| | | THE OFFER, PRORATION PERIOD AND WITHDRAWAL RIGHTS WILL EXPIRE AT 12:00 MIDNIGHT, NEW YORK CITY TIME, AT THE END OF THE DAY ON DECEMBER 19, 2025, UNLESS THE OFFER IS EXTENDED (SUCH TIME, AS IT MAY BE EXTENDED, THE “EXPIRATION TIME”). | | |
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By First Class, Registered or
Certified Mail: Computershare Trust Company, N.A. Depositary c/o Voluntary Corporate Actions PO Box 43011 Providence, Rhode Island 02940-3011 |
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By Express or Overnight Delivery:
Computershare Trust Company, N.A. Depositary c/o Voluntary Corporate Actions 150 Royall Street, Suite V Canton, Massachusetts 02021 |
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1st:
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4th:
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| | 5th: | | |
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DESCRIPTION OF SHARES TENDERED
(See Instructions 3 and 4) |
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Shares Tendered
(Attach additional list if necessary) |
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Name(s) and Address(es) of Registered
Holder(s) (Please fill in exactly as name (s) appear(s) on certificate(s)) |
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Certificate
Number(s)* |
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Number of Shares
Represented by Certificate(s)* |
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Total Number of
Shares Represented by Book entry (Electronic Form) Tendered |
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Number of Shares
Tendered** |
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Total Shares
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*
Need not be completed if Shares are delivered by book-entry transfer.
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**
Unless otherwise indicated, it will be assumed that all Shares represented by any certificates delivered to the Depositary are being tendered. See Instruction 4.
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| | Name of Tendering Institution: | | |
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DTC Participant Number:
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Account Number:
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Transaction Code Number:
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Name(s) of the Tendering Shareholder(s):
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Window Ticket Number (if any):
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Date of Execution of Notice of Guaranteed Delivery:
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Name of Eligible Institution Which Guaranteed Delivery:
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DTC Participant Number (if delivered by book-entry transfer):
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☐
$1,850
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☐
$1,855
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☐
$1,860
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☐
$1,865
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☐
$1,870
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☐
$1,875
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☐
$1,880
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☐
$1,885
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☐
$1,890
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☐
$1,895
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☐
$1,900
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☐
$1,905
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☐
$1,910
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☐
$1,915
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☐
$1,920
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☐
$1,925
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☐
$1,930
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☐
$1,935
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☐
$1,940
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☐
$1,945
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☐
$1,950
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☐
$1,955
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☐
$1,960
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☐
$1,965
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☐
$1,970
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☐
$1,975
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☐
$1,980
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☐
$1,985
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☐
$1,990
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☐
$1,995
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☐
$2,000
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☐
$2,005
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☐
$2,010
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☐
$2,015
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☐
$2,020
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☐
$2,025
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☐
$2,030
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☐
$2,035
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☐
$2,040
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☐
$2,045
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☐
$2,050
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SPECIAL DELIVERY INSTRUCTIONS
(See Instructions 4 and 9) |
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| | | To be completed ONLY if the check for the aggregate Purchase Price of Shares purchased and/or certificates for Shares not tendered or not purchased are to be mailed to someone other than the undersigned or to the undersigned at an address other than that shown below the undersigned’s signature. | | | |||
| | | Mail ☐ check and/or ☐ certificates to: | | | |||
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(Please Print)
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(Please Include Zip Code)
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SPECIAL PAYMENT INSTRUCTIONS
(See Instructions 1, 4, 5, 6 and 9) |
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| | | To be completed ONLY if the check for the aggregate Purchase Price of Shares purchased and/or certificates for Shares not tendered or not purchased are to be issued in the name of someone other than the undersigned. | | | |||
| | | Issue any ☐ check and/or ☐ certificates to: | | | |||
| | | Name | | |
(Please Print)
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| | | Address | | |
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(Please Include Zip Code)
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(Taxpayer Identification Number)
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SIGN HERE
(See Instructions 1 and 5) (Please complete Substitute Form W-9 below or appropriate W-8, as applicable) By signing below, the undersigned expressly agrees to the terms and conditions set forth above. |
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(Please Print)
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(Include Zip Code)
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Taxpayer Identification or Social
(See Instruction 11)
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| | | (Must be signed by registered holder(s) exactly as name(s) appear(s) on share 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. See Instruction 5.) | | | |||
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SIGN HERE
(See Instructions 1 and 5) (Please complete Substitute Form W-9 below or appropriate W-8, as applicable) By signing below, the undersigned expressly agrees to the terms and conditions set forth above. |
