Harbinger Group Inc.
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SEC Filings

S-4
HRG GROUP, INC. filed this Form S-4 on 01/15/2016
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PLEASE SIGN HERE
(TO BE COMPLETED BY ALL TENDERING HOLDERS WHETHER OR NOT
INITIAL NOTES ARE BEING PHYSICALLY TENDERED HEREBY)
(Please Also Complete and Return the Accompanying IRS Form W-9 or W-8 as applicable)
 
 
 
 
 
x
 
 
  
 
 
 
 
x
 
 
  
 
Signature(s) of Owner(s)
 
 
  
Date
Area Code and Telephone Number:                                                                                                                   
If a holder is tendering any Initial Notes, this Letter must be signed by the registered holder(s) exactly as the name(s) appear(s) on the certificate(s) for the Initial Notes or on a security position listing as the owner of Initial Notes by person(s) authorized to become registered holder(s) by a properly completed bond power from the registered holder(s), a copy of which must be transmitted with this Letter. If Initial Notes to which this Letter relates are held of record by two or more joint holders, then all such holders must sign this Letter. If signature is by a trustee, executor, administrator, guardian, officer or other person acting in a fiduciary or representative capacity, then such person must (i) set forth his or her full title below and (ii) unless waived by the Company, submit evidence satisfactory to the Company of such person’s authority to so act. See Instruction 3.
 
 
 
Name(s): 
  
 
(Please Type or Print)
 
 
(Please Type or Print)
 
 
Capacity: 
  
 
 
 
Address:
  
 
 
 
 
  
 
(Including Zip Code)
SIGNATURE GUARANTEE BY AN ELIGIBLE INSTITUTION
(If required by Instruction 3)
Signature(s) Guaranteed by an Eligible Institution:
  
 
(Authorized Signature)
 
 
(Title)
 
 
(Name of Firm)
 
 
(Address, Include Zip Code)
 
 
(Area Code and Telephone Number)
Dated:                                  



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