**INA Insurance Company of North America**

**CANADIAN DECLARATIONS**

| Canadian Agent and | Johnson & Higgins-Willis Faber Ltd. |
|-------------------|------------------------------------|
| Address and Phone  | Place Victoria, Suite 2500         |
|                   | Montreal, Canada                   |
| No.               | 3386                              |

**1. NAMED INSURED**
- **Address:** INTERNATIONAL BUSINESS MACHINES CORP., et al.
- **Address:** Armonk, New York 10504

**Business of the Named Insured:** Mfg. of business machines

**2. Policy Period: From** 5/21/73 to 5/21/76

**3. PREMIUM COMPUTATION: Description of Property, Coverages, including Limits of Liability**

- **Certificate of excess insurance:** $5,000,000. Quota share part of $40,000,000 excess of primary and $40,000,000 intervening excess

**MAJOR PERIL OR LOSS:** $211.00 prepaid for 3 years

**Secretary:** [Signature]
**Charles K. [Last Name]**