PROOF OF CLAIM and SUBSTITUTE W-9 FORM GENERAL INSTRUCTIONS

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1 IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE BLACKTHORN PARTNERS, L.P., a Delaware limited partnership, on behalf of itself and all others similarly situated, Plaintiff, v. JOHN C. MALONE, EVAN D. MALONE, GREGORY B. MAFFEI, ROBERT R. BENNETT, DONNE F. FISHER, MALCOLM IAN GRANT GILCHRIST, PAUL A. GOULD, DAVID E. RAPLEY, M. LAVOY ROBISON, and LARRY E. ROMRELL C.A. No CS Defendants. PROOF OF CLAIM and SUBSTITUTE W-9 FORM GENERAL INSTRUCTIONS (Please see page 8 of the Notice for additional instructions) 1. To recover as a Member of the Class based on the claims asserted on your behalf in the lawsuit captioned above (the Litigation ), you must complete, sign and return this Proof of Claim and the accompanying Substitute Form W-9. Even if you do not fill out and return this document, any and all claims you may have against the Settling Defendants in this Litigation are released to the full extent defined below by virtue of your participation in this Litigation as a non-excluded Class Member. If you fail to file a properly addressed (as set forth in paragraph 3 below) Proof of Claim and Substitute W-9 Form, your claim may be rejected and you may be precluded from any recovery from the Net Settlement Fund created in connection with the proposed Settlement of the Litigation. 2. Submission of this Proof of Claim and Substitute W-9 Form, however, does not assure that you will share in the proceeds of the Settlement of this Litigation. Your Proof of Claim and Substitute W-9 Form must be verified and approved by the Claims Administrator before you can share in the proceeds of the Settlement. 3. YOU MUST MAIL YOUR COMPLETED AND SIGNED PROOF OF CLAIM AND SUBSTITUTE W-9 FORM POSTMARKED ON OR BEFORE AUGUST 7, 2012, ADDRESSED AS FOLLOWS: Liberty Media Shareholder Litigation Settlement Heffler Claims Administration PO Box Philadelphia, PA If you are NOT a Member of the Class, as defined in the Notice of Pendency of Class Action, Proposed Settlement of Class Action, Settlement Hearing and Right to Appear ( Notice ), DO NOT submit a Proof of Claim and Substitute W-9 Form. 11

2 5. If you are a Member of the Class, you are bound by the terms of any Judgment entered in the Litigation, including the Release included in the Stipulation and Agreement of Compromise, Settlement and Release (the Stipulation ), whether or not you submit a Proof of Claim and Substitute W-9 Form. 6. If you held LMDIB in your name, you are the beneficial owner as well as the record owner. If, however, the securities were registered in the name of a third party, such as a nominee or brokerage firm through which you purchased the stock, you are the beneficial owner and the third party is the record owner. 7. Use Part I of this form entitled Claimant Identification to identify each owner of record, if different from the beneficial owner of LMDIB on whose behalf the claim is submitted. 8. All joint owners must sign this claim. Executors, administrators, guardians, conservators and trustees must complete and sign this claim form on behalf of persons represented by them and evidence of their authority must accompany this claim and their titles or capacities must be stated. The last four digits of the social security (or taxpayer identification) number and telephone number of the beneficial owner may be used in verifying the claim. Failure to provide the foregoing information could delay verification of your claim or result in rejection of the claim. 9. Use Part II of this form entitled Claimant Holdings to identify the number of shares of LMDIB you owned as of October 9, Brokerage statements reflecting your holdings, or other documentation of your holdings in LMDIB should be attached to your claim. Failure to provide this documentation could delay verification of your claim or result in rejection of your claim. 12

3 IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE LIBERTY MEDIA SHAREHOLDER LITIGATION SETTLEMENT PROOF OF CLAIM FORM MUST BE POSTMARKED NO LATER THAN: AUGUST 7, 2012 Please Type or Print PART I: CLAIMANT IDENTIFICATION Beneficial Owner s Name (First, Middle, Last) Joint Owner s Name (First, Middle, Last) If you are a bank or other institution filing on behalf of a third-party, and an account number is needed to identify the claimant for your records, indicate the account number here: Attn: Street Address: City: State: Zip Code: - Foreign Province: Foreign Postal Code: Foreign Country: Area Code Telephone No. (day) Area Code Telephone No. (evening) Social Security Number (for individual) OR - Employer Identification Number (for estates, trusts, corps, etc.) Check Appropriate box: Individual Corporation Joint Owners IRA Trust Estate Other Record Owner s Name (if different from beneficial owner(s) listed above) 13

