| 
			 Policy or Plan Ending Date in month of:  | 
			
			 File return no later than:  | 
			
			 Applicable rate:  | 
		
|---|---|---|
| 
			 Jan - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 Feb - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 Mar - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 Apr - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 May - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 Jun - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 Jul - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 Aug - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 Sep - 2014  | 
			
			 July 31, 2015  | 
			
			 $2  | 
		
| 
			 Oct - 2014  | 
			
			 July 31, 2015  | 
			
			 $2.08  | 
		
| 
			 Nov - 2014  | 
			
			 July 31, 2015  | 
			
			 $2.08  | 
		
| 
			 Dec - 2014  | 
			
			 July 31, 2015  | 
			
			 $2.08  | 
		
| 
			 Jan - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 Feb - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 Mar - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 Apr - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 May - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 Jun - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 Jul - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 Aug 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 Sep - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.08  | 
		
| 
			 Oct - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.17  | 
		
| 
			 Nov - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.17  | 
		
| 
			 Dec - 2015  | 
			
			 July 31, 2016  | 
			
			 $2.17  |