| | | | |
THE OFFER AND WITHDRAWAL RIGHTS WILL EXPIRE ONE MINUTE AFTER 11:59 P.M., NEW YORK TIME, ON JUNE 7, 2018, UNLESS THE OFFER IS EXTENDED OR EARLIER TERMINATED (SUCH DATE AND TIME, AS IT MAY BE EXTENDED, THE “EXPIRATION DATE”).
|
|
| | |
DESCRIPTION OF SHARES TENDERED
|
| ||||||||||||
| | |
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) |
| |
Shares Tendered
|
| |||||||||
| | | | | |
Certificate
Number(s)(*) |
| |
Class of Shares
(Common or 7% Series B Convertible Preferred) |
| |
Total Number
of Shares Represented by Certificate(s)(**) |
| |
Total Number
of Shares Tendered(**) |
|
| | | | | | | | | | | | | ||||
| | | | | | | | | | | | | ||||
| | | | | | | | | | | | | ||||
| | | | |
Total Shares
|
| | | | | | | ||||
| | |
(*)
Certificate numbers are not required if tender is being made by book-entry transfer.
|
| ||||||||||||
| | |
(**)
Unless a lower number of Shares to be tendered is otherwise indicated, it will be assumed that all Shares described above are being tendered. See Instruction 4.
|
| ||||||||||||
| | ☐ | | | CHECK HERE IF TENDERED SHARES ARE BEING DELIVERED HEREWITH. | |
| | ☐ | | | CHECK HERE IF YOU HAVE LOST YOUR SHARE CERTIFICATE(S) AND REQUIRE ASSISTANCE IN OBTAINING REPLACEMENT CERTIFICATE(S). BY CHECKING THIS BOX, YOU UNDERSTAND THAT YOU MUST CONTACT THE TRANSFER AGENT TO OBTAIN INSTRUCTIONS FOR REPLACING LOST CERTIFICATES. SEE INSTRUCTION 11. | |
| | ☐ | | | CHECK HERE IF TENDERED SHARES ARE BEING DELIVERED BY BOOK-ENTRY TRANSFER MADE TO AN ACCOUNT MAINTAINED BY THE DEPOSITARY WITH DTC AND COMPLETE THE FOLLOWING (NOTE THAT ONLY FINANCIAL INSTITUTIONS THAT ARE PARTICIPANTS IN THE SYSTEM OF DTC MAY DELIVER SHARES BY BOOK-ENTRY TRANSFER): | |
| | Name of Tendering Institution | | |
|
|
| | DTC Account Number: | | |
|
|
| | Transaction Code Number: | | |
|
|
| | ☐ | | | CHECK HERE IF TENDERED SHARES ARE BEING DELIVERED PURSUANT TO A NOTICE OF GUARANTEED DELIVERY PREVIOUSLY SENT TO THE DEPOSITARY AND COMPLETE THE FOLLOWING: | |
| | Name(s) of Tendering Stockholder(s): | | |
|
|
| | Window Ticket Number (if any): | | |
|
|
| | Date of Execution of Notice of Guaranteed Delivery: | | |
|
|
| | Name of Eligible Institution that Guaranteed Delivery: | | |
|
|
| | | | |
SPECIAL PAYMENT INSTRUCTIONS
(See Instructions 1, 5, 6 and 7) |
| |||
| | | | | To be completed ONLY if the check for the purchase price of Shares accepted for payment and/or Share 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: | | |||
| | | | |
Name:
|
| |
(Please Print)
|
|
| | | | |
Address:
|
| |
(Include Zip Code)
|
|
| | | | | | | |
(Taxpayer Identification or Social
Security No.) |
|
| | | | |
(Also Complete, as applicable, IRS Form W-9 Included Below, or appropriate
IRS Form W-8) |
| |||
| | | | |
SPECIAL DELIVERY INSTRUCTIONS
(See Instructions 1, 5, 6 and 7) |
| |||
| | | | | To be completed ONLY if the check for the purchase price of Shares accepted for payment and/or Share 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 Share Certificates to: | | |||
| | | | |
Name:
|
| |
(Please Print)
|
|
| | | | | Address: | | |
|
|
| | | | | | |
(Include Zip Code)
|
| |
| | | | | | | | | |
| | | | |
IMPORTANT
STOCKHOLDER: 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 appropriate IRS Form W-8) |
|
| | | | |
(Signature(s) of Holder(s) of Shares)
|
|
| | | | |
Name(s)
(Please Print)
|
|
| | | | |
Capacity (full title) (See Instruction 5):
|
|
| | | | |
Address:
|
|
| | | | |
(Include Zip Code)
|
|
| | | | |
Area Code and Telephone No.:
|
|
| | | | |
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 stock 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.) | |