Homeowners Insurance Change

Date Loan Number Name(s) on Loan Property Address New Insurance Company Agents Name Agents Phone Number Effective Date of New Policy Old Insurance Company

Acknowledgement

I (We) authorize First Federal Savings Bank to pay my (our) homeowner's insurance premiums to our new insurance company as of the above date

Yes, I agree the above information is correct.

First Federal Savings Bank advises you to return the unearned premium refund from the prior insurance company to your escrow account. Please be aware that First Federal Savings Bank cannot cancel your prior policy on your behalf. It is your responsibility to contact the insurance agent to process the cancellation.

Mortgagee clause:
First Federal Savings Bank, lSAOA
PO Box 527
Rochester, IN 46975-0527

Call Us800-422-3372