ELECTIONS — BOI 58 SAMPLE LT Investor ID Number ELECTION FORM COMPANY A AND COMPANY B. (ADD TEXT HERE) I/we the undersigned surrender to you for exchange the share(s) identified below. I/we certify that I/we have complied with all requirements as stated in the instructions on the reverse side was/were the registered holder(s) of the shares of COMPANY A stock represented by the enclosed certificates have full authority to surrender these certificate(s) and give the instructions in this Transmittal Form and warrant that the shares represented by these certificates are free and clear of all liens restrictions adverse claims and encumbrances. PLEASE CERTIFY YOUR TAXPAYER IDENTIFICATION NUMBER (TIN) BY COMPLETING THE INFORMATION IN BOX NUMBER ON THE REVERSE SIDE. PLACE AN [X]IN ONE ELECTION BOX ONLY P 1 All Cash Election Only l~ I All Stock Election Only (SHARES ELECTED FOR CASH) A Signature: This form must be signed by the registered holder(s) exactly as their name(s) appears on the certifi- i 1zx ... i 1 1 1 1 1 1 1 1 i 1 1 1 1 v cate(s) or by person(s) authorized to sign on behalf of the registered holder(s) by documents transmitted herewith. Q Mixed ^ X            WHOLE SHARES FRACTIONS Signature of Stockholder            Date Daytime Telephone Note: Remaining shares are elected for stock. X            P No Preference Signature of Stockholder Date Daytime Telephone If you cannot produce some or all of your COMPANY A stock certificates you must obtain a lost instrument open penalty surety bond. Please see the reverse side of this form for instructions. Please complete the back if you would like to transfer ownership or request special mailing. AFFIDAVIT OF LOST MISSING OR DESTROYED CERTIFICATE(S) AND AGREEMENT OF INDEMNITY Investor ID Number THIS AFFIDAVIT IS INVALID IF A CHECK IS NOT INCLUDED AND IF THE AFFIDAVIT IS NOT SIGNED AND NOTARIZED BELOW. NOTE: FOREIGN OWNERS MUST also include Apostille seal or legal equivalent. TOTAL SHARES LOST Please Fill In Certificate No(s). if Known Number of Shares Attach separate schedule if needed By signing this form I/We or myself/ourselves swear depose and state that: I/We or myself/ourselves am/are the lawful owner(s) of the certificate(s) hereinafter referred to as the “securities” described in the Letter of Transmittal. The securities have not been endorsed pledged cashed negotiated transferred assigned or otherwise disposed of. I/We or myself/ourselves have made a diligent search for the securities and have been unable to find it or them and make this Affidavit for the purpose of inducing the sale exchange redemption or cancellation of the securities as outlined in the Letter of Transmittal without the surrender of the original(s) and also to request and induce Federal Insurance Company to provide suretyship for me/us to cover the missing securities under its Blanket Bond 8302-00-67. I/We or myself/ourselves hereby agree to surrender the securities for cancellation should I/We or myself/ourselves at any time find the securities. I/We or myself/ourselves hereby agree for myself/ourselves my/our heirs successors assigns and personal representatives in consideration of the proceeds of the sale exchange redemption or cancellation of the securities and the aforementioned suretyship to indemnify protect and hold harmless Federal Insurance Company (the Surety) BNY Mellon Shareowner Services COMPANY A COMPANY B etc. all their subsidiaries and any other party to the transaction from and against any and all loss costs and damages including court costs and attorney s fees which they may be subject to or liable for in respect to the sale exchange redemption or cancellation of the securities without requiring surrender of the original securities. The rights accruing to the parties under the preceding sentence shall not be limited or abridged by their negligence inadvertence accident oversight breach or failure to inquire into contest or litigate any claim whenever such negligence inadvertence accident oversight breach or failure may occur or may have occurred I/We or myself/ourselves agree that this Affidavit and Indemnity Agreement is to become part of Blanket Bond 8302-00-67 underwritten by Federal Insurance Company. Any person who knowingly and with intent to defraud any insurance company or other person files an application or statement of claim containing any materially false information or conceals for the purpose of misleading information concerning any fact material thereto commits a fraudulent insurance act which is a crime and shall also be subject to civil penalties as prescribed by law. X Signed by Affiant (stockholder) on this (date) (Deponent) (Indemnitor) (Heirs Individually) Month Day Year Social Security Date Notary Public Lost Securities Surety Premium/Service Fee Calculation The following formula should be used to calculate the surety premium if any and service fee that you must submit with this form. 1. Calculate the share value of the lost shares by multiplying the number of shares that are lost by the Cash Rate: Enter number of share(s) lost X (Cash Rate) $XXXXX.XX $share value If the share value exceeds $500 000 or if the shareholder is foreign and the share value exceeds $100 000 do not complete this affidavit. Complete only the Transmittal Form and contact BNY Mellon Shareowner Services regarding the lost certificate(s). 2. Only calculate a Surety Premium if the share value exceeds $3 000.00 otherwise enter zero (0) on the Surety Premium line below. The surety premium equals 1% (.01) of the share value noted in line 1 above: $X(1%)or(.01) $Surety Premium 3. Add the service fee based on the share value fee guide noted below. $Service Fee If the share value is less than or equal to $250.00 the Service Fee $50.00 If the share value is greater than $250.00 but less than or equal to $3 000.00 the Service Fee $100.00 If the share value is greater than $3 000.00 the Service Fee $200.00 4. Total amount due (add lines 2 & 3)... $Total Amount Please enclose a money order certified check or cashiers check for the required amount made payable to BNY Mellon Shareowner Services.