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(Please Print)
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(Include Zip Code)
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Taxpayer Identification or Social
(See Instruction 11)
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| | | (Must be signed by registered holder(s) exactly as name(s) appear(s) on share 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. See Instruction 5.) | | | |||
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GUARANTEE OF SIGNATURE(S)
(See Instructions 1 and 5) |
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(Please Print)
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(Include Zip Code)
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| | | PAYER’S NAME: Computershare Trust Company, N.A. | | | ||||||||
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SUBSTITUTE
FORM W-9 |
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Part 1 — PLEASE PROVIDE YOUR TIN IN THE BOX AT RIGHT AND CERTIFY BY SIGNING AND DATING BELOW
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Social Security Number(s)
OR
Employer Identification Number(s)
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Department of the Treasury Internal
Revenue Service |
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Part 2 — Certification — Under penalties of perjury, I certify that:
(1)
the number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a number to be issued to me);
(2)
I am not subject to backup withholding because (a) I am exempt from backup withholding or (b) I have not been notified by the Internal Revenue Service (the “IRS”) that I am subject to backup withholding as a result of a failure to report all interest or dividends or (c) the IRS has notified me that I am no longer subject to backup withholding; and
(3)
I am a U.S. citizen or other U.S. person for U.S. Federal income tax purposes; and
(4)
The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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Part 3 — Awaiting TIN ☐
Part 4 — Exempt payee code
(if any)
Part 5 — Exemption from FATCA reporting code
(if any)
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Payer’s Request for Taxpayer Identification Number (TIN)
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Certification instructions — You must cross out item (2) in Part 2 above if you have been notified by the IRS that you are subject to backup withholding because of under-reporting interest or dividends on your tax returns. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS stating that you are no longer subject to backup withholding, do not cross out such item (2). If you are exempt from backup withholding, enter any code(s) that may apply to you in the appropriate space in Part 4 above.
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SIGN SIGNATURE OF U.S. PERSON
HERE DATE |
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CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER
I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver such an application in the near future. I understand that if I do not provide a taxpayer identification number to Computershare Trust Company, N.A., 24% of all reportable payments made to me will be withheld, but will be refunded to me if I provide a certified taxpayer identification number within 60 days.
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Signature
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Date
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For this type of account
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Give the name and
SOCIAL SECURITY number of: |
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1.
An individual’s account
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| | The individual | |
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2
Two or more individuals (joint account) other than an account maintained by a foreign financial institution (“FFI”)
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| | The actual owner of the account or, if combined funds, the first individual on the account(1) | |
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3.
Two or more U.S. persons (joint account maintained by a FFI)
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| | Each holder of the account | |
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4.
Custodian account of a minor (Uniform Gifts to Minors Act)
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| | The minor(2) | |
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5.
a.
The usual revocable savings trust (grantor is also trustee)
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| | The grantor-trustee(1) | |
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b.
So-called trust account that is not a legal or valid trust under state law
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| | The actual owner(1) | |
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6.
Sole proprietorship or disregarded entity owned by an individual
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| | The owner(3) | |
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7.
Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1.671-4(b)(2)(i)(A))
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| | The grantor* | |
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Give the name and
EMPLOYER IDENTIFICATION number of: |
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8.
Disregarded entity not owned by an individual
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| | The owner | |
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9.
A valid trust, estate, or pension trust
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| | Legal entity(4) | |
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10.
Corporation or LLC electing corporate status on Form 8832 or Form 2553
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| | The corporation | |
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11.
Association, club, religious, charitable, educational, or other tax- exempt organization
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| | The organization | |
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12.
Partnership or multi-member LLC
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| | The partnership | |
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13.
A broker or registered nominee
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| | The broker or nominee | |
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14.
Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments
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| | The public entity | |
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15.
Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1.671-4(b)(2)(i)(B))
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| | The trust | |
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By First Class, Registered or
Certified Mail: Computershare Trust Company, N.A., Depositary c/o Voluntary Corporate Actions PO Box 43011 Providence, Rhode Island 02940-3011 |
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By Express or Overnight Delivery:
Computershare Trust Company, N.A., Depositary c/o Voluntary Corporate Actions 150 Royall Street, Suite V Canton, Massachusetts 02021 |
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BofA Securities
BofA Securities, Inc. One Bryant Park New York, NY 10036 Toll Free: (888) 803-9655 |
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Barclays
Barclays Capital Inc. 745 Seventh Avenue, 5th Floor New York, NY 10019 Direct: (212) 528-7581 Toll Free: (888) 610-5877 |
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