments, please note that only the savings portions of your premiums are available for the values in the table. This is because your premium has three components:

Reconciliation list Data transfer Employee payments 01/2012