INSTRUCTIONS FOR FILING IRS SECTION 83(b) ELECTION FORM

IRS FILING POSTMARK DEADLINE: 30 days after date of purchase

This information is supplied to you in connection with your recent purchase of shares of Common Stock of [Company Name] (the “Company”).

IT IS YOUR SOLE RESPONSIBILITY, AND NOT THE COMPANY’S, TO TIMELY FILE THIS ELECTION WITH THE INTERNAL REVENUE SERVICE.

THE SAMPLE FORM ATTACHED IS INTENDED FOR INDIVIDUAL FILERS ONLY. IT IS NOT DESIGNED FOR USE BY ENTITY PURCHASERS SUCH AS A CORPORATION, LIMITED LIABILITY COMPANY OR TRUST.

Filing of the IRS Section 83(b) Election form is a two-step process.

Complete and sign the attached 83(b) Election form, including your spouse’s signature, if applicable.

Make four (4) copies of the signed form.

Complete and send the attached cover letter with the signed original of the 83(b) Election form, and one copy, to the IRS via U.S. Certified Mail, Return Receipt Requested, within 30 days after the date of purchase (allowing time for receipt by the IRS). Include a self-addressed, stamped envelope for the IRS to use to mail back a date-stamped copy of the form for your records.

As proof of filing the election within 30 days after your stock purchase, retain (a) the date-stamped Certified Mail Receipt card, (b) the “postmarked” paper mailing slip, and (c) the IRS date-stamped copy of the 83(b) Election form when returned. If the IRS fails to return a date-stamped copy of the 83(b) Election form, the Certified Mail card and “postmarked” paper mailing slip along with your copy of the enclosure letter sent with the signed form will be your only proof of filing. You should also retain your cancelled check (or other applicable records) for the purchase of the shares of stock. You may also confirm delivery by checking the US Postal Service website “track & confirm” at www.usps.com using the certified postal number.

Send a PDF copy of the signed 83(b) Election form and cover letter to [LAW FIRM], Attention: [________] ([_______]@[EMAIL DOMAIN]) for the Company’s records.

Applicable state law may require that you attach a copy of your 83(b) Election form to your personal state income tax return(s) for the relevant tax year (assuming you file a personal state income tax return). Please consult your personal tax advisor(s) to determine whether or not a copy of your 83(b) Election form should be filed with your personal state income tax return(s).

As proof of filing for the 83(b) Election form, retain a copy of the date-stamped 83(b) Election form along with your tax return for the year.

If your tax return is audited by the IRS, you may need to produce the documents you retained in in Filing Step One and Filing Step Two, including your cancelled check for the purchase of the shares of stock. The IRS will not have a copy in your tax file of the 83(b) Election form filed in Filing Step One.