# FORMS SCHEDULE

**Named Insured:** International Business Machines Corporation  
**Policy Number:** 60703940  
**Effective 12:01 A.M.:** May 21, 2017  

| End't. No. | Form Name | Form No. | Edition Date |
|------------|-----------|----------|--------------|
| 1.         | The Bermuda Shorts Form - 03 Dec The Bermuda Shorts Form - 03 Policy | 103281 | 11/09 |
| 2.         | Schedule of Excess Policy (ies) | 103280 | 11/09 |
| 3.         | Premium Payment Condition | 104228 | 11/09 |
| 3.         | Violation of Statutes in Connection with Sending, Transmitting or Communicating Any Material or Information Exclusion | 104228 | 11/09 |
| 4.         | Economic Sanctions | 117163 | 12/13 |
| 5.         | Personal and Advertising Injury Endorsement Limitation - (Cyber) | Manuscript | Manuscript |
| 6.         | Cancellation Condition Amendatory Endorsement | Manuscript | Manuscript |

**1 of 1**

FF-04 FMS (6/05)  
2 Forms Schedule 2017