Benefit Claim Form Deferred Profit-Sharing Plan (DPSP) / Retirement Plan (RP) OFIS #0001

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1 BENEFIT OPTIONS All terminating participants, regardless of age and service, may elect one of the following forms of benefit from each plan: A. Direct Rollover (Lump Sum Distribution) tax-deferred rollover made payable to an IRA or another employer plan. A rollover is a payment of your plan benefits to your individual retirement arrangement (IRA) or to another employer s 401k plan. B. Direct Rollover to TAXCAP (Lump Sum Distribution) tax-deferred deposit into your TAXCAP account as a qualified rollover. For A or B, once you have rolled over your benefit you cannot use other potentially favorable tax treatments on the rolled-over benefit. READ the DPSP/RP Special Tax Notice Regarding Plan Payments included with this form for more detailed information on tax consequences. Your choice will affect the tax you owe. C. Direct Payment to Participant (Lump Sum Distribution) paid directly to you, with taxes withheld. D. Partial Direct Rollover (Lump Sum Distribution) a percentage of your choosing is rolled over. The remainder is paid directly to you, with taxes withheld. This is a combination of A or B and C above. E. Single Life Annuity (if lump sum value is more than $5,000) a monthly payment for the remainder of your life. F. Joint and 50%, 75% or 100% Survivor Annuity (if lump sum value is more than $5,000) a monthly benefit for the remainder of your life. After your death, 50%, BENEFIT 75% OPTIONS or 100% IN of FURTHER the monthly DETAIL payment continues for the life of the designated survivor. G. Leave your benefit amount(s) at HP at this time. The benefit amount in either the DPSP or RP must be more than $5,000 to select this option. This is the default when you do not submit any forms. However, payment of your benefits must be made or begin by age 70-1/2. ELECTIONS ARE RESTRICTED AS FOLLOWS: 1. If a lump sum has been elected, the choice is irrevocable after the lump sum is paid. 2. Benefits from the Retirement Plan cannot be paid prior to benefits from the Deferred Profit-Sharing Plan. 3. An annuity election CANNOT be changed after the date benefit payments are scheduled to begin. Annuity options are not eligible for rollover. BENEFIT AMOUNTS: 1. Amount(s) indicated on the U.S. Retirement Plan Administration Web site are estimates, as are any other previously quoted amounts. They were based on the latest information available at the time of calculation. 2. The amount(s) can change to be significantly less or more as the result of (i) investment performance of any DPSP account you may have, (ii) the month your distribution is to be made, (iii) changes in the 30 year Treasury interest rate or your age, and (iv) changes in government prescribed conversion factors. BENEFIT OPTIONS IN FURTHER DETAIL A. If you choose a DIRECT ROLLOVER A Direct Rollover Confirmation Form (OFIS 0003) must be completed by the receiving institution. Your payment will not be taxed in the current year and no federal or state income tax will be withheld. Your payment will be made by a check made payable to your IRA, or, if you choose, to another employer plan that accepts your rollover. The check will be mailed to your home address; you must deposit the check with the institution. Your payment will be taxed later when you take it out of the IRA or the employer plan. B. If you choose a DIRECT ROLLOVER TO TAXCAP You must have a TAXCAP account and positive balance. A Retirement Rollover Contribution Application (OFIS 0131) must be completed by you. Your payment will not be taxed in the current year and no federal or state income tax will be withheld. Your payment will be made by a check made payable to your TAXCAP account and delivered directly to Fidelity. You get consistent treatment with your other TAXCAP funds you control investments, daily exchanges, etc.

