# CHUBB EXCESS LIABILITY INSURANCE - SL

## Schedule of Forms

| Policy Period | MAY 21, 2014 to MAY 21, 2015 |
|---------------|--------------------------------|
| Effective Date | May 21, 2014                  |
| Policy Number | 7966-56-84 DTO                |
| Insured       | INTERNATIONAL BUSINESS        |
|               | MACHINES CORPORATION          |
| Name of Company | FEDERAL INSURANCE COMPANY     |
| Date Issued   | May 19, 2014                  |

## Form number

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

| Description                                      | Form number |
|--------------------------------------------------|-------------|
| PREMIUM BILL                                     | 07-10-0542 (10/06) |
| 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) |
| NY - EXCESS LIAB - SL DEC                        | 07-02-2325 (12/09) |
| CHUBB EXCESS LIAB-SL-NEW YORK CANCELLATION      | 07-02-1305 (11/04) |
| CHUBB EXCESS LIABILITY INSURANCE-SL CANCELLAT    | 07-02-1351 (12/97) |
| NEW YORK AMENDATORY ENDORSEMENT                  | 07-02-1439 (06/13) |
| INFO LAWS INCL. UNAUTH OR UNSOLIC COMMUNI EXCL  | 07-02-2174 (01/13) |
| 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) |

Form 07-02-0975 (Rev. 5/95) Schedule of Forms Page 1 last page