**Endorsement No. 2**

**Canadian Declarations**

**Named Insured:** International Business Machines Company Limited (Canada)

**Producer:** Johnson & Higgins Willis Faber Ltd., Place Victoria, Montreal, Canada

**Premium:** $186.77

On account of the foregoing, the additional premium is $ , the return premium is $ This endorsement shall not be binding upon the company unless countersigned by a duly authorized representative of the company. This endorsement forms a part of the designated policy and applies, unless otherwise stated herein, as of the effective time and date of such policy.

Policy No. LX.1.21.75.12 issued to

BY (Insert Name of Company)
Effective 19... at ... M.
(Date) (Hour and Minute)

COUNTERSIGNED BY (Authorized Representative)
BRANCH
OFFICE
GENERAL
AGENT
AGENT OR BROKER
(ADDRESS)
LIAB. 5087C