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PROOF OF CLAIM AND RELEASE FORM

Instructions for online claim filing


If you purchased or held Fortis Shares at any time between 28 February 2007 close of trading and 14 October 2008 close of trading (in such case, you are an "Eligible Shareholder"), please read these instructions and file a Proof of Claim and Release Form (“Claim Form”), as you may be entitled to a distribution related to the Settlement Amount created as a result of the Settlement Agreement.

Please take some time to gather your records prior to submitting your claim, as supporting documentation is required for all holding transactions listed on your Claim Form and must be uploaded when you file your Claim Form online. Within the designated Claim Form schedules, please provide the required information and documentation with respect to all of your holdings of Fortis Shares. In the event that you do not have supporting documentation immediately available, please wait to file your Claim Form until the supporting documentation is available for uploading. Once you have filed your Claim Form, if you discover additional supporting documentation that would be helpful, you may mail it in at a later date using the transmittal letter provided at the end of this online claim filing tool. Upon completion and submission of your Claim Form, you will receive an email confirmation that your Claim Form has been received. Please retain this confirmation of your filing, which will include a unique identifier ("Claim ID") tied to your Claim Form.

Appropriate supporting documentation may include copies of broker confirmation slips, monthly brokerage statements, custodian bank statements, or other documents confirming the particulars of your holdings of Fortis Shares. These should be uploaded as part of your Claim Form. If any such documents are not in your possession, please obtain a copy or equivalent documents before filing your Claim Form online as these documents are necessary to prove and process your claim. Failure to provide this documentation may delay verification of your claim or result in rejection of your claim. The Claims Administrator may require additional information or documentation from you at any time. If you are filing on behalf of another person you must provide and upload a power of attorney document showing your authority to file a claim in their name. A template power of attorney form can be found here illustrating the required information.

Please take note of the following important information:

By submitting this Claim Form you are agreeing to submit to the jurisdiction of the Claims Administrator and the Dispute Committee and of the Amsterdam District Court and its appellate courts, and agreeing to be subject to inquiry by the Claims Administrator and the Dispute Committee.

Your submission will constitute a Release, as defined in the Settlement Agreement, of each Releasee from any and all claims, actions, charges, and damages that you have had, now have or may in the future have against any Releasee in relation to the Events and a waiver of any and all of your rights in connection thereto.

Before you submit your Claim Form, you will be required to review and agree to the terms of this Release.

To submit an online Claim Form, you will be required to certify that all of the information included with your Claim Form is accurate and that it is complete. Failure to provide the required certification may result in the rejection of your Claim Form.

Please review carefully all of the information in the Binding Declaration Notice, Claim Form and other settlement related documents provided on this website. Do not submit this Claim Form until, and unless, you have reviewed the Court-approved documents and agree to the terms and conditions contained in those documents.

If your contact details or bank account details change, you must inform the Claims Administrator in writing of your changed details. Please also include your name as it appears on the Claim Form, your Claim ID, and the last four digits of the securities account number through which your Fortis Shares were held for verification purposes. You may email your request to forsettlement@computershare.com or mail to one of the post office boxes below:

Computershare Investor Services plc
Fortis settlement Claims Administrator
P.O. Box 304
2800 Mechelen
Belgium

Computershare Investor Services plc
Fortis settlement Claims Administrator
P.O. Box 7148
3109 AC Schiedam
The Netherlands

The capitalized terms used on this interactive form shall have the same meanings ascribed to them in the Settlement Agreement.

If you would like to mail in your claim rather than using the online claim filing tool, you may download a copy of the Claim Form here. Please mail the Claim Form and supporting documentation to one of the addresses listed on the Claim Form.

If you wish to opt out of the settlement, you may download an Opt-Out Notice here. Please follow the instructions provided on the Opt-Out Notice. If you submit an Opt-Out Notice, you will not receive any compensation under the Settlement Agreement.

For the administration and assessment of your claim all the information that you provided concerning you or your claim (“Personal Data”) shall be processed by:

  1. the Claims Administrator and any entity that has legal or regulatory powers over the Claims Administrator;
  2. Ageas, Stichting FORsettlement, and the Dispute Committee;
  3. entities of the Computershare Group;
  4. entities that any party mentioned under (a)-(c) has entered into an agreement with for the administration and assessment of your claim, in which case appropriate steps will be taken to ensure adequate levels of protection of your Personal Data and provided that we are satisfi ed that these entities apply the standards of protection of Personal Data as contained in the Data Protection Directive (95/46/EC) and the EU General Regulation on Data Protection (2016/679); and
  5. competent public authorities when this is required to comply with a legal obligation.

Your Personal Data will be processed in accordance with the principles set out in the Data Protection Directive (95/46/EC) and the EU General Regulation on Data Protection (2016/679).

Your Personal Data may be transferred to countries outside the European Economic Area if this is required for the administration and assessment of your claim, in which case appropriate steps will be taken to ensure adequate levels of protection of your Personal Data and provided that we are satisfied that the same standards of protection of personal data have been applied either by contract or law.

Your Personal Data shall be retained as long as necessary for the administration of your claim or as long as required by law. You may request access, rectification, erasure or object to processing of your Personal Data.