It is understood and agreed that $76.05 of the policy premium is payable in Canadian Currency - This is applicable to the Insured's Canadian operation and is brokered through Johnson & Higgins Willis Faber Ltd., Place Victoria, Montreal, Canada

| POLICY NUMBER | INSURED | EFFECTIVE |
|---------------|---------|-----------|
| XL 75249      | International Business Machines Corp., et al | 5/21/67 |

FIREMAN'S FUND INSURANCE COMPANY<br>
THE AMERICAN INSURANCE COMPANY<br>
NATIONAL INSURANCE CORPORATION<br>
ASSOCIATED INDEMNITY CORPORATION<br>
AMERICAN AUTOMOBILE INSURANCE COMPANY<br>
FIREMAN'S FUND INSURANCE COMPANY OF TEXAS

Johnson & Higgins<br>
COUNTERSIGNATURE OF AUTHORIZED AGENT
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This text appears to be an excerpt from an insurance policy document, detailing the payment terms for a portion of the premium in Canadian currency and listing the insured parties and the insurance companies involved.