# Receipt of Followed Policy Endorsement

End 023-04/14  
Form BSF-03  
Page 1 of 1  

**ADDITIONAL/RETURN PREMIUM: NIL**

**RECEIPT OF FOLLOWED POLICY ENDORSEMENT**

It is understood and agreed that the Insurer has been provided with a copy of the Followed Policy identified in paragraph 1 below, as required pursuant to Endorsement No. 6, paragraph 2, such that, except for such provisions of the Followed Policy as are different from those set out in the binder and as are identified in paragraph 2 below (the "Differing Provisions"), the terms of Endorsement No. 6, paragraph 1 are superseded, and the term "Followed Policy" shall mean ACE Property and Casualty Insurance Company Policy Number XOO G2763848A, as issued. With respect to the Differing Provisions set forth below, the Followed Policy shall be deemed not to include such provisions, and the original provisions referenced in the binder identified in paragraph 1 of Endorsement No. 6 shall be deemed to be included in such Followed Policy, except as otherwise agreed and as set forth by Endorsement attached to this Policy.

1. ACE Property and Casualty Insurance Company Policy Number XOO G2763848A
2. Differing Provisions:

| Form Number - Edition Date | Title |
|-----------------------------|-------|
| XS-28500a (08/13)           | ACE Group Specialty Claims Loss Notification Form |
| CC24180c (03/14)            | Signatures |

Nothing herein contained shall be held to vary, alter, waive, or extend any of the terms, conditions, exclusions or limitations of the Policy referenced below, except as expressly stated herein.

The effective date of this endorsement is May 21, 2015  
All other terms and conditions remain unchanged.  
This endorsement is attached to and made a part of Policy No. IBM-0025/BSF03  
of ACE Bermuda Insurance Ltd.  

Issued to: International Business Machines Corporation  
Date of Issue: July 15, 2015  
By [Authorized Representatives]  
End No. 7