FORM 3 U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
Washington, D.C. 20549
OMB Number 3235-0104
Expires: January 31, 2005
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Estimated average burden
hours per response ... 0.5
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility
Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting 2. Date of Event 4. Issuer Name and Ticker or Trading
Person* Requiring Statement Symbol
(Month/Day/Year)
White Mountains Insurance Group, Ltd.
October 9, 2002 Montpelier Re Holdings Ltd., "MRH" on the New York Stock Exchange
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(Last) (First) (Middle) 3. I.R.S. or Social 5. Relationship of Reporting Person 6. If Amendment, Date of
Security Number of to Issuer (Check all applicable) Original (Month/Day/Year)
One Beacon Street Person (Voluntary)
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- -------------------------------------- Director X Owner 7. Individual or Joint/Group
(Street) --- --- Filing (Check applicable
line)
Boston, Massachusetts 02108 --- Officer --- Other Form filed by one
- -------------------------------------- (give title below) (specify below) --- Reporting Person
(City) (State) (Zip) X Form filed by more
--- than one Reporting
Person
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Table I-- Non-Derivative Securities Beneficially Owned
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial Ownership
(Instr. 4) Indirect (I) (Instr. 5)
(Instr. 5)
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Common Shares 900,000 I By Camden Fire
Insurance Company(1)
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Common Shares 8,100,000 (2) By OneBeacon
Insurance Company
(1)(2)
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Common Shares 1,800,000 I By Pennsylvania
General Insurance
Company(1)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one Reporting Person, see Instruction 5(b)(v). (Over)
SEC 1473 (3-99)
(1) Camden Fire Insurance Company, OneBeacon Insurance Company and Pennsylvania General Insurance Company are indirect
wholly-owned subsidiaries of White Mountains Insurance Group, Ltd.
(2) These shares are owned directly by OneBeacon Insurance Company, a ten percent owner of the issuer, and indirectly by
White Mountains Insurance Group, Ltd.
Potential persons who are to respond to the collection of information contained in this form are not
required to respond unless the form displays a currently valid OMB control number
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FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative 2. Date Exercisable 3. Title and Amount of Securities 4. Conversion 5. Ownership 6. Nature of
Security (Instr. 4) and Expiration Date Underlying Derivative Security or Exercise Form of Indirect
(Month/Day/Year) (Instr. 4) Price of Derivative Beneficial
Derivative Security: Ownership
Security Direct (D) or (Instr. 5)
--------------------------------------------------------- Indirect (I)
(Instr. 5)
Amount or
Date Expiration Title Number of
Exercisable Date Shares
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Warrant Shares Currently 1/3/2012 Common Shares 4,781,571 $16.67 D
Exercisable
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Explanation of Responses:
By: /s/ Dennis Beaulieu September 26, 2002
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Name: Dennis Beaulieu Date
Title: Corporate Secretary
On behalf of White Mountains
Insurance Group, Ltd.
** Signature of Reporting Person
By: /s/ Dennis Beaulieu September 26, 2002
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Name: Dennis Beaulieu Date
Attorney-in-fact
On behalf of OneBeacon Insurance Company
** Signature of Reporting Person
* Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, See Instruction 6 for procedure.
Potential persons who are to respond to the collection of information
contained in this form are not required to respond unless the form displays
a currently valid OMB Number.
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SEC 1473 (3-99)