4 PART II: CLAIMANT HOLDINGS Total number of shares of LMDIB held as of October 9, 2009: (must be documented) (Note: Please see page 8 of the Notice and your name and address label for share information, if available.) PART III. SUBMISSION TO JURISDICTION OF COURT AND ACKNOWLEDGMENTS I (We) submit this Proof of Claim Form under the terms of the Stipulation described in the Notice. I (We) also submit to the jurisdiction of the Court of Chancery of the State of Delaware, with respect to my (our) claim as a Class Member (as defined in the Notice) and for purposes of enforcing the release set forth herein. I (We) further acknowledge that I am (we are) bound by and subject to the terms of any judgment that may be entered in the Litigation. I (We) agree to furnish additional information to Lead Counsel or the Claims Administrator to support this claim if required to do so. I (We) have not submitted any other claim covering the same holdings of LMDIB as of October 9, 2009 and know of no other Person having done so on my (our) behalf. Under penalty of perjury, I (we) hereby certify and represent that I (we) have included information about all of my holdings of LMDIB as of October 9, 2009 and that such information and documentation is true and correct to the best of my (our) knowledge. By executing this certification, I (we) acknowledge and agree to be bound by the Release set forth above. Executed this day of, (Month/Year) in,. (City) (State/Province, Country) (Sign your name here) (Joint Owner Sign your name here) (Type or print your name here) (Joint Owner Type of print your name here) (Capacity of persons signing e.g. Beneficial Purchaser, Executor or Administrator) 14

5 SUBSTITUTE FORM W-9 Request for Taxpayer Identification Number ( TIN ) and Certification PART I Name: Check appropriate box: Individual/Sole Proprietor Corporation Partnership Pension Plan IRA Trust Other (specify) Enter your TIN in the appropriate space below. For individuals, this is your Social Security Number ( SSN ). For sole proprietors, you must show your individual name, but you may also enter your business or doing business as name. You may enter either your SSN or your Employer Identification Number ( EIN ). For other entities, it is your EIN. Social Security Number Employer Identification Number (for estates, trusts, corps, etc) - - OR - NOTE: If you require instructions for Completing Substitute Form W-9, please make a written request to Liberty Media Shareholder Litigation Settlement, Heffler Claims Administration, P.O. Box 59090, Philadelphia, PA or visit the Claims Administrator s website at Please note that your accountant should also be able to provide you with these instructions. PART II CERTIFICATION UNDER THE PENALTY OF PERJURY, I (WE) CERTIFY THAT ALL OF THE INFORMATION PROVIDED IN THIS FORM IS TRUE, CORRECT AND COMPLETE. I (We) certify that I am (we are) NOT subject to backup withholding under the provisions of Section 3406 (a)(1)(c) of the Internal Revenue Code because: (a) I am (we are) exempt from backup withholding; or (b) I (we) have not been notified by the Internal Revenue Service that I am (we are) subject to backup withholding as a result of a failure to report all interest or dividends; or (c) the Internal Revenue Service has notified me (us) that I am (we are) no longer subject to backup withholding. NOTE: If you have been notified by the Internal Revenue Service that you are subject to backup withholding please cross out the word NOT in the certification above. (Sign your name here) (Date) (Joint Owner Sign your name here) (Date) (Type or print your name here) (Joint Owner Type of print your name here) (Capacity of person(s) signing, e.g. Beneficial Purchaser, Executor or Administrator) 15

6 Liberty Media Shareholder Litigation Settlement Heffler Claims Administration PO Box Philadelphia, PA FIRST-CLASS MAIL U.S. POSTAGE PAID PEARL PRESSMAN LIBERTY COMMUNICATIONS GROUP IMPORTANT LEGAL INFORMATION ACCURATE CLAIMS PROCESSING TAKES A SIGNIFICANT AMOUNT OF TIME. THANK YOU FOR YOUR PATIENCE. Reminder Checklist: 1. Please sign both the claim form at Part III and the Substitute Form W-9 at Part II. 2. Remember to attach supporting documentation. 3. Do not send original or copies of stock certificates. 4. Keep a copy of your claim form for your records. 5. If you desire an acknowledgment of receipt of your Proof of Claim and Substitute W-9 Form, please send it Certified Mail, Return Receipt Requested. 6. If you move after submitting your Proof of Claim and Substitute W-9 Form, please send your new address to the Claims Administrator.