# Premium Allocation Endorsement

IT IS AGREED THAT THE PREMIUM FOR WHICH THIS POLICY IS WRITTEN SHALL BE PAYABLE AS FOLLOWS:

- UNITED STATES: $3633.
- CANADIAN: $117.

CANADIAN FUNDS PAYABLE THROUGH:

- JOHNSON & HIGGINS WILLIS FAHER LTD.
  - PLACE VICTORIA
  - MONTREAL, QUEBEC, CANADA.

**POLICY NUMBER:** XL-95789  
**INSURED:** INTERNATIONAL BUSINESS MACHINES CORP.  
**EFFECTIVE:** 5/21/70  

**PRODUCER:**  
**COUNTERSIGNATURE OF AUTHORIZED AGENT:** (Signature)