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.: X 633 11 34

Effective: [Blank]

Named Insured and Address (Number and Street Number or City, County and State): [Blank]

Endorsement #3

Canadian Declarations

Named Insured: INTERNATIONAL BUSINESS MACHINES COMPANY LIMITED (CANADA)

Producer: JOHNSON & HIGGINS WILLIS FABER LTD. PLACE VICTORIA, MONTREAL, CANADA

Premium: $35.00

This endorsement shall not be binding upon the company unless countersigned by a duly authorized representative of the company.

Countersigned by: [Signature]