# SKANDIA AMERICA REINSURANCE CORPORATION

- ATLANTA
- CHICAGO
- HOUSTON
- LOS ANGELES
- NEW YORK
- SAN FRANCISCO

## CASUALTY FACULTATIVE REINSURANCE ENDORSEMENT

**National Facultative Services**
5 Marine View Plaza
Hoboken, New Jersey 07030

**Attention:** Mr. Leon Gonzalez

| Certificate No. | N-26176 |
|-----------------|---------|
| Endorsement No. | 1       |
| Effective Date  | 5/21/80 |
| Expiration Date | 5/21/81 |
| Policy No.      | To Be Determined |

**Coding Company** | **Intermediary** |
|------------------|------------------|
| National Union Fire Insurance Company | National Facultative Services |
| Name of Insured  | International Business Machines |
| City             | Armonk            |
| State            | New York          |

**Description of Change**

The Ceding Company's policy number is amended to read:
991 03 10

It is further agreed General Condition #9 Cancellation is amended to
60 Days except for non-payment of Premium.

| Premium | Date Payable | Company Gross | Skandia Gross | Commission |
|---------|--------------|---------------|---------------|------------|
| Additional | | | | |
| Return | | | | |

All other terms and conditions of this certificate remain unchanged.

IN WITNESS WHEREOF, Skandia has caused this Endorsement to be executed and attested and it shall become valid and binding when signed by a duly authorized representative.

**ATTEST:**

**Vice President** | **President** |
|------------------|---------------|
| Signature        | Signature     |
| Date             | Date          |
| 9/23/80          |               |
| WGK:lc           |               |

**Authorized Representative**

**Date** | **Form CF 2009 (1/79)**