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ACCOUNT #
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CERT SHARES
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BOOK SHARES
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TOTAL SHARES
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SSUE #
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FOR OFFICE USE ONLY Approved
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W-9 Completed
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Box 1 — DESCRIPTION OF ADSs TENDERED
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Account Registration
(Please Fill in, if blank) Please make any address correction below |
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ADS Certificate(s) Tendered
(Please attach additional signed list, if necessary) |
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□
indicates permanent address change
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Certificate
Number(s) and/or indicate Book- Entry |
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Total Number of
Shares Represented by Certificate(s) |
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Number
of Shares Tendered(1)(2) |
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| | | | | | | Total Shares Tendered | | | ||||||||
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(1)
If shares are held in Book-Entry form, you must indicate the number of shares you are tendering. Otherwise, all Shares represented by Book-Entry delivered to the Depositary Agent will be deemed to have been tendered. By signing and submitting this Letter of Transmittal you warrant that these ADSs will not be sold, including through limit order request, unless properly withdrawn from the Offer. See Instruction 4.
(2)
If you wish to tender fewer than all ADSs represented by any certificate listed above, please indicate in this column the number of shares you wish to tender. Otherwise, all ADSs represented by ADS Certificates delivered to the Tender Agent will be deemed to have been tendered.
(3)
If your Share Certificate(s) have been lost or mutilated. See Instruction 4.
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IMPORTANT
ADS HOLDER: SIGN HERE |
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(Signature(s) of Owner(s))
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(See Instructions)
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(Include Zip Code)
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| | | (Must be signed by the registered holder(s) exactly as name(s) appear(s) on ADS certificate(s) or on a security position listing or by the 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, officer of a corporation or other person acting in a fiduciary or representative capacity, please set forth full title) | | | |||
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GUARANTEE OF SIGNATURE(S)
(If required — See Instructions 1) |
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APPLY MEDALLION GUARANTEE STAMP BELOW
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Box 3 — SPECIAL PAYMENT INSTRUCTIONS
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(See Instruction 2)
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| | | To be completed ONLY if the check for payment is to be issued in the name of someone other than the registered holder. | | | |||
| | | Issue To: | | | |||
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(Please Print)
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(Include Zip Code)
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(recipient must complete the enclosed form w-9 (or appropriate internal revenue service form w-8, as applicable))
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Box 4 — SPECIAL DELIVERY INSTRUCTIONS
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(See Instruction 3)
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| | | To be completed ONLY if the check is to be sent to someone other than the undersigned or to the undersigned at an address other than that shown under “Description of ADSs Tendered.” | | |
| | | Mail To: | | |
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(Please Print)
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(Include Zip Code)
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