# 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. 3, 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as are identified in paragraph 2 below (the "Differing Provisions"), the terms of Endorsement No. 3, paragraph 1 are superseded, and the term "Followed Policy" shall mean ACE Property and Casualty Insurance Company Policy Number XOO G27983212 001, as issued.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. 3 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 G27983212 001
### 2. Differing Provisions: None

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, 2016  
**All other terms and conditions remain unchanged.**  
**This endorsement is attached to and made a part of Policy No.:** IBM-0062/BSF03  
**of ACE Bermuda Insurance Ltd.**

**Issued to:** International Business Machines Corporation  
**Date of Issue:** August 24, 2016  
**By:** [Signature]  
**Authorised Representatives**

**End No. 5**