An error has occurred

You may want to try one of the following:

Close this dialog and continue to use this page.
Reload this page. Note that you will lose any unsaved changes.
If the above does not work, try reloading the page yourself. Note that you will lose any unsaved changes:
- With Firefox: hold down the shift key and click the Reload button in your browser toolbar.
- With Safari and Chrome: click the Reload button in your browser toolbar.
- With Internet Explorer: hold down the control key and click the Reload button in your browser toolbar.
Return home.

Reloading form

This form has to be reloaded. This most likely happened because your session has expired, which might take to the login page. (If you think that you shouldn't see this message and that the problem persists, please contact support.)

Go to Content

Equity Registration Form XS Notes

Please read through the following e-form in full and then answer all of the questions / fields that are marked with a mandatory *

Once you have filled and completed the form, press 'Submit' at the bottom and a copy will be email to the relevant email addresses as marked throughout the form as well as to the agent. Any attachments that are submitted to the form will also be emailed.

Please use Edge or Chrome to complete this form, Internet Explorer is not supported.

Please note that this E-Form Portal is the sole manner in which subscription forms will be accepted via electronic or online transmission. When you submit a subscription form using the E-Form Portal, you will be asked to electronically “sign” your form. You hereby agree that your electronic signature in respect of such completed form complies with the U.S. federal ESIGN Act of 2000, and accordingly shall have the same legal effect as your original signature.

+++ PLEASE NOTE THAT THE DEADLINE TO SUBMIT THIS FORM IS NOVEMBER 19, 2022+++

The equity distributed in accordance with plan is not DTC eligible. Therefore, the Debtors have coordinated the issuance of the equity directly on the books and records of the Company's transfer agent. As a result, please indicate on the lines provided below the name and address in which you would like your Equity Securities to be registered.

Please also indicate the applicable “account type” for the New Registered Shareholder at the end of this section.

New Registered Shareholder NameMissing or incorrect valueRegistration in the name of DTC or Cede & Co. is not permitted in this section. In addition, if the resulting securities are being registered to a trust, you must provide the name of the trustee and the trust date. Failure to provide this information will result in a delay in delivery of the resulting securities.

Address 1:Missing or incorrect value

Address 2:

City:Missing or incorrect value

State:Missing or incorrect value

ZIP Code:Missing or incorrect value

Country: Missing or incorrect value

Telephone Number:Missing or incorrect value

Email Address:Missing or incorrect value

Do you have a U.S. Tax Identification Number?YesNoMissing or incorrect value

Account Type. Please indicate the “account type” that may be used in connection with registration of your Subscribed Securities in the name of the New Registered Shareholder. Please check only one box:INDIVIDUAL ACCOUNT;IRA ACCOUNTCORPORATIONS (S-CORP): (ASSOCIATED, ASSOCIATES, ASSOCIATION, CO, CO. COMPANY, CORP, CORPORATE/PARTNER, ENTERPRISE(S), FUND, GROUP, INCORPORATED, INC, INTERNATIONAL, INTL, LIMITED, LTD, LIFETIME LIMITED COMPANY, LLC, L.L.C., PARTNER, PARTNERS, PLC, PUBLIC LIMITED COMPANY)PARTNERSHIP: (LP, L P, L.P., LLP, LIMITED PARTNERSHIP, LIFETIME LIMITED PARTNERSHIP);BANKNOMINEE ACCOUNTSTHE NEW C-CORPNON-PROFIT: (CEMETERY, CHURCH, COLLEGE, COMMISSION FOR CHILDREN WITH, COMMISSION FOR HANDICAPPED, COMMISSION MINISTRIES INC, COMMISSION OF PUBLIC WORKS, COMMISSION OF BANKING & FOUNDATIONS, HOSPITAL, SCHOOL, SYNAGOGUE, UNIVERSITY);FIDUCIARY ACCOUNT: (CUSTODIAN, CO-TRUSTEE, ESTATE, EXECUTOR, EXECUTRIX, FBO, F/B/O, FAO, FIDUCIARY TRUST, ITF, LIFE TEN, PENSION PLAN, INDIVIDUAL NAME PROFIT SHARING PLAN, RETIREMENT PLAN, 401K PLAN, SELL TRANSFER PLEDGE, STATE UNIFORM TRANSFER TO MINOR’S ACT, TTEE, TTEES, UW, UTMA, UGMA, USUFRUCT, UNIFIED, UNIF GIFT MIN ACT, UNIF TRUST MIN ACT, UNIFIED GIFT TO MINORS ACT, UNIFORM GIFT TO MINORS, UNIFORM TRANSFER TO MINORS, GRANT (GRANTOR ANNUITY TRUST));TENANTS IN COMMON;TENANTS BY ENTIRETY: (TEN ENT, TENANTS ENT, TENANTS ENTIRETY, TENANTS BY ENTIRETY, TENANTS BY ENTIRETIES);JOINT TENANTS: (JT TEN, JT TEN WROS, JT WROS, J/T/W/R/S, JOINT TENANCY, JOINT TENANTS WITH RIGHT OF SURVIVORSHIP, JT OWNERSHIP, IF JT ACCOUNT WITH TOD); orCOMMUNITY PROPERTY: (COM PROP, COMM PROP, COM PROPERTY, COMM PROPERTY, MARITAL PROPERTY, HWACP, HUSBAND & WIFE AS COMMUNITY PROPERTY).Missing or incorrect value

