Conditional Capital

Alternatively, this form may be sent to SIX Exchange Regulation AG by e-mail or post.

Issuer*

Title category*

Security no.*

ISIN*

Monthly reporting of newly created equity securities from conditional capital

Conditional capital pursuant to articles of incorporation (to message per article)*

Status as of the end of (month)*

Number of spent securities (total share capital)*

Number of spent securities previous month (total share capital)*

Number of exercised securities from conditional capital previous month*

Number of remaining securities conditional capital (formally listed)*

Number of remaining securities conditional capital previous month (formally listed)*

Other details, if applicable

Date*

Contact person*

Bank/Issuer*

Phone no.*

E-mail contact person*