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<br />The undersigned ackno\\ !,es receipt of the information containel ,rein prior to any purchase and <br />approves the proposed transaction on behalf of the Plan without receiving, either directly or <br />indirectly, any personal compensation in connection with the purchase of policies under this Plan. <br /> <br />FOR CITY OF PARIS, PURCHASER: <br /> <br />(Date) <br /> <br />Title: <br /> <br />FOR HEALTIlCARE BENEFITS, INC., CONTRAcroR: <br /> <br />Jeffery Langmead (Date) <br />Senior Vice President - HealthCare Benefits, Inc. <br /> <br />2 <br />