Q SUBSTITUTE FORM W-9 — Department of the Treasury Q Special Transfer Instructions and Signature Guarantee Medallion d Internal Revenue Service If you want your COMPANY B stock check for fractional             shares and/or check for cash to be Payer s Request for T axpayer Identification Number (T in) issued in another name fill in this section with the information for the account name FILL IN the space below. Part 1 — PLEASE PROVIDE YOUR TAXPAYER IDENTIFICATION NUMBER (“TIN”) IN THE BOX AT THE RIGHT AND CERTIFY BY SIGNING AND DATING BELOW Under penalties of perjury I certify I 1 Name (Please Print First Middle & Last Name) (Title of Officer Signing this Guarantee that: 1. my e co um rrec ber t shown EXEMPT PAYEE [ Address (Number and Street) (Name of Guarantor — Please Print) number (or I am waiting for a 1 number to be issued to me) and Please check appropriate box: Individual/Sole proprietor ~ (City State & Zip Code) (Address of Guarantor Firm) 2. I am not subject to backup withholding because: (a) I am Corporation Partnership exempt from backup withholding or (b) I have not been . imilari li ab ili ty mnom i i (Tax Identification or Social Security Number) notified by the Internal Revenue Limited tob ^ compan y — . Service (l.fts) that I am subject to > I meon Special Mailing Instructions fa a ilure p to re hol ort ng a s l a nterest f or D disregarded entity            Fill in O nly if mailing (q the y undersigned or to the undersigned at an dividends or (c) the IRS has I I I address other than that shown on the front of th s card. not f ed me that am no longer C corporat on 1 Partnersh p 1 Ma l cert f cate(s) and check(s) to: subject to backup w thhold ng and vy vy Other 3. perso a n U.S nclud n ng r ot a erU .S. Name (Please Pr nt F rst M ddle & Last Name) res dent al en). Address (Number and Street) S gnature Date (C ty State & Z p Code) NSTRUCT ONS FOR COMPLET NG THE STOCK TRANSM TTAL FORM O S gn date and nclude your dayt me telephone number n th s Transm ttal form n Box 1 and after complet ng all other appl cable sect ons return th s form and your stock cert f cates n the enclosed envelope. f you are elect ng to rece ve all your shares n cash please check th s box only. f you are elect ng to rece ve all your shares n stock please check th s box only. 0 f you are elect ng to rece ve your shares n both cash and stock please check th s box and nd cate the number of shares you would l ke to rece ve n cash. The rema n ng shares presented w ll be rece ved n stock. f you do not have a preference to rece ve your shares n cash or stock please check th s box only. f you cannot produce some or all of your COMPANY A stock cert f cates you must obta n a lost nstrument open penalty surety bond and f le t w th Mellon. To do so through Mellon s program w th Federal nsurance Company complete Box 6 on the front s de of th s form nclud ng the lost secur t es prem um and serv ce fees calculat ons and return the form together w th your payment as nstructed. Please pr nt clearly. Alternat vely you may obta n a lost nstrument open penalty surety bond from an nsurance company of your cho ce that s rated A+XV or better by A. M. Best & Company. n that nstance you would pay a surety prem um d rectly to the surety bond prov der you select and you would pay Mellon ts serv ce fee only. Please contact us at the number prov ded below for further nstruct ons on obta n ng your own bond. O            PLEASE S GN N BOX 7 TO CERT FY YOUR TAXPAYER D OR SOC AL SECUR TY NUMBER f you are a U.S. Taxpayer. f t he Taxpayer D or Soc al Secur ty Number s ncorrect or blank wr te the corrected number n Box 7 and s gn to cert fy. Please note that BNY Mellon Shareowner Serv ces may w thhold 28% of your proceeds as requ red by the RS f the Taxpayer D or Soc al Secur ty Number s not cert f ed on our records. f you are a non — U.S. Taxpayer please complete and return form W-8BEN. f you want your COMPANY B stock check for fract onal shares and/or check for cash to be ssued n another name complete the Spec al Transfer nstruct ons n Box 8. S gnature(s) n Box 8 must be medall on guaranteed. F ll n Box 9 f ma l ng to someone other than the unders gned or to the unders gned at an address other than that shown on the front of th s card. HOW TO CONTACT BNY MELLON SHAREOWNER SERV CES By Telephone — 9 a.m. to 6 p.m. New York T me Monday through Fr day except for bank hol days: From w th n the U.S. Canada or Puerto R co: 1-XXX-XXX-XXXX (Toll Free) From outs de the U.S.: 1-XXX-XXX-XXXX (Collect) WHERE TO FORWARD YOUR TRANSM TTAL MATER ALS By Ma l: By Overn ght Cour er or By Hand: BNY Mellon Shareowner Serv ces BNY Mellon Shareowner Serv ces Attn: Corporate Act on Dept. 27 th Floor Attn: Corporate Act on Dept. 27 th Floor P.O. Box XXXX 480 Wash ngton Boulevard South Hackensack NJ 07606 Jersey C ty NJ 07310