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<br />Proposal of Insurance For Naveed Haider, M.D. <br />Page 16 of 16 <br /> <br />To Waive Prior Acts Coverage <br />I, Haider, Naveed, acknowledge the need to purchase tail coverage (reporting endorsement) from my previous insurance carrier which <br />insured me under a claims-made policy. I understand that my failure to purchase such tail coverage from my expiring insurance carrier <br />will result in an uninsured exposure for any claims which may arise in the future as a result of professional services rendered by me <br />between retro date on the expiring policy and expiration date of the expiring policy. I understand that the insurance policy I am <br />purchasing with Kinsale Insurance Company, which has a policy inception and retroactive date of 11/01/2016, will not provide prior acts <br />coverage. <br /> <br /> <br /> <br /> <br /> <br />Signature: Naveed Haider, M.D. <br /> <br /> <br />Date <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Appendix A (Policy Specimen) <br />