**Document Title:**

This document appears to be an insurance policy endorsement form, specifically related to International Business Machines Corporation (IBM). The form is dated 5/21/79 and references a specific policy number.

**Details:**

- **Policy Number:** 69 28 463
- **Special Date of Policy:** 5/5/21/79
- **Effective Date of End:** 5/21/79
- **Agency No.:** 50 56
- **Additional Premium:** $ - 
- **Return Premium:** $ -
- **Named Insured:** INTERNATIONAL BUSINESS MACHINES CORPORATION

**Endorsement Details:**

The endorsement is issued by the company named below, which is the insurer under the policy designated above. It forms part of said policy as of the effective date hereof, at the hour stated in the policy declarations.

**Amendment:**

It is understood and agreed that Item 4, Policy Number, is amended to read:

- **Policy Number:** 462-01-86-23

**Other Terms and Conditions:**

All other terms and conditions remain unchanged.

**Signatures:**

- **JOHNSON & HIGGINS:** DW: eq 6/27/79
- **ZURICH INSURANCE COMPANY**
- **AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

**Countersigned:**

- **Authorized Agent:**
- **United States Manager (Zurich)**
- **President (American Guarantee)**
- **Secretary (American Guarantee)**

**Form Reference:**

U-GU-116-G REV. 11-76