# Forms Schedule

**Named Insured:** INTERNATIONAL BUSINESS MACHINES CORP  
**Policy No.:** 8653496  
**Effective Date:** 05/21/91  

| Form Number | Edition Date | Title |
|-------------|--------------|-------|
| LEXOCCFF4   | 11/89        | FOLLOW FORM X/S DEC 4 |
| LEXOCCFF4T  | 12/90        | OCC FOLLOW FORM 4 TEXT |
| ENDT # 001  |              | MINIMUM EARNED PREMIUM |
| ENDT # 002  |              | NAMED PERIL POLLUTION |

DOC018(Ed.12/87)  
LX0295