# Skandia America Reinsurance Corporation

## Casualty Facultative Reinsurance Endorsement

**Skandia Group®**

- **ATLANTA**: ☐
- **CHICAGO**: ☐
- **HOUSTON**: ☐
- **LOS ANGELES**: ☐
- **NEW YORK**: ☑
- **SAN FRANCISCO**: ☐

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

**Attention:** Mr. Leon Gonzalez

| Certificate No. | N-26176 |
|-----------------|---------|
| Endorsement No. | 2        |
| Effective Date  | 5/21/80  |
| Expiration Date | 5/21/81  |
| Policy No.      | 991 03 10 |

**Ceding Company** | **Intermediary** |
|------------------|------------------|
| National Union Fire Insurance Company | National Facultative Services |

**Name of Insured** | **City** | **State** |
|-------------------|----------|-----------|
| International Business Machines | Armonk | New York |

**Description of Change**

In consideration of the premium already charged,
it is agreed to add the following to our certificate:
Canadian Policy 991-0310/ ce 364 0492

| 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**  
**Date**  
**Authorized Representative**