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| . + ELECTION CHOICES I在此選擇收取以下作為我的城鄉普通股合併的對價，可按比例分配和調整, 如 根據合併Agreement. ALL S T OCK ELECTION (to確定的 僅接受股票對價) 勾選此框以選擇接受關於您的所有 城鎮和國家 普通股的股票對價(股票對價固定為 HBT Financial股票的 1.9010 {br 普通股(加上現金 以代替任何零碎的 HBT Financia l 普通股) 城鎮和鄉村 普通股(“股票對價”) 所有現金 選擇(只收取現金對價) 勾選此框以選擇接受關於以下方面的 現金 對價您的所有 城鎮和鄉村 普通股( 現金 對價是固定的 每股35.66美元 每股無息 城鎮和鄉村 普通股 普通股(“ Cash Consideration”)) MIXED ELECTION Mark此框選擇 }receive S tock Consideration with關於您持有的以下數量的and Country common stock. Your城鎮股份 剩餘的城鎮鄉村普通股將被交換 for the Cash Consideration. Please fill in t He number of shares of城鄉通用stock for which you would like to receive the Stock考慮事項 在 框中從 到 The right. These elections will be subject to proration based on the proration procedures在合併協議中規定了 多個 - 批次 SHARES Stockholders holding fewer than 100 shares of Town和Country common stock may have their shares of Town以及國家/地區 通用 sto c k accepted for payment before any proration of other tendered shares of Town and Country common stock{Br} if they request preferential treatment by marking the box belo w . This preference is not available to{Br} (i) s h ares held in the Town和Country Financial Corporation Employee Stock Ownership Plan , (ii) partial tenders or (iii) beneficial or record holders of an aggregate of 100 or more shares 城鄉 普通股 股票， even if such holders have separate accounts or certificates r e presenting fewer than 100 shares of (Company) common stock. Accordingl y ， this section is to be completed ON L Y if shares of Town和Country common stock are being {Br}tendered by or on behalf of a person owning an aggregate of fewer than 100 shares of 城鎮和Country common stock. Mark this box if you own an aggregate of fewer than 100 shares of Town以及鄉村 普通 股票， 是否正在競標 所有此類 股票， and are electing preferential treatment in the event of proration. LOS T ， S T OLEN OR DESTROYED CERTIFIC A TE(S) If your certificate(s) representing shares of Town和Country common stock have been mutilated， 已銷燬， lost or stolen and you wish to tender your共享， 請 聯繫 傳輸代理 [ 手機 ] regarding the requirements for replacement of the certificate(s). [通過 直接註冊 系統進行 Replacement shares will be issued in book - entry form。 ] Y ou may be asked to post a surety bond for your lost shares of Town and Country common stock. Y our shares of Town and Country common stock will not be included in the exchange offer unless you satisfy the requirements for replacement of your mutilated, destroyed, lost or stolen certificate(s). Y ou are urged to call Transfer Agent immediately to ensure timely processing of the documentation. T o be effective, this Election Form must be properly completed, signed and delivered to the Exchange Agent at one of the addresses listed in the Exchange and T ransmittal Information Booklet, together with your stock certificate(s), confirmation of book - entry transfer or a properly completed Notice of Guaranteed Deliver y , by the Expiration. Do not send your election materials to Town and Country or HBT Financial . SIGN A TURE(S) REQUIRED. Signature of Registered Holder(s) or Agent Must be signed by the registered holder(s) EXACT L Y as name(s) appear(s) on stock certificate(s). If signature is by a trustee, executo r , administrato r , guardian, attorney - in - fact, o f ficer for a corporation in a fiduciary or representative capacit y , or other person, please set forth full title. Please refer to the Exchange and T ransmittal Informati o n Booklet, Signature Guarantees. By signing belo w , I represent and warrant as follows: (1) I have full power and authority to surrender the shares of Town and Country common stock represented by the stock certificat e (s) surrendered herewith or transferred in book - entry form, or covered by a guarantee of deliver y , free and clear of all liens, claims and encumbrances. I will, upon request, execute and deliver any additional docum e nts reasonably deemed by the Exchange Agent to be appropriate or necessary to complete the surrender and exchange of my shares of Town and Country common