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Page 2—Appendix A 502686980 v1 <br /> <br />U.S. Bank National Association, as Paying Agent <br /> <br />Dated: . <br /> <br /> Withholding of 28% of gross redemption proceeds of any payment made within the <br />United States may be required by the Jobs and Growth Tax Relief Reconciliation Act of 2003 <br />(the “Act”) unless the Paying Agent has the correct taxpayer identification number (social <br />security or employer identification number) or exemption certificate of the payee. Please furnish <br />a properly completed Form W-9 or exemption certificate or equivalent when presenting your <br />Bonds. <br />