cuestionario norma

Exhibit A INTERNATIONAL BOND REQUEST FORM issued pursuant to the Reinsurance Agreement by and between Continental Casualty Company, including its various affiliated companies and branches (hereinafter collectively referred to as "Continental Casualty Company")on the one part, and Afianzadora Aserta , S.A. de C.V., Grupo Financiero Aserta (hereinafter collectively referred to as "Aserta") on the other part Dated 24 de Septembre, 2013 DATE: NEW BOND REQUEST — BOND NO. (Please Type or Print Clearly) Complete the items below fully and without abbreviations, exactly the way they should appear on the bond.

BOND ISSUING COMPANY:

PRINCIPAL NAME:

FULL MAILING ADDRESS:

TELEPHONE NO.

OBLIGEE NAME:

FULL MAILING ADDRESS:

TELEPHONE NO.:

TYPE OF BOND:

BOND AMOUNT (USD/MXP/CAD) TO BE 100% REINSURED ($)