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If delivering by hand, express mail, courier,
or other expedited service: |
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If delivering via a USPS Service:
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Broadridge Corporate Issuer Solutions, LLC
Attn: BCIS IWS 51 Mercedes Way Edgewood, NY 11717 |
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Broadridge Corporate Issuer Solutions, LLC
Attn: BCIS Re-Organization Dept. P.O. Box 1317 Brentwood, NY 11717-0718 |
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Name(s) and Address(es) of Registered Holder(s)
If there is any error in the name or address shown below, please make the necessary corrections. |
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Number of ADSs Tendered (Book-
Entry ADSs) (Please fill in. Attach separate schedule if needed — See Instruction 3) |
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TOTAL
ADSS: |
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Indicate below the order in which ADSs are to be purchased in the event of proration (attach additional signed list if necessary). If you do not designate an order and if less than all ADSs tendered are purchased due to proration, ADSs will be selected for purchase by the Depositary. See Instruction 11.
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| | | 1st: | | | 2nd: | | | 3rd: | | |
| | | 4th: | | | 5th: | | | | | |
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SPECIAL PAYMENT INSTRUCTIONS
(See Instructions 1, 4, 5 and 6) |
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To be completed ONLY if the check for the purchase price for ADSs accepted for payment (less any applicable withholding taxes and without interest, less a cancellation fee of $0.05 per ADS accepted for purchase in the Offer that will be paid to The Bank of New York Mellon) are to be issued in the name of someone other than the undersigned.
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| | | Issue check to: | | | | | |
| | | Name: | | |
(Please Print)
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| | | Address: | | |
(Include Zip Code)
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(Tax Identification or Social Security Number)
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SPECIAL DELIVERY INSTRUCTIONS
(See Instructions 1, 4, 5 and 6) |
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To be completed ONLY if the check for payment of the purchase price for ADSs accepted for payment (less any applicable withholding taxes and without interest, less a cancellation fee of $0.05 per ADS accepted for purchase in the Offer that will be paid to The Bank of New York Mellon) are to be sent to someone other than the undersigned or to the undersigned at an address other than that shown in the box titled “Description of ADSs Tendered.”
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| | | Issue check to: | | | | | |
| | | Name: | | |
(Please Print)
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| | | Address: | | |
(Include Zip Code)
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| | Signature of Owner(s): | | |
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| | Signature(s) of Owner(s): | | |
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| | Dated: | | |
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(Must be signed by registered holder(s) exactly as name(s) appear(s) on a security position listing or by person(s) authorized to become registered holder(s) ADSs as evidenced by endorsement or stock powers transmitted herewith. If signed by a trustee, executor, administrator, guardian, attorney-in-fact, officer of a corporation or other person acting in a fiduciary or representative capacity, the full title of the person should be set forth. See Instruction 4).
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| | Name(s): | | |
(Please Print)
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| | Capacity (full title): | | |
(Please Print)
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| | Address: | | |
(Include Zip Code)
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| | Daytime Area Code and Telephone Number: | | |
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| | Taxpayer Identification or Social Security No.: | | |
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| | Name of Firm: | | |
(Please Print)
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| | Address: | | |
(Include Zip Code)
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| | Authorized Signature: | | |
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| | Name: | | |
(Please Print)
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Area Code and Telephone Number:
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| | Dated: | | |
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