# FORMS SCHEDULE

**Named Insured:** International Business Machines Corporation  
**Policy Number:** 60703940  
**Effective 12:01 A.M.:** May 21, 2012  

| End't. No. | Form Name | Form No. | Edition Date |
|------------|-----------|----------|--------------|
| 1.         | The Bermuda Shorts Form Dec. | 107115   | 02/11        |
|            | The Bermuda Shorts Form Policy | 103271   | 11/09        |
| 2.         | Schedule of Excess Policy (ies) | 103281   | 04/11        |
| 3.         | Arbitration Endorsement | 103277   | 11/09        |
| 4.         | Premium Payment Condition | 103280   | 11/09        |
| 5.         | Violation of Statutes in Connection with Sending, Transmitting or Communicating Any Material or Information Exclusion | 104228   | 11/09        |
| 6.         | Choice of Law Endorsement - II | 106116   | 08/10        |
|           | Coverage Territory Endorsement | 89644    | 07/05        |

**1 of 1**  
Forms Schedule 2012