| |
DESCRIPTION OF ADSs TO BE WITHDRAWN
|
| |||
| | Number of ADSs to be withdrawn: | | |
|
|
| | CUSIP No.: | | |
|
|
| | Name of Tendering Stockholder: | | |
|
|
| | Name of Registered Holder of the ADSs: | | |
|
|
| |
By Mail:
|
| |
By Registered or Overnight Delivery:
|
|
| |
Computershare Trust Company, N.A.
c/o Voluntary Corporate Actions P.O. Box 43011 Providence, RI 02940-3011 |
| |
Computershare Trust Company, N.A.
c/o Voluntary Corporate Actions 150 Royall Street, Suite V Canton, MA 02021 |
|
| |
Name of Book-Entry Transfer Facility Participant:
|
| |
|
|
| | Account Number(s): | | |
|
|
| | Signature(s): | | |
|
|
| | Capacity (Full Title): | | |
|
|
| | Address (and Zip Code): | | |
|
|
| | Telephone Number: | | |
|
|
| | TIN or SSN: | | |
|
|
| | Book-Entry Transfer Facility Participant No.: | | |
|
|
| | Transaction Code Number: | | |
|
|
| | Date: | | |
|
|