I, (“Subscriber”), hereby acknowledge and understand the following:

Pursuant to the not-for-profit reciprocal exchange structure and the provisions of N.J.S.A. 17:50-5, former subscribers of New Jersey Physicians United Reciprocal Exchange (“NJ PURE”) may voluntarily contribute funds to address a reported financial shortfall that, if unmet, could result in regulatory action including liquidation or insolvency.

NJ PURE has reported an estimated capital shortfall of $12,714,000 as of year-end 2025. If sufficient funds are collectively pledged and funded by subscribers to eliminate this shortfall on or before May 8, 2026, NJ PURE may retain its license and avoid liquidation.

In consideration of the foregoing, and subject to the conditions set forth herein, I hereby irrevocably pledge to contribute the sum of: $9,240.00.

This pledge is expressly conditioned upon the following:

1. Sufficiency Condition – My pledged contribution shall be due and payable only if the total aggregate pledged amounts from all subscribers, when combined with my pledge, are sufficient to fully satisfy the required shortfall and thereby prevent NJ PURE from entering liquidation or insolvency.
2. All-or-Nothing Condition – In the event that the total pledged funds are insufficient to meet the required amount necessary to prevent liquidation, or if DOBI proceeds with liquidation despite the pledges, this pledge shall be deemed null and void, and I shall have no obligation to fund the pledged amount.
3. Notification Requirement – I shall receive written notice no later than May 8, 2026 at 5:00 PM confirming whether this pledge is required to be funded.
4. Return of Capital – In the event the shortfall is cured and NJ PURE successfully completes a runoff of its remaining claims, NJ PURE will establish a contractual plan to return any unused contributed capital to the subscribers. I acknowledge that any such repayment is not guaranteed and remains strictly contingent upon the availability of surplus funds and the prior regulatory approval of DOBI.

If the above conditions are satisfied and the pledged funds are collected, I acknowledge that NJ PURE’s continued operation may preserve the benefits associated with my prior policy coverage, including limits of $1,000,000 per incident and $3,000,000 aggregate annually, subject to applicable terms and regulatory requirements. I further acknowledge that if NJ PURE were to enter formal liquidation, my coverage limits would be statutorily capped at $300,000 per covered claim by the New Jersey Property-Liability Insurance Guaranty Association (PLIGA), potentially exposing me to personal financial liability for claims exceeding that limit.

I further understand and acknowledge that while curing the current capital shortfall may prevent immediate liquidation, it does not guarantee immunity from future regulatory action. Should claims develop adversely in the future causing a new capital deficit, DOBI may force liquidation at that time, in which case my pledged funds would become part of the NJ PURE insolvency estate.

This pledge constitutes a legally binding commitment, enforceable in accordance with its terms, upon satisfaction of the conditions set forth herein.