Binder For State Farm Automobile Insurance

Policy Number: 112 6320-C07-46

Policy Owners (Named Insureds) Agent

Zardadkhan, Irfan R Melissa L Harwood
Khatami, Najme M 1703 Colley Ave
Norfolk, VA 23517-1610
(757)626-1020

Mailing Address
808 W 48th St Apt 2
Norfolk, VA 235082000

Vehicle Application
Year: 2000 Effective date: 09-09-2010
Make: KIA Application date: 09-07-2010
Model: SEPHIA Application time: 09:50:02 AM CST
Body Style: 4D SED GAS
VIN: KNAFB1213Y5819161

During the past 3 years has any driver or household member had
A major violation? No
License suspended, revoked, or refused? No
Does any driver have
An at-fault accident within the last 3 years? No
A minor violation within the last 3 years? No
Primary use of vehicle? Pleasure

The premium shown below must be in compliance with the Company's rules and rates and is subject
to revision.

Six Month
Coverage Applied For Limits (* denotes thousands) Premium
Liability - Bodily Injury/Property Damage $25/$50/$25 * $154.60
Uninsured Motor Vehicle $25/$50/$20 * $14.10

Premium adjustments
Vehicle Safety Discount
Good Driving Discount

Total 6 month premium -- $168.70

Payment received - $168.70
Balance due $0.00

NOTE: The premium amounts shown above do not include the additional fees required if the monthly
payment plan was selected.

Policy owners (Named insureds): Zardadkhan, Irfan R

Khatami, Najme M
Effective date: 09-09-2010
Policy number: 112 6320-C07-46
Application date: 09-07-2010
Application time: 09:50:02 AM CST

A State Farm representative may contact you soon to arrange for inspection of your vehicle and to
obtain the documents required below:

Coverage Selection Rejection Form

Depending on the limits you selected for Uninsured Motor Vehicle Coverage Bodily Injury and
Uninsured Motor Vehicle Coverage Property Damage, you may be required to complete a written
selection or rejection of these coverages. You will be contacted if this is necessary. If the needed form
is not completed within 30 days, we will increase your coverage to the minimum required without the
completion of the form and add the appropriate charges for the additional coverage.

State Farm Mutual Automobile Insurance Company of Bloomington, Illinois , hereby binds as of the
requested effective date for a period of 30 days from such date, the insurance applied for, subject to all
of the terms and conditions of the automobile policy and applicable endorsements in current use by
such Company. The issuance by the Company of the Declarations page of the policy applied for voids
this binder.

It is a crime to knowingly provide false, incomplete or misleading information to an insurance company

for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of
insurance benefits.

Notice of information collection practices for personal, family, or household insurance

transactions -- We often collect personal information from persons other than the individuals applying
for coverage. Such information may, in certain circumstances, be disclosed to third parties without
your authorization. If you would like additional information concerning the collection and disclosure of
personal information - and your right to see and correct any personal information in your files - it will be
furnished upon request.

In connection with this application for insurance, State Farm may obtain an insurance score for you or
a member of your household. We may use a third party in connection with the development of your
insurance score, which will be based on credit history and prior automobile insurance claim history.
You may request that your credit information be updated and if you question the accuracy of the credit
information we will, upon your request, reevaluate your application based on corrected information
received from a consumer reporting agency.

Read your policy. The policy of insurance for which this application is being made, if issued,
may be cancelled without cause at the option of the insurer at any time in the first 60 days
during which it is in effect and at any time thereafter for reasons stated in the policy.

By submission of this application, you agree that: (1) you have read this application, (2) your
statements on this application are correct, (3) statements made on any other applications on this date
for automobile insurance with this company are correct and are made part of this application, (4) you
are the sole owner of the described vehicles except as otherwise stated, and (5) the limits and
coverages were selected by you. It is further understood and agreed that no insurance is
effective under this agreement (A) unless the binder is completed designating the company
accepting this application or (B) until the date the policy or binder is issued by the company
accepting this application.

Policy owners (Named insureds): Zardadkhan, Irfan R

Khatami, Najme M
Effective date: 09-09-2010
Policy number: 112 6320-C07-46
Application date: 09-07-2010
Application time: 09:50:02 AM CST

IB VA .5 (rev 07/2009)

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