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.

Issued By: [Blank]

Producer's Name and Address: [Blank] | Producer's Code: [Blank]

Policy No.: LX 633 11 34

Effective: [Blank]

On Account of the Following The Additional Premium is $ [Blank] Return Premium is $ [Blank]

Endorsement No. 1

Named Insured

International Business Machines Corporation,
I.B.M. World Trade Corp. and any other subsidiary or affiliated corporation of each provided such other subsidiary or affiliated corporation warrants that it is under the same operative and financial control through the identity of its officers, directors or stockholders.

This endorsement shall not be binding upon the company unless countersigned by a duly authorized representative of the company.
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**Note:** The blanks need to be filled with the appropriate information for the endorsement to be valid.