stock. (2) I understand that neither surrender nor an election is made in acceptable form until receipt by the Exchange Agent of this Election Form , duly completed and manually signed, together with any stock certificate(s) representing shares of Town and Country common stock and all accompanying evidences of authorit y . I agree that all questions as to validit y , form and eligibility of any surrender of the shares of Town and Country common stock will be determined by the Exchange Agent. (3) I understand that, pending the completion of the Merge r , I may not and shall not sell or otherwise transfer the shares of Town and Country common stock subject to this Election Form unless the Merger Agreement is terminated or I properly revoke this election prior to the Expiration. (4) I acknowledge that, until I properly surrender the certificate(s) representing the shares of Town and Country common stock to which this Election Form relates or properly transfer such shares of Town and Country common stock in book - entry form, I will not receive any consideration issuable or payable in connection with the Merge r . Deliv e ry of such certificate(s) will be e f fected, and risk of loss and title to such certificate(s) will pass, only upon proper delive ry thereof to the Exchange Agent in the appropriate manner to one of the addresses listed in the E xchange and T ransmittal Information Booklet. (5) I acknowledge that, in the event the exchange o f fer is consummated but fewer than all of the issued and outstanding shares o f HBT Financial common stock are exchanged because the exchange o f fer is not fully subscribed, Town and Country will distribute the remaining shares of HBT Financial common stock on a pro rata basis to Town and Country stockholde r s only with respect to those shares of Town and Country common stock that remain outstanding after the consummation of the exchange o f fe r , and I hereby waive and forfeit any rights to any of the remaining sh a res of HBT Financial common stock so distributed with respect to any shares of Town and Country common stock that are exchanged in the exchange o f fe r . Sig n an d provid e you r T axpaye r Identificatio n Numbe r o r Socia l Securit y Numbe r , a s applicable , o n th e IR S For m W - 9 i f provide d (o r th e appropriat e IR S For m W - 8 i f yo u ar e a non - U.S . stockholde r , a cop y o f whic h ca n b e obtaine d a t ww w .irs.gov). Signature of owner Signature of co - owne r , if any Area Code/Phone Number SIGN A TURE(S) GUARANTEED (IF REQUIRED) . Unles s th e share s wer e tendere d b y th e registere d holder(s ) o f th e commo n shares , o r fo r th e accoun t o f a membe r o f a U.S . eli g ibl e institutio n (a s define d i n th e Exchang e an d T ransmitta l Info rmatio n Booklet) , you r signature(s ) must b e guarantee d b y a n eligibl e institution. Authorized Signature Name of Firm Address of Firm – Please Print 1 2 3 4 5 6 7 8 9 0 1 2 3 4 6 V O L C O Y C C L S + |
| SPECIAL TRANSFER INSTRUCTIONS T o be completed ON L Y if the shares and/or cash in lieu of fractional shares are to be registered in the name of someone other than the undersigned. All changes in registration require a Medallion Signature Guarantee. Joint registrations must include the form of tenanc y . Custodial registrations must include the name of the custodian (only one). T rust account registrations must include the names of all current acting trustees and the date of the trust agreement. Name: (PLEASE TYPE OR PRINT) Address: (INCLUDE ZIP CODE) ( T AX PA YER IDENTIFIC A TION OR SOCIAL SECURITY NUMBER) (SEE SUBSTITUTE FORM W - 9) SPECIAL DELIVE R Y INSTRUCTIONS T o be completed ON L Y if the shares and/or cash in lieu of for fractional shares are to be mailed or sent to someone other than the undersigned or to the undersigned at an address other than that designated above. Name: (PLEASE TYPE OR PRINT) Address: (INCLUDE ZIP CODE) ( T AX PA YER IDENTIFIC A TION OR SOCIAL SECURITY NUMBER) |
