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IV. CLAIM FORM 1. Use Part II of this form entitled "Schedule of U.S. Dollar LIBOR -Based Instruments" to supply all required details of your transaction(s). If you need more space, photocopy or attach separate sheets giving all of the required information in substantially the same form. Sign and print or type your name on each additional sheet. 2. On the schedules, provide all of the requested information with respect to all of your purchases or other acquisitions of U.S. Dollar LIBOR -Based Instruments which were held at any time from August 1, 2007 through May 31, 2010, inclusive. Failure to report all such transactions may result in the rejection of your claim. 3. List each transaction separately and in chronological order, by trade date, beginning with the earliest. You must accurately provide the month, day and year of each transaction you list. 4. You must supply the name of the counterparty for each transaction you list in Part II. To qualify for a claim, you must have purchased at least one U.S. Dollar LIBOR -Based Instrument in the United States directly from a Defendant (or a Defendant's subsidiary or affiliate), and owned that instrument any time during the period August 2007 through May 2010 (the "Class Period"). The Defendants in the OTC action are: • Credit Suisse Group AG; Credit Suisse International; Credit Suisse (USA) Inc. (together, "Credit Suisse"); • Bank of America Corporation and Bank of America, N.A, (together, "Bank of America"); • JPMorgan Chase & Co. and JPMorgan Chase Bank, NA (together, "JPMorgan Chase"); • HSBC Holdings PLC and HSBC Bank PLC (together, "HSBC");* • Barclays Bank plc; • Lloyds Banking Group PLC ("Lloyds); • WestLB AG and Westdeutsche Ummobilienbank AG (together "WestLB"); • UBS AG ("UBS"); • The Royal Bank of Scotland Group PLC ("RBS"); • Citizens Bank of Massachusetts a/k/a RBS Citizens Bank N.A. ("Citizens Bank"); • Deutsche Bank AG ("Deutsche Bank"); • Citibank NA and Citigroup Inc. (together, "Citibank"); • Cooperatieve Central Raiffeisen Boerenleenbank B.A. ("Rabobank"); • The Norinchukin Bank ("Norinchukin"); • The Bank of Tokyo -Mitsubishi UFJ, Ltd ("Bank of Tokyo"); • HBOS PLC ("HBOS"); • Societe Generale S.A.; and • Royal Bank of Canada ("RBC"). 5. Documentation to support your transactions in U.S. Dollar LIBOR -Based Instruments is NOT required at this time, however, the Claims Administrator may ask you to provide documentation to substantiate your transactions during auditing. 6. NOTICETO INSTITUTIONAL FILERS: Certain claimants with large numbers of transactions may request, or may be requested, to submit information regarding their transactions in electronic files. All claimants MUST submit a manually signed paper Claim Form whether or not they also submit electronic copies. If you wish to file your claim electronically, you must call the Claims Administrator toll-free at 1 (888) 568-7640, send an e-mail to info@BarclaysLiborSettlement.com, or visit the website for the Settlement at www.BarclaysLiborSettlement.com to obtain the required file layout. 7. A Proof of Claim received by the Claims Administrator shall be deemed to have been submitted when posted, if mailed by December 21, 2017 and if a postmark is indicated on the envelope and it is mailed first class, and addressed in accordance with the above instructions. In all other cases, a Proof of Claim shall be deemed to have been submitted when actually received by the Claims Administrator. 8. You should be aware that it will take a significant amount of time to process fully all of the Proofs of Claim and to administer the Settlements. This work will be completed as promptly as time permits, given the need to investigate and tabulate each Proof of Claim. Please notify the Claims Administrator of any change of address. ACCURATE CLAIMS PROCESSING TAKES A SIGNIFICANT AMOUNT OF TIME. - THANK YOU FOR YOUR PATIENCE. Instructions - Page 2 P167