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THE OFFER AND WITHDRAWAL RIGHTS WILL EXPIRE AT
THE END OF THE DAY, ONE MINUTE AFTER 11:59 P.M., EASTERN TIME, ON FRIDAY, MAY 27, 2022, UNLESS THE OFFER IS EXTENDED OR EARLIER TERMINATED (SUCH DATE AND TIME, AS IT MAY BE EXTENDED, THE “EXPIRATION DATE”). |
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If delivering by UPS, FedEx or Courier:
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If using a USPS Service:
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Broadridge Corporate Issuer Solutions, Inc.
Attn: BCIS IWS, 51 Mercedes Way, Edgewood, NY 11717 |
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Broadridge Corporate Issuer Solutions, Inc.
Attn: BCIS Re-Organization Dept., P.O. Box 1317, Brentwood, NY 11717-0718 |
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DESCRIPTION OF SHARES TENDERED
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Name(s) and Address(es) of Registered Holder(s)
(Please fill in, if blank, exactly as name(s) appear(s) on certificate(s)) (Attach additional signed list if necessary) |
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Shares Tendered
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Total Number
of Shares Tendered* |
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Certificate
Number(s) |
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Total Number of
Shares Represented by Certificate(s) |
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Book-Entry
Shares Tendered |
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| | | | | | | Total Shares | | | | | | | | | | | | | | |
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*
Unless otherwise indicated, it will be assumed that all Shares described in the chart above are being tendered. See Instruction 4.
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SPECIAL PAYMENT INSTRUCTIONS
(See Instructions 1, 5, 6 and 7) |
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| | | To be completed ONLY if the check for the purchase price of Shares accepted for payment and/or Certificates not tendered or not accepted for payment are to be issued in the name of someone other than the undersigned. | | |
| | | Issue check and/or Certificates to: | | |
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Name:
(Please Print)
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Address:
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(Include Zip Code)
(Taxpayer identification or Social Security No.)
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SPECIAL DELIVERY INSTRUCTIONS
(See Instructions 1, 5, 6 and 7) |
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| | | To be completed ONLY if the check for the purchase price of Shares accepted for payment and/or Certificates evidencing Shares not tendered or not accepted are to be mailed to someone other than the undersigned or to the undersigned at an address other than that shown above. | | |
| | | Mail check and/or Certificates to: | | |
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Name:
(Please Print)
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Address:
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(Include Zip Code)
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IMPORTANT
STOCKHOLDER: YOU MUST SIGN BELOW (U.S. Holders: Please complete and return the IRS Form W-9 included below) (Non-U.S. Holders: Please obtain, complete and return IRS Form W-8BEN or other IRS Form W-8) |
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(Signature(s) of Holder(s) of Shares)
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Dated:
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Name(s):
(Please Print)
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Capacity (full title) (See Instruction 5):
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Address:
(Include Zip Code)
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Area Code and Telephone No.:
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| | | Tax Identification or Social Security No. (See IRS Form W-9 included below): | | |
| | | (Must be signed by registered holder(s) exactly as name(s) appear(s) on Certificate(s) or on a security position listing or by person(s) authorized to become registered holder(s) by Certificates and documents transmitted herewith. If signature is by a trustee, executor, administrator, guardian, attorney-in-fact, agent, officer of a corporation or other person acting in a fiduciary or representative capacity, please set forth full title and see Instruction 5.) | | |
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If delivering by UPS, FedEx or Courier:
|
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If using a USPS Service:
|
|
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Broadridge Corporate Issuer Solutions, Inc.
Attn: BCIS IWS, 51 Mercedes Way, Edgewood, NY 11717 |
| |
Broadridge Corporate Issuer Solutions, Inc.
Attn: BCIS Re-Organization Dept., P.O. Box 1317, Brentwood, NY 11717-0718 |
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