# Endorsement Issuance

**American Re-Insurance Company**
(Herein Called the Reinsurer)
One Liberty Plaza * 91 Liberty Street
New York, New York 10006

**Johnson & Higgins**
Insurance Brokers
Employer Benefit Plan Consultants
38 Wall St., New York 10005
WH 4-3160

**Attention:**
Mr. Richard Michel
International Business Machines Corp., Etal
(Theeinafter Called the Insured)

**Certificate Number:** M-0692473
**Effective Date of Endorsement:** 5/21/76
**Endorsement Number:** 5
**From:** 5/21/76
**To:** 5/21/77
**Reinsurance Certificate Period:** 5/21/76 to 5/21/77
**Total Additional or Return Premium:** $8,654.00

**Renewal Extension Endorsement**

In consideration of the payment of the premium shown above, it is understood and agreed that the coverage provided by the Certificate is extended for a further period of one year to expire May 21, 1977.

**Date of Next Installment:** [Not specified]

**American Re-Insurance Company**
Countersigned by:
[Signature]
Authorized Representative