# Document Image

The document appears to be an insurance register or claim form from B.S.D., Johnson & Higgins, Office 001. Here is the transcription of the visible information:

## Header Information
- **Office**: B.S.D., Johnson & Higgins, Office 001
- **Date**: 10/08/84
- **Time**: 14:45
- **Page**: 1
- **ID**: 2305-00000
- **Invoice Number**: 3010-124576
- **To Parent**: Our 0363 Michel R
- **From**: 03984
- **Amount**: $2,022.00
- **Payment Method**: Check
- **Check Number**: 10577
- **Due Date**: 11/21/84
- **Insurance Company**: Business Machines Corp.
- **Address**: 2000 Purchase Street, Purchase NY
- **Agent**: J.M. Costello, INS Dept.

## Insurance Pre-filling Details
- **Policy Number**: 03278478
- **Class**: General Liability
- **Underwriter**: 052185
- **Payee**: 079
- **Log**: 079
- **Amount**: $2,024.00
- **Commission**: $47.00
- **Tax Received**: $0.00

## Installment Schedule
- **Installment No.**: 1
- **Date**: 12/21/84
- **Amount**: $337.00
- **Billed**: Yes

## Additional Information
- **Transaction ID**: 124576
- **Transaction Type**: 1 (Monthly)
- **Transaction Amount**: $337.00
- **Transaction Status**: Billed

## Footer Information
- **MM**: 009852

This document seems to be related to an insurance claim or payment processing for a general liability policy with Business Machines Corp.