Conditional Capital

Alternatively, this form may be sent to the SIX Swiss Exchange by fax or post.

Issuer*

Last name*

First name*

E-mail*

Phone no.*

Monthly reporting of newly created equity securities from conditional capital

Title category*

Security no.*

Intended use (pursuant to articles of association)*

Duration in the case of warrant bonds and convertible bonds*

The current capital structure of our company is as follows

Spent equity capital

Status as of the end of*

Number of shares*

CHF*

Status as at the end of the previous month (1)

Number of shares (1)*

CHF (1)*

Conditional capital

Number of exercised securities (2)

Number of shares (2)*

CHF (2)*

Amount of remaining conditional capital (3)

Number of shares (3)*

CHF (3)*