2 C. If you choose a DIRECT PAYMENT TO PARTICIPANT HP is required to withhold and send 20% of the payment to the IRS as income tax withholding to be credited against your federal taxes. You may need to make a state tax withholding election. Your payment will be subject to ordinary income tax in the current year unless you roll it over (see next bullet). After receiving your benefit check you can still decide to roll over the payment by depositing it into an IRA or employer plan within 60 days of the check date. If you want to roll over 100% of your benefit to an IRA or an employer plan, you must find other money to replace the federal and state income tax that was withheld. If you roll over only the amount that you received, you will be taxed on the amount that was withheld and not rolled over. A rollover has tax advantages explained in the DPSP/RP Special Tax Notice Regarding Plan Payments. D. If you choose a PARTIAL DIRECT ROLLOVER The bulleted items listed under option A or B apply for the portion that is rolled over. The bulleted items listed under option C apply for the portion that is a direct payment to the participant. E. If you choose a SINGLE LIFE ANNUITY If you are married your spouse must consent by completing the Spousal Consent Form (OFIS 0002). Lump sum value of your benefit must be more than $5,000. To request estimates of the value of annuities, send a written request to Hewlett-Packard Company, Pension Administration, P.O. Box 50604, Palo Alto, CA You may change a previously elected form of benefit to another available form any time before annuity payments are scheduled to begin or a lump sum has been paid. Annuity payments commence as soon as administratively practical after receipt of a completed Benefit Claim Form. Please refer to the Forms of Payout discussion in the RP and DPSP section of Your Hewlett-Packard Benefits Summary for further details. Pension Administration will send you tax form W4-P with your first annuity check for federal tax withholding election. Make an election for state tax withholding in Part IV of the Benefit Claim Form. F. If you choose a JOINT AND 50%, 75% OR 100% SURVIVOR ANNUITY If you do not list your spouse as your joint annuitant Spousal Consent Form (OFIS 0002) is required. Lump sum value of your benefit must be more than $5,000. To request estimates of the value of annuities, send a written request to Hewlett-Packard Company, Pension Administration, P.O. Box 50604, Palo Alto, CA Include the date of birth of the designated survivor. You may change a previously elected form of benefit to another available form any time before annuity payments are scheduled to begin or a lump sum has been paid. Annuity payments commence as soon as administratively practical after receipt of a completed Benefit Claim Form. Please refer to the Forms of Payout discussion in the RP and DPSP section of Your Hewlett-Packard Benefits Summary for further details. Pension Administration will send you tax form W4-P with your first annuity check for federal tax withholding election. Make an election for state tax withholding in Part IV of the Benefit Claim Form. G. If you choose to LEAVE YOUR BENEFIT AMOUNTS AT HP The benefit amount in either the DPSP or RP must be more than $5,000 to select this option. Do not submit a Benefit Claim Form. No action is necessary at this time. To request your benefit in the future, you will need to complete the forms required for the option you select at that time. A Retirement Program Trust statement will be mailed to your address on file once a year. FORMS: Before completing and signing the Retirement Benefit Claim Form, please carefully consider all benefit and payment options. Before your claim will be processed, the completed and signed Retirement Benefit Claim Form, together with any required Spousal Consent Form, and rollover form, must be filed with HP. NO payment can be made until all the necessary form(s) are completed and filed.

3 Select a benefit option (A, B, C, D, E or F). Benefit Claim Form FILLING OUT THE BENEFIT CLAIM FORM (OFIS 0001) Complete the first two rows by filling in your name, employee number, home telephone number and your last day on the payroll. PART I. MARITAL STATUS For all benefit options you are required to check one box. PART II. DISTRIBUTION ELECTION For benefit options A, B, C or D check Lump Sum For benefit option E, check Single Life Annuity. For benefit option F, check Joint & % Survivor. Please indicate whether you are selecting 50%, 75% or 100%. PART III. PAYMENT OPTION Complete this portion if you have selected benefit option A, B, C or D. If you selected benefit options E or F, please go to Part V. Please note there are two columns. Please select a box from each option that you have a balance in. If you selected benefit option A or B and wish to roll over your entire benefit, check the box labeled 100% Direct Rollover. If you selected benefit option C, check the box labeled 100% Direct Payment to Participant. If you selected benefit option D, check the box labeled Partial Direct Rollover of %. Please fill in the blank with a percentage to be rolled over. When selecting your percentage, please use whole numbers (for example, 65%, not 65.20%). The remaining benefit will be paid directly to you. If you require a specific amount (net) paid directly to you, please indicate that amount clearly in a blank area on the form. For example, you may write $8, net to be paid directly. Remainder to be rolled over. PART IV. TAXES For benefit options A or B no election is necessary. For benefit options C or D please make a state tax election. HP will withhold tax in accordance with those states requiring an election at the time of termination. If the state to which the check is being mailed does not require HP to withhold tax, HP will not withhold any tax even if you elect to have state tax withheld. The benefit, however, will be reported as income, and you will be responsible to satisfy any state tax liability. For more information, please review the page titled State Tax Withