| CLASS ACTION CLAIM CHECK CALCULATOR |
| Enter your data separately for each tax lot (purchase date): |
| 1. Name of Stock that paid class action claim |
|
| 2. Date of purchase (tax lot) (mm/dd/yyyy) |
|
| 3. Date of claim check payment (mm/dd/yyyy) |
|
| 4. Number of shares of stock owned |
(no commas) |
| 5. Adjusted cost basis (total, not per share) immediately prior to this claim check payment |
$ (no commas) |
| 6. Claim check payment for this tax lot (total, not per share) |
$ (no commas) |
| |
|
