ELECTION CHOICES
I hereby elect to receive the following as consideration for my Emclaire common shares held in this account:
STOCK ELECTION (2.15 Farmers common shares for each Emclaire common share, subject to adjustment)
You will be deemed to have made a NO ELECTION if:
| A. | You fail to follow the instructions on the “Election Form and Letter of Transmittal” or otherwise fail properly to make an election; |
| B. | A properly completed “Election Form and Letter of Transmittal,” together with your certificate(s) or confirmation of book-entry transfer, is not actually received by the Exchange Agent at or before the Election Deadline; |
| C. | You properly and timely revoke a prior election without making a new election; or |
| D. | You check the “No Election” box above. |
By making “No Election”, the form of consideration that you will receive as a result of the Merger will be determined by Farmers or, at Farmers’ direction, the Exchange Agent, in accordance with the terms of the Merger Agreement.
These elections will be subject to proration based on a proration adjustment if Stock Consideration is oversubscribed or undersubscribed. The allocation procedures set forth in the Merger Agreement are intended to ensure that 70% of the outstanding Emclaire common shares are converted into the right to receive Farmers common shares and 30% of the outstanding Emclaire common shares are converted into the right to receive cash.
No guarantee can be made that you will receive the amount of Cash Consideration or Stock Consideration that you elect. No guarantee can be made as to the value of the consideration received relative to the value of the Emclaire common shares being exchanged. You are encouraged to obtain current market quotations for Farmers and Emclaire when making your election.
To be effective, this Election Form and Letter of Transmittal must be properly completed, signed and delivered to the Exchange Agent at one of the addresses listed in the Instructions, together with your certificate(s) or confirmation of book-entry transfer, by the Election Deadline. Do not send your election materials to Emclaire, Farmers or Georgeson (the Information Agent).
SIGNATURE(S) REQUIRED. Signature of Registered Holder(s) or Agent
Must be signed by the registered holder(s) EXACTLY as name(s) appear(s) on your certificate(s). If signature is by a trustee, executor, administrator, guardian, attorney-in-fact, officer for a corporation in a fiduciary or representative capacity, or other person, please set forth full title. See Instructions 5, 6, 7 and 8.
By signing below, I represent and warrant as follows:
(1) I have full power and authority to surrender the Emclaire common shares represented by the certificate(s) surrendered herewith or transferred in book-entry form, or covered by a guarantee of delivery, free and clear of all liens, claims and encumbrances. I will, upon request, execute and deliver any additional documents reasonably deemed by the Exchange Agent to be appropriate or necessary to complete the surrender and exchange of my Emclaire common shares.
(2) I understand that neither surrender nor an election is made in acceptable form until receipt by the Exchange Agent of this Election Form and Letter of Transmittal, duly completed and manually signed, together with any certificate(s) representing Emclaire common shares and all accompanying evidences of authority. I agree that all questions as to validity, form and eligibility of any surrender of the Emclaire shares will be determined by the Exchange Agent.
(3) I understand that I may not and shall not sell or otherwise transfer the Emclaire common shares subject to this Election Form unless the Merger Agreement is terminated or I properly revoke this election prior to the Election Deadline.
(4) I acknowledge that, until I properly surrender the certificate(s) representing the Emclaire common shares to which this Election Form and Letter of Transmittal relates or properly transfer such Emclaire shares in book-entry form, I will not receive any consideration issuable or payable. Delivery of such certificate(s) will be effected, and risk of loss and title to such certificate(s) will pass, only upon proper delivery thereof to the Exchange Agent in the appropriate manner to one of the addresses listed in the Instructions.
Sign and provide your tax ID number on the IRS Form W-9 provided herein (or the appropriate IRS Form W-8 if you are a non-U.S. holder, a copy of which can be obtained at www.irs.gov). See Instruction 9.
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Signature of owner | | | | Signature of co-owner, if any | | | | |
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SIGNATURE(S) GUARANTEED (IF REQUIRED) See instruction 6.
Unless the shares were tendered by the registered holder(s) of the common shares, or for the account of a member of a Eligible Institution, your signature(s) must be guaranteed by an Eligible Institution.
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Authorized Signature | | | | | | | | |
| | | | Name of Firm | | | | |
Address of Firm – Please Print | | | | | | | | |
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