Item 7. Eligible Holder Certification.

The undersigned Eligible Holder certifies that (i) as of the date hereof, the undersigned is the Eligible Holder of the Technical ISINs set forth on the following page and will continue to be the Eligible Holder thereof through the Blocking Deadline (as applicable), and (ii) the undersigned has received a copy of the Plan and the Disclosure Statement.

The undersigned Eligible Holder acknowledges that, by executing this Registration Form, the undersigned has elected to receive their Plan Equity associated with the amounts blocked via Euroclear or Clearstream, as applicable.

Date;

Name of Eligible Holder:Missing or incorrect value

U.S. Federal Tax EIN/SSN (optional):

Are you a:Non-U.S. PersonU.S. PersonMissing or incorrect value

Do you wish to sign electronically or upload a signature page?Sign electronicallyUpload a signature pageMissing or incorrect value

Name of Signatory:Missing or incorrect value

Title:Missing or incorrect value

Address:Missing or incorrect value

Telephone Number:Missing or incorrect value

Email:Missing or incorrect value

Are you submitting this form for Technical CodeXS2417183956XS2417184178BothMissing or incorrect value

PLEASE COMPLETE THIS EQUITY REGISTRATION FORM

(WITH ACCOMPANYING IRS FORM W-9 OR APPROPRIATE IRS FORM W- 8, AS APPLICABLE AND SIGNATURE PAGE TO THE NEW STOCKHOLDERS AGREEMENT) AND RETURN TO THE SUBSCRIPTION AGENT.

IF YOU HOLD YOUR TECHNICAL ISIN THROUGH A NOMINEE, PLEASE RETURN THIS FORM (WITH ACCOMPANYING IRS FORM W-9 OR APPROPRIATE IRS FORM W- 8, AS APPLICABLE AND SIGNATURE PAGE TO THE NEW STOCKHOLDERS AGREEMENT) TO YOUR NOMINEE (OR AS OTHERWISE DIRECTED BY YOUR NOMINEE). DO NOT RETURN THIS EQUITY REGISTRATION FORM DIRECTLY TO THE SUBSCRIPTION AGENT (UNLESS OTHERWISE DIRECTED TO DO SO BY YOUR NOMINEE).

Questions relating to the Equity Registration Event should be directed to the Subscription Agent as follows: (a) calling (877) 455-7605 (U.S./Canada toll free) or +1 (347) 817-4086 (international toll); or (b) emailing carlsonsubscription@primeclerk.com (please include CWT Subscription in the subject line).

Nominees (or Eligible Holders that are instructed by their Nominees to return the Registration Form directly to the Subscription Agent) must return the Registration Form, including a duly executed signature page to the New Stockholders Agreement, and the appropriate IRS tax form by no later than the Registration Deadline via the following:

Electronic Form: Prime Clerk will accept Electronic Forms if properly completed through the E-Portal.

To access the Electronic Portal, visit https://cases.primeclerk.com/carlsontravel, click on the “Submit Equity Registration Form” section of the website and follow the instructions to submit your form.

You may only return the applicable documents via the Electronic Portal.

Download signature page to Stockholders Agreement

CWT - Sig Page to Stockholders Agreement (1).pdf 106 KB

Drag files here or use the button below. Remove File

Select File

Upload signature page to Stockholders Agreement

Drag files here or use the button below. Remove File

Select File

Missing or incorrect value

Do you need to submit a IRS Form W-9 or IRS Form W-8?Form W-9Form W-8Missing or incorrect value

e81cfbb7f3542378b70ed785a2a0f945b6cb71a2

Confirm

Form Submitted

Review Form Validation Messages

Unable to complete action

Confirmation

Equity Registration Form XS Notes

Instructions

Post Effective Date Equity Registration Form