Please complete all fields marked with an asterisk (*). After submitting, your request will be reviewed, and, if approved, will be posted on the Determinations Committee website. Please note your personal contact information will not be posted. If you are submitting a General Interest Question (see below) your company name will not be posted as well. Please also note that you should review any document you submit for metadata or other information that you do not wish to be publicly disclosed. DC Administration Services does not review documents provided to it for any information that may identify the question submitter.

Submitter Infomation

Company Name* Full Name* Telephone* Email Address*

Is the question a General Interest Question?*

If yes, the question will not be attributed to you or your institution and requires two voting members of the relevant Determinations Committee to agree to deliberate the question. If no, the question will be attributed to your institution and requires only one voting member of the relevant Determinations Committee to agree to deliberate the question. Questions submitted which do not get the required number of voting members agreeing to consider will be deemed rejected and cannot be re-submitted unless new, additional information is provided.

Yes No

Reference Entity

Reference Entity*

Coverage Election*
Select an option 2014 Definitions 2003 Definitions 2014 and 2003 Definitions

Transaction Type* Select an option North American Corporate Standard North American Corporate European Corporate Australia Corporate New Zealand Corporate Japan Corporate Singapore Corporate Asia Corporate Subordinated European Insurance Corporate Emerging European Corporate LPN Emerging European Corporate Latin America Corporate B Latin America Corporate BL Asia Sovereign Emerging European and Middle East Sovereign Japan Sovereign Australia Sovereign New Zealand Sovereign Singapore Sovereign Latin America Sovereign Western European Sovereign Undetermined Not Applicable

Question for the Determinations Committee*
Select an option Has a Bankruptcy Credit Event occurred with respect to the Reference Entity? Has a Failure to Pay Credit Event occurred with respect to the Reference Entity? Has a Repudiation/Moratorium Credit Event occurred with respect to the Reference Entity? Has an Obligation Acceleration Credit Event occurred with respect to the Reference Entity? Has a Restructuring Credit Event occurred with respect to the Reference Entity? Has a Governmental Intervention Credit Event occurred with respect to the Reference Entity? Is there a Successor to the Reference Entity? Is the obligation with [CUSIP/ISIN] number [relevant number] a Substitute Reference Obligation of the Reference Entity? Other

Publicly Available Information ("PAI")

Please insert details of your request. If you are requesting a determination on whether a Credit Event has occurred, please include links to press releases, press reports or other Publicly Available Information that describes the occurrence of the Credit Event:

*So that requests can be processed in the most expeditious manner, we ask that you link to the website where documents that you wish to provide as the PAI to your question are hosted. Should you have any difficulty with this, please contact DC Secretary.