# CHUBB EXCESS LIABILITY INSURANCE - SL

## Schedule of Forms

**Policy Period:** MAY 21, 2012 to MAY 21, 2013

**Effective Date:** May 21, 2012

**Policy Number:** 7966-56-84 DTO

**Insured:** INTERNATIONAL BUSINESS MACHINES CORPORATION

**Name of Company:** FEDERAL INSURANCE COMPANY

**Date Issued:** May 8, 2012

**Form number**

As of the effective date printed above, this is the Schedule of Forms applicable to this policy:

| Description | Form number |
|-------------|-------------|
| IMPORTANT NOTICE TO POLICYHOLDERS-TRIPRA | 99-10-0732 (12/07) |
| IMPORTANT NOTICE - OFAC | 99-10-0796 (09/04) |
| AOD IMPORTANT POLICYHOLDER NOTICE | 99-10-0872 (06/07) |
| EXCESS-SL-DECLARATIONS-VERSION 2 - FEDERAL | 07-02-1322 (12/97) |
| CHUBB EXCESS LIAB-SL-NEW YORK CANCELLATION | 07-02-1305 (11/04) |
| NEW YORK AMENDATORY ENDORSEMENT | 07-02-1439 (11/98) |
| INFORMATION DISTRIBUTION LAWS EXCLUSION | 07-02-2174 (11/04) |
| NEW YORK LATE NOTICE MANDATORY | 07-02-2313 (01/09) |
| LIMITS OF INSURANCE - EXCESS LIAB. INS. SL | 07-02-1334 (12/97) |
| CANCELLATION NOTICE CONDITION | 07-02-1576 (02/00) |
| CAP ON CERTIFIED TERRORISM LOSSES | 07-02-1953 (12/07) |
| MANUSCRIPT ENDORSEMENT | 07-02-1381 (12/97) |

**Reference Copy**
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