Fidelity Stock Plan Services, LLC Stock Plan Participant Instructions for Foreign Tax Certification

Please read, complete, and sign the Substitute Form W-8BEN, and return this form and any other required documentation (see instructions below) using either of the addresses below. Please send your form and any required documentation to: Fidelity Stock Plan Services, LLC, PO Box 770001, Cincinnati, OH 45277-0002. If you would like to overnight your form and any required tax certification documentation, please send it to: Fidelity Stock Plan Services, LLC, 100 Crosby Parkway, Mail Zone: KC1K, Covington, KY 41015.

I. P ARTICIPANT I NFORMATION

P ARTICIPANT N UMBER

Please fill in the Participant Number (your i-number) that Fidelity Stock Plan Services uses to identify you.

F ULL L EGAL N AME

OF I NDIVIDUAL

B ENEFICIAL O WNER

Your full legal name is required.

T ELEPHONE N UMBER

In the event that Fidelity Stock Plan Services needs to contact you regarding the information provided on this form, please provide your telephone number, including country code.

4/5

P ERMANENT R ESIDENCE A DDRESS /M AILING A DDRESS

Your permanent residential address is required. Please note: Generally, as a person of foreign status, you would not have a permanent residence in the United States. If different from your permanent address, please provide your mailing address. If you submit a United States mailing address, Treasury regulations require Fidelity Stock Plan Services to obtain documentary evidence from you demonstrating that you have a tax residence outside the United States. In addition, you would be required to provide a reasonable explanation, in writing, that supports your claim of having a tax residence outside the United States. Suitable documentation is defined by the IRS and includes a currently valid document that was issued by a local government authority that contains your name and address in your country of residence (e.g., a copy of a passport or drivers license). Failure to submit proper documentation will require us to implement backup withholding until we are able to properly verify your foreign status.

U.S. T AXPAYER I DENTIFICATION N UMBER

This is not a required field. If you do not have a United States Social Security Number nor Individual Tax Identification Number, please leave this section blank.

II. C LAIM

OF

T AX T REATY B ENEFITS

To enable treaty benefits, you must complete Section II by 1) Checking the box to indicate claim of treaty; 2) Filling in your country of tax residence; and (3) signing the form. If the country you fill in is different from that entered in either Section I, Box 4 or Section I, Box 5, we are required to obtain a reasonable explanation in writing, or additional documentation that establishes residency in the treaty country. Please furnish the explanation or additional documentation.

PLEASE COMPLETE THIS FORM BY SIGNING ON THE LINE PROVIDED.

Fidelity Stock Plan Services, LLC Substitute Form W-8BEN

P ARTICIPANT I NFORMATION

1. Participant Number
i__________________________________________________________

2. Full Legal Name of Individual Beneficial Owner 3. Telephone Number (include country code)
__________________________________________________________ __________________________________________________________

4. Permanent Residence Address

__________________________________________________________ Street, Apt./Suite No., or Rural Route __________________________________________________________ __________________________________________________________ __________________________________________________________ City or Town __________________________________________________________ State or Province __________________________________________________________ Postal Code __________________________________________________________ Country (Do not abbreviate)

5. Mailing Address (if different)

__________________________________________________________ Street, Apt./Suite No., or Rural Route __________________________________________________________ __________________________________________________________ __________________________________________________________ City or Town __________________________________________________________ State or Province __________________________________________________________ Postal Code __________________________________________________________ Country (Do not abbreviate)

If you have provided a mailing address in the United States, please provide an explanation, either by checking the applicable box below, or by providing a written explanation: The United States address is a secondary address, such as a vacation home, to which I would like my U.S. mail sent. The United States address is that of my financial advisor/attorney/fiduciary. I do not wish to use a non-United States postal service. The United States addressee provides mail forwarding to me at my non-United States address. Other __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________

6. U.S. Taxpayer Identification Number (SSN/ITIN) (if available):

II

C LAIM

OF

T AX T REATY B ENEFITS

I certify that I am a resident of (Country)_________________ within the meaning of the income tax treaty between the United States and that country. If available, the U.S. taxpayer identification number is stated in Section I, 6.

Certification
Under the penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that: (1) I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates; (2) the beneficial owner is not a U.S. person; (3) the income to which this form relates is not effectively connected with the conduct of a trade or business in the United States or is effectively connected but is not subject to tax under an income tax treaty; and (4) for broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the IRS instructions to IRS Form W-8BEN. Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish your status as a non-US person and, if applicable, obtain a reduced rate of withholding. ______________________________________________________________________________ SIGNATURE of participant ___________________ Date (month, day, year)

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1.833056.104 W8-BEN-0910