Affidavit Of Unauthorized Use

Capital One ShareBuilder, Inc. | PO Box 4249 | Seattle, WA 98194-0249 800. 747. 2537 Page 1 of 4 Secure your computer: • SOME TYPES OF MALWARE MAY REQUIRE THE ASSISTANCE OF A COMPUTER PROFESSIONAL TO HAVE THEM REMOVED. • SET YOUR COMPUTER’S OPERATING SYSTEM TO RECEIVE AUTOMATIC UPDATES IF POSSIBLE; IF NOT, DOWNLOAD AND INSTALL UPDATES REGULARLY. • MAKE SURE YOU ARE USING THE MOST RECENT VERSION OF YOUR INTERNET BROWSER; PREVIOUS VERSIONS CAN HAVE SECURITY WEAKNESSES THAT PUT YOU AT RISK. • USE AN INTERNET BROWSER THAT SUPPORTS ADVANCED SECURITY FEATURES SUCH AS PHISHING SITE DETECTION, AND SUPPORT FOR EXTENDED SECURITY CERTIFICATES, SUCH AS:

• MICROSOFT INTERNET EXPLORER V7 AND UP • MOZILLA FIREFOX V3 AND UP • USE ANTI-VIRUS AND ANTI-SPYWARE SOFTWARE AND SET THEM TO AUTO-UPDATE AS WELL. • USE IDENTITY THEFT PROTECTION SOFTWARE LIKE TRUSTEER’S RAPPORT TO FIGHT ONLINE FRAUD. IT’S FREE. • PROTECT ANY COMPUTER CONNECTED TO THE INTERNET WITH A FIREWALL. Change your password for your ShareBuilder and all other ?nancial accounts. NEED MORE TIPS ON HOW TO KEEP YOUR MONEY SAFE AND SECURE? HTTP://WWW. SHAREBUILDER. COM/SHAREBUILDER/SECURE-PROTECT-ACCOUNT. ASPX Other Steps to Take if Unauthorized Activity Has Occurred: 1COMPLETE the Af?

davit of Unauthorized Activity as soon as possible. Delays on your part could slow the investigation. If you are unable to complete the af? davit, someone with power of attorney may complete it for you. If this af? davit is requested in a lawsuit, it may be provided to the requesting party. Steps to complete the Af? davit of Unauthorized Activity: 2INCLUDE a complete listing of all unauthorized transactions that occurred in the account such as: • Deposits • Withdrawals • Purchase or sale of securities – include the name of the security, symbol, number of shares, and the dollar amount of the transaction.

• Changes to account profile – email, phone number or bank account Affidavit of Unauthorized Activity 3SIGN the Af? davit of Unauthorized Activity in front of a Notary Public. Securities products are offered by Capital One ShareBuilder, Inc. , a registered broker-dealer and member of FINRA/SIPC. Capital One ShareBuilder, Inc. is a subsidiary of Capital One, N. A. Securities products are: Not FDIC insured ·Not Bank guaranteed · May lose value FAX document to: MAIL document to: Capital One ShareBuilder, Inc. fax number (available 24 hours per day) 866. 996. 6417 OR 206. 805. 0791 Capital One ShareBuilder, Inc. P. O. Box 4249.

Seattle, WA 98194-0249 SEND the completed Af? davit of Unauthorized Activity along with any supporting documents (for example, police report) to: 4 Capital One ShareBuilder, Inc. | PO Box 4249 | Seattle, WA 98194-0249 800. 747. 2537 Page 2 of 4 THIS AREA RESERVED FOR OF? CE USE. Af? davit of Unauthorized Activity Account information Account Number(s): Account Holder(s) Name: Af? davit of unauthorized activity Except as may be provided below, I, , did not authorize any person other than myself to use my name or personal information to obtain access to or perform transactions in the above-referenced ShareBuilder account

(the “Account”). I did not authorize the following transactions in my Account: Additional transaction details may be listed on a separate sheet and attached. Date of Transaction Description of Transaction (purchase, sale, transfer, etc. ) Stock Symbol Number of Shares Dollar Amount Capital One ShareBuilder, Inc. | PO Box 4249 | Seattle, WA 98194-0249 800. 747. 2537 Page 3 of 4 THIS AREA RESERVED FOR OF? CE USE. Af? davit of Unauthorized Activity Additional information Please check Yes or No to the below questions and provide any additional information needed: I have ?

led a police report: Yes No If yes: I have ? led a police report with the law enforcement agency named below: Report Number: Police Department Address: Of? cer Name: Badge Number: If charges are brought against the person(s) who has committed this fraud, I am willing to cooperate fully with law enforcement of? cials, including assisting in prosecution and authorizing the release of information. Yes No I am aware that my computer has been infected with malware (viruses, trojans, etc). Yes No If yes: The following is a list of malware I know my computer to be infected with:

Please check “I agree” or “I disagree” to the below: I did not receive any money, goods, or services nor did I bene? t in any other way as a result of these unauthorized transactions. I agree with the above I disagree with the above I did not knowingly share with any other person my ShareBuilder username, logon ID, password, or other related con? dential information. I agree with the above I disagree with the above I have no direct knowledge of who may have entered these transactions. I agree with the above I disagree with the above Address Line 1 Address Line 2 City/State/Zip.

Additional information may be listed on a separate sheet and attached. Capital One ShareBuilder, Inc. | PO Box 4249 | Seattle, WA 98194-0249 800. 747. 2537 Page 4 of 4 THIS AREA RESERVED FOR OF? CE USE. Af? davit of Unauthorized Activity Authorization and signature I CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL THE INFORMATION ON AND ATTACHED TO THIS AF? DAVIT IS TRUE, CORRECT, COMPLETE, AND MADE IN GOOD FAITH. I UNDERSTAND THAT THIS AF? DAVIT OR THE INFORMATION IT CONTAINS MAY BE MADE AVAILABLE TO FEDERAL, STATE, AND/OR LOCAL LAW ENFORCEMENT AGENCIES FOR SUCH ACTION WITHIN.

THEIR JURISDICTION AS THEY DEEM APPROPRIATE. SEAL OF NOTARY SEAL OF NOTARY STATE OF COUNTY OF ON BEFORE ME, THE UNDERSIGNED, A NOTARY PUBLIC IN AND FOR THE STATE, PERSONALLY APPEARED KNOWN TO ME TO BE THE PERSON WHOSE NAME IS SUBSCRIBED TO THE INSTRUMENT AND ACKNOWLEDGED HE/SHE EXECUTED THE SAME. WITNESS MY HAND AND OF? CIAL SEAL. SIGNATURE OF NOTARY X SIGNATURE OF NOTARY X Additional information (continued) If the answer to either or both of the above two questions is “I agree,” please provide additional information:

The following people had access to my user name or password during the time periods in which the transactions listed above took place: The following people had access to my computer or smartphone during the time periods in which the transactions listed above took place: Name Relationship to Account Holder Address Phone Number Additional information may be listed on a separate sheet and attached. Name Relationship to Account Holder Address Phone Number Additional information may be listed on a separate sheet and attached. NAME OF ACCOUNT HOLDER SIGNATURE X DATE NAME OF JOINT ACCOUNT HOLDER SIGNATURE X DATE.