Johnson & Higgins
032-034344

It is agreed that the policy premium is amended to read $4,838. in lieu of $4,816.

New Premium: $4,838.
Old Premium: $4,826.
Add'l Premium: $ 12.

This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below.

| ENDORSEMENT NO. | POLICY NO | ISSUED TO | EFFECTIVE DATE OF CHANGE |
|-----------------|-----------|-----------|-------------------------|
| 12              | RDX 1785610 | International Business Machine Corp. | ADDITIONAL OR $ 12. |

SUBSEQUENT ANNIVERSARY DATES
| 2               | PREVIOUS INSTALLMENT | ☐ ADDITIONAL OR ☐ RETURN | REVISED INSTALLMENTS |
|                 | $                  | $                        | $                    |
| 3               | $                  | $                        | $                    |

INSURANCE FROM
CNA
5/15/81 ec

Countersigned by
Authorized Agent