# Schedule of Forms and Endorsements

| Policy No. | Eff. Date of Pol. | Exp. Date of Pol. | Eff. Date of End. | Producer | Add'l Prem. | Return Prem. |
|------------|-------------------|------------------|------------------|----------|-------------|--------------|
| AEC 5574320-01 | 05/21/2014 | 05/21/2015 | 05/21/2014 | 50522000 | ---------- | ---------- |

## Named Insured and Mailing Address:
**INTERNATIONAL BUSINESS MACHINES CORPORATION**
1 New Orchard Rd
Armonk, NY 10504

## Producer:
AON RISK SERVICES NORTHEAST INC
199 WATER ST FL 32ND
NEW YORK, NY 10038-3526

## Form Name | Form Number | Edition Date
--- | --- | ---
Advisory Notice To Policyholders Regarding the U.S. Treasury Department's Office of Foreign Assets Control ("OFAC") Regulations | U-GU-1041-A | (03/11)
Disclosure of Premium (Relating to Disposition of TRIA) | U-GU-692-C CW | (06/13)
Following Form Excess Liability Policy Declarations | U-EXS-D-100-B FTZ | (01/12)
Following Form Excess Liability Policy | U-EXS-100-C CW | (01/12)
Certified Act of Terrorism Retained Amount Provisions | U-EXS-279-B CW | (01/08)
Absolute Pollution Follow Form | U-EXS-264-B CW | (04/11)
Amended Defense and Supplementary Payments | U-EXS-378-B CW | (04/11)
Knowledge of Occurrence - Risk Manager | U-EXS-411-A CW | (03/12)
New York Changes | U-EXS-241-C NY | (02/13)
Exclusion - Collection or Distribution of Material or Information in Violation of Law | U-EXS-312-E CW | (01/12)
Important Notice - In Witness Clause | U-GU-319-F NY | (01/09)
CAP on Losses from Certified Acts of Terrorism | U-GU-767-A CW | (01/08)

**U-EXS-215-A CW (04/99)**  
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