Suspicious transaction reporting form

1. Description of the transaction(s). If not applicable, please state N/A.

Please include details of the financial instrument(s), including the ISIN code of the instrument; the market(s) concerned; the original order's entry date/time, price and size; the times and sizes of the transaction(s); the type and characteristics of the order, etc.

2. Reasons for suspecting that the transaction(s) might constitute insider dealing/market manipulation. If not applicable, please state N/A.

3. Identities of persons carrying out transaction(s). If not applicable, please state N/A.

Names, address, telephone number, date of birth, account number, client identification code used by the firm, etc.

4. Identities of any other persons known to be involved in the transaction(s). If not applicable, please state N/A.

Names, address, telephone number, location, date of birth, relation to person carrying out transaction; position held , role played, etc.

5. Capacity in which the person performing the transaction(s) acts e.g. broker, underwriter, agent. If not applicable, please state N/A.

6. Further information which may be of significance. If not applicable, please state N/A.

(Please list any accompanying material you are supplying.)

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