# Premium Allocation Endorsement

**IT IS AGREED THAT THE PREMIUM FOR WHICH THIS POLICY IS WRITTEN SHALL BE PAYABLE AS FOLLOWS:**

- **UNITED STATES:** $5450.
- **CANADIAN:** $175.

**CANADIAN FUNDS PAYABLE THROUGH:**
- JOHNSON & HIGGINS WILLIA FAHER LTD.
- PLACE VICTORIA
- MONTREAL, QUEBEC, CANADA

**POLICY NUMBER:** LX-75249  
**INURED:** INTERNATIONAL BUSINESS MACHINES CORP.  
**EFFECTIVE:** 5/21/70  

**PRODUCER:** FIREMAN'S FUND INSURANCE COMPANY, THE NATIONAL SURETY CORPORATION, ASSOCIATED INSURANCE CORPORATION, AMERICAN AUTOMOBILE INSURANCE COMPANY, FIREMAN'S FUND INSURANCE COMPANY OF TEXAS  

**COUNTERSIGNATURE OF AUTHORIZED AGENT:** [Signature]