Common use of INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM Clause in Contracts

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form postmarked no later than XXXXXXXX to the Settlement Administrator at the following address: It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form. 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment will be made to the participant. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form that is postmarked no later than XXXXXXXX XXXXXXXX, 2018 to the Settlement Administrator at the following address: It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form. 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment will be made to the participant. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form that is postmarked no later than XXXXXXXX , 2019 to the Settlement Administrator at the following address: It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form. 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment will be made to the participant. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form postmarked no later than XXXXXXXX to the Settlement Administrator at the following address: It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form. 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment you will be made to receive a check in the participantmail. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form that is postmarked no later than XXXXXXXX XXXXXXXX, 2018 to the Settlement Administrator at the following address: It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form. 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment net of taxes will be made to the participantparticipant in the form of a check. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form postmarked to the following address so that it is received by the Settlement Administrator no later than XXXXXXXX to the [Time] PM Central Standard Time on [Date]: Novant 401(k) Settlement Administrator at the following address: It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form.Administrator 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment will be made to the participant. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.