PROVIDE
INSURANCE AND AGREES TO ITS TERMS. THIS AGREEMENT IS DATED MAY 1, 2007.
GRANTOR:
UROPLASTY, INC.
By:
/s/ Mahedi Jiwani
Mahedi Jiwani, CFO/Treasurer of Uroplasty, Inc.
AGREEMENT TO PROVIDE INSURANCE
Loan No: 12300
(Continued)
Page 2
FOR LENDER USE ONLY
INSURANCE VERIFICATION
DATE:
PHONE
AGENT'S NAME:
AGENCY:
ADDRESS:
INSURANCE COMPANY:
POLICY NUMBER:
EFFECTIVE DATES:
COMMENTS:
LASER PRO Lending, Ver. 5.35.00.004 Copr. Harland Financial Solutions, Inc.
1997, 2007. All Rights Reserved. - MN c:\APPS\CFI\CFI\LPL\110.FC TR-2787 PR-20