**POLICY NO:** 8448300  
**EFFECTIVE DATE:** DEC. 31, 1963  
**AGENCY NO:** 50-515  
**ADD'L PREMIUM:** $  
**RETURN PREMIUM:** $  

**Named Insured:** INTERNATIONAL BUSINESS MACHINES CORPORATION, ETAL

This endorsement is issued by that company named below which is the insurer under the policy designated above issued to the Named Insured and forms a part of said policy as of the effective date hereof, at the hour stated in the policy Declarations.

**THIS ENDT. CANCELS & SUPERSEDES ENDT. #15 PREVIOUSLY ISSUED.**

**PREMIUM COMPUTATION ENDORSEMENT**

THE PREMIUM FOR SUCH INSURANCE AS IS AFFORDED BY THE POLICY SHALL BE COMPUTED BY APPLYING TO EACH $1,000 OF WORKMEN'S COMPENSATION PAYROLL THE COMPOSITE RATE ESTABLISHED FOR THE POLICY.

| EST. ANN. PAYROLL | COMPOSITE RATES | EST. PREM. |
|------------------|-----------------|------------|
| 610,000,000      | B.I.            | .18126     | 110,483.80 |
|                  | P.D.            | .03574     | 23,716.20  |
|                  |                 | .22000     | 134,200    |
|                  |                 | (INCL. PREM. DISC.) |

**JOHNSON & HIGGINS**  
**CBM:BW**

**ZURICH INSURANCE COMPANY**  
**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

**Countersigned:**  
**Vital P. Nigos**  
**Duly authorized agent**  
**ATTORNEY IN FACT**

**Form 116-G**  
**100 M. 12-64**  
**100 - CBM**

**United States Manager (Zurich)**  
**President (American Guarantee)**

**Secretary (American Guarantee)**

**Z 006869**