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UNITED STATES DISTRICT COURT <br />SOUTHERN DISTRICT OF NEW YORK <br />In re LIBOR -Based Financial Instruments Antitrust Litigation <br />THIS DOCUMENT RELATES TO: <br />OTC ACTION <br />MDL No. 11 -MD -2262 (NRB) <br />PROOF OF CLAIM <br />FOR THE OTC PLAINTIFFS SETTLEMENT WITH BARCLAYS <br />I. GENERAL INSTRUCTIONS <br />1. To recover as an Authorized Claimant based on your claim in the action entitled In re LIBOR -Based Financial Instruments <br />Antitrust Litigation, MDL No. 2262 (NRB), pending in the United States District Court for the Southern District of New York, <br />involving plaintiffs who entered into over-the-counter financial derivative and non -derivative instruments directly with <br />Defendants (the "OTC Action"), you must complete a Proof of Claim form. if you fail to submit a properly completed and <br />addressed Proof of Claim form, your claim may be rejected and you may be precluded from any recovery from the Net <br />Settlement Fund created in connection with the Barclays Settlement of the OTC Action. <br />2. Submission of this Proof of Claim form, however, does not assure that you will share in the Net Settlement Fund. <br />3. You have two options for completing a Proof of Claim form: <br />a. You can mail your completed and signed Proof of Claim form postmarked no later than December 21, 2017, to: <br />U.S. Dollar LIBOR Settlement <br />P.O. Box 2602 <br />Faribault, MN 55021-9602 <br />b. You can complete and submit the Proof of Claim form through the Settlement website by visiting <br />www.BarclaysLiborSettlement.com. Upon completion of the online Proof of Claim form, you will receive an <br />acknowledgment that your Proof of Claim has been submitted. If you choose this option and file a Proof of Claim <br />electronically, you must file on or before December 21, 2017. <br />4. If you are NOT an OTC Class Member (as defined in the Notice), DO NOT submit a Proof of Claim form. <br />5. If you are an OTC Class Member and have not requested exclusion, you will be bound by the terms of the Settlement and any <br />judgment entered in the OTC Action, WHETHER OR NOTYOU SUBMIT A PROOF OF CLAIM FORM. <br />I1. DEFINITIONS <br />Capitalized terms not defined in this Proof of Claim have the same meaning as defined in the following Settlement Agreement <br />with Barclays Bank plc ("Barclays"), dated November 11, 2015. (The Settlement Agreement, in its entirety, is available at <br />www.BarclaysLiborSettlement.com.) <br />I11. CLAIMANT IDENTIFICATION <br />1. If you purchased or otherwise acquired U.S. Dollar LIBOR -Based Instruments and held them in your name, you are the <br />beneficial purchaser as well as the record purchaser. If, however, you purchased the U.S. Dollar LIBOR -Based Instruments <br />but they were registered in the name of a third party, such as a nominee or brokerage firm, you are the beneficial purchaser <br />and the third party is the record purchaser. <br />2. Use Part I of this form entitled "Claimant Identification" to identify the purchaser of record ("nominee"), if different from the <br />beneficial purchaser of U.S. Dollar LIBOR -Based Instruments which form the basis of this claim. THIS CLAIM MUST BE FILED <br />BY THE ACTUAL BENEFICIAL PURCHASER OR PURCHASERS, OR THE LEGAL REPRESENTATIVE OF SUCH PURCHASER OR <br />PURCHASERS OFTHE SECURITIES UPON WHICH THIS CLAIM IS BASED. <br />NOTE: A single Proof of Claim should be submitted on behalf of one legal entity including all transactions made by that entity, no <br />matter how many separate accounts that entity has. <br />P166 <br />