Common use of CLAIMANT INFORMATION Clause in Contracts

CLAIMANT INFORMATION. The Claims Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Claims Administrator in writing at the address above. Claimant Names(s) (as the name(s) should appear on check, if eligible for payment; if the shares are jointly owned, the names of all beneficial owners must be provided): Name of Person the Claims Administrator Should Contact Regarding this Claim Form (Must Be Provided): Mailing Address – Line 1: Street Address/P.O. Box: Mailing Address – Line 2 (If Applicable): Apartment/Suite/Floor Number: City: State/Province: Zip Code: Country: Last 4 digits of Claimant Social Security/Taxpayer Identification Number:1

CLAIMANT INFORMATION. The Claims Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Claims Administrator in writing at the address above. Claimant Names(sName(s) (as the name(s) should appear on check, if eligible for payment; if the shares securities are jointly owned, the names of all beneficial owners must be provided): Name of Person the Claims Administrator Should Contact Regarding this Claim Form (Must Be Provided): Mailing Address – - Line 1: Street Address/P.O. Box: Mailing Address – - Line 2 (If Applicable): Apartment/Suite/Floor Number: City: State/Province: Zip Code: Country: Last 4 digits of Claimant Social Security/Taxpayer Identification Number:1

CLAIMANT INFORMATION. The Claims Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Claims Administrator in writing at the address above. Claimant Names(s) (as the name(s) should appear on check, if eligible for payment; if the shares are jointly owned, the names of all beneficial owners must be provided): Name of Person the Claims Administrator Should Contact Regarding this Claim Form (Must Be Provided): Mailing Address – Line 1: Street Address/P.O. Box: Mailing Address – Line 2 (If Applicable): Apartment/Suite/Floor Number: City: State/Province: Zip Code: /Postal Code (if outside U.S.): Country: Last 4 digits of Claimant Social Security/Taxpayer Identification Number:1

CLAIMANT INFORMATION. The Claims Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Claims Administrator in writing at the address above. Claimant Names(s) (as the name(s) should appear on check, if eligible for payment; if the shares are were jointly owned, the names of all beneficial owners must be provided): Name of Person the Claims Administrator Should Contact Regarding this Claim Form (Must Be Provided): Mailing Address – Line 1: Street Address/P.O. Box: Mailing Address – Line 2 (If Applicable): Apartment/Suite/Floor Number: City: State/Province: Zip Code: Country: Last 4 digits of Claimant Social Security/Taxpayer Identification Number:1

CLAIMANT INFORMATION. The Claims Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Claims Administrator in writing at the address above. Claimant Names(s) (as the name(s) should appear on check, if eligible for payment; if the shares are jointly owned, the names of all beneficial owners must be provided): Name of Person the Claims Administrator Should Contact Regarding this Claim Form (Must Be Provided): Mailing Address – Line 1: Street Address/P.O. Box: Mailing Address – Line 2 (If Applicable): Apartment/Suite/Floor Number: City: State/Province: Zip Code: /Postal Code (if outside U.S.) Country: Last 4 digits of Claimant Social Security/Taxpayer Identification Number:1