This endorsement effective on
at 12:01 A.M. standard time
forms part of Policy Number:
NEA 0109021
Issued to:
IBM CORPORATION
By:
RELIANCE INSURANCE COMPANY

NEW YORK
POLICYHOLDER NOTICE

Any person who knowingly and with intent to defraud any Insurance company or other person files an application for insurance containing any materially false information or conceals for the purpose of misleading, Information concerning any fact material thereto commits a fraudulent insurance act, which is a crime, and shall be also subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

N/A
Insured's Signature

NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS.