**POLICY NO.** | **EFFECTIVE DATE** | **AGENCY NO.** | **ADD'L PREMIUM** | **RETURN PREMIUM**
8359700 | DEC. 31, 1962 | 50-515 | $ | $

**Named Insured:** INTERNATIONAL BUSINESS MACHINES CORPORATION, ETAL

This endorsement is issued by the company named below which is the insurer under the policy designated above issued to the Named Insured and forms a part of said policy as of the effective date hereof at the hour stated in the policy Declarations.

**PREMIUM COMPUTATION ENDORSEMENT**

THE PREMIUM FOR SUCH INSURANCE AS IS AFFORDED BY THE POLICY SHALL BE COMPUTED BY APPLYING TO EACH $1000 OF WORKMEN'S COMPENSATION PAYROLL, THE COMPOSITE RATE ESTABLISHED FOR THE POLICY.

| EST. ANN. PAYROLL | COMPOSITE RATE PER $1000. OF PAYROLL | DISCOUNTED EST. PREMIUM |
| --- | --- | --- |
| $549,000,000. | 2.4954 | $137,000.00 |

**ZURICH INSURANCE COMPANY**  
**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

**JOHNSON & HIGGINS**  
**GS:AD**

**United States Manager (Zurich)**  
**President (American Guarantee)**

**Countersigned:**  
**Daily authorized agency:**  
**ATTORNEY IN FACT**

**Form 116-G**  
**100 W 10-62**  
**100-64M**

**Z 006839**