FORM OF BENEFICIAL OWNER ELECTION FORM
I (we) acknowledge receipt of your letter and the enclosed materials relating to the offering of rights (the "Series A Rights") to purchase shares of Series A Liberty Ventures common stock, par value $0.01 per share (the "Series A Liberty Ventures Common Stock"), of Liberty Interactive Corporation (the "Company").
In Part I of this form, I (we) instruct you whether to exercise, sell or transfer the Series A Rights distributed pursuant to the terms and subject to the conditions set forth in the prospectus dated [ ], 2012 (the "Prospectus").
PART I
BOX 1. o | Please do not exercise Series A Rights. | |
BOX 2. o |
Please exercise Series A Rights as set forth below: |
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Number of Series A Rights |
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Subscription Price | |
Payment | |
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Basic Subscription Privilege: |
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x | $[ ] |
= | $ |
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(Line 1) | ||||||
Oversubscription Privilege: |
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x | $[ ] |
= | $ |
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(Line 2) |
By exercising the oversubscription privilege (the "Oversubscription Privilege") with respect to my (our) Series A Rights, I (we) hereby represent and certify that I (we) have fully exercised my (our) basic subscription privilege (the "Basic Subscription Privilege") received in respect of shares of Series A Liberty Ventures Common Stock held in the below described capacity.
Total Payment Required = $
(Sum of Lines 1 and 2 must equal total of amounts in Boxes 3 and 4)
BOX 3. o | Payment in the following amount is enclosed: | |
BOX 4. o |
Please deduct payment from the following account maintained by you as follows: |
Type of Account |
Account No. |
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Amount to be deducted: $ |
Date: | |
, 2012 | Signature |
BOX 5. o | Please sell of my Series A Rights. | |
BOX 6. o |
Please have Computershare Trust Company, N.A. effect my specific instructions that I have attached hereto and for which I have had an Eligible Institution guarantee my signature. |
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Signature(s): |
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Signature(s): |
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Please type or print name(s) below: |
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Signature(s) Guaranteed by: |
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