**THE UNITY FIRE AND GENERAL INSURANCE COMPANY**
THE GENERAL SECURITY ASSURANCE CORPORATION OF NEW YORK
127 JOHN STREET
NEW YORK, N.Y. 10038

**National Facultative Services**
5 Marineview Plaza
Hoboken, NJ 07030
ATTENTION: Mr. Lee Gonzalez

**Policy Number:** A-1025
**Effective Date:** 5/21/80
**Expiration Date:** 5/21/81
**Company Policy Number:** 991 03 10

**Insured:**
National Union Fire Insurance Company
National Facultative Services
International Business Machines Corp., etal
Address of Insured: Armonk, NY

**Description of Change:**
It is agreed that the Company Policy Number is amended to read:
US: 991 03 10
Canada: CE 364 0505

**Additional Premium:** ☐
(Return Premium): ☐

**At Inception:** $ | $ | % | $ | I
$ | $ | % | $ |
$ | $ | % | $ |
Totals: $ | $ | $ |

**All other terms and conditions remain unchanged**

IN WITNESS WHEREOF THE REINSURER DESIGNATED ABOVE HAS CAUSED THIS ENDORSEMENT TO BE SIGNED BY ITS PRESIDENT AND SECRETARY AND IT SHALL BECOME VALID AND BINDING WHEN SIGNED BY A DULY AUTHORIZED REPRESENTATIVE OR CHIEF AGENT.

**James T. Dunne**  
Secretary  
6/8/81

**Rak/kg**  
**Date:**  
**CFD 1001**

**Authorized Representative or Chief Agent:**  
**President:**  
**Signature:**