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THE OFFER AND WITHDRAWAL RIGHTS EXPIRE AT ONE MINUTE FOLLOWING 11:59 P.M., EASTERN TIME, ON NOVEMBER 7, 2023, UNLESS THE OFFER IS
EXTENDED OR TERMINATED. |
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THIS FORM SHOULD BE COMPLETED, SIGNED AND SENT TOGETHER WITH ALL OTHER DOCUMENTS, INCLUDING YOUR CERTIFICATES FOR SHARES OF COMMON STOCK, TO COMPUTERSHARE TRUST COMPANY, N.A. (THE “DEPOSITARY & PAYING AGENT”) AT ONE OF THE ADDRESSES SET FORTH BELOW. DELIVERY OF THIS LETTER OF TRANSMITTAL OR OTHER DOCUMENTS OR INSTRUCTIONS TO AN ADDRESS OTHER THAN AS SET FORTH BELOW DOES NOT CONSTITUTE VALID DELIVERY. DELIVERIES TO INTERSTELLAR ACQUISITION INC., ALFASIGMA S.P.A. OR GEORGESON LLC. (THE “INFORMATION AGENT”) WILL NOT BE FORWARDED TO THE DEPOSITARY & PAYING AGENT AND THEREFORE WILL NOT CONSTITUTE VALID DELIVERY. DELIVERIES TO THE DEPOSITORY TRUST COMPANY WILL NOT CONSTITUTE VALID DELIVERY TO THE DEPOSITARY & PAYING AGENT.
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By First Class, Registered or Certified Mail:
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By Express or Overnight Delivery:
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Computershare Trust Company, N.A., Depositary
c/o Voluntary Corporate Actions P.O. Box 43011 Providence, RI 02940-3011 |
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Computershare Trust Company, N.A., Depositary
c/o Voluntary Corporate Actions 150 Royall Street, Suite V Canton, MA 02021 |
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DESCRIPTION OF SHARES TENDERED
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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) or DRS Account) |
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Shares Tendered
(Attach additional list if necessary — See Instruction 3) |
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Share Certificate
Number(s)* |
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Total Number of
Shares Evidenced by Certificate(s) or DRS Shares** |
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Number of
Shares Tendered*** |
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*
Need not be completed by stockholders tendering by book-entry transfer or if Shares are held through a book-entry/direct registration account (a “DRS Account”) maintained by Intercept Pharmaceuticals, Inc’s transfer agent (such Shares, “DRS Shares”).
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**
Need not be completed by stockholders tendering by book-entry transfer.
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***
Unless otherwise indicated, it will be assumed that all Shares described above are being tendered. See Instruction 4.
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Name of Tendering Institution:
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| Account Number: | | |
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| Transaction Code: | | |
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Name(s) of Tendering Stockholder(s):
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| Date of Execution of Notice of Guaranteed Delivery: , 2023 | | |||
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Name of Eligible Institution which Guaranteed Delivery:
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| If Delivery is by Book-Entry Transfer: | |
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Name of Tendering Institution:
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| Account Number: | | |
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| Transaction Code Number: | | |
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| Name: | | |
(Please Print)
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| Address: | | |
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(Include Zip Code)
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Taxpayer Identification Number:
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Account Name:
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Name:
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(Please Print)
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| Address: | | |
(Include Zip Code)
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Sign Here:
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Sign Here:
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| Name(s): | | |
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Business name, if different from above:
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(Please Print)
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Capacity (Full Title):
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| Address: | | |
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(Include Zip Code)
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Area Code and Telephone Number:
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Name of Firm:
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| Address: | | |
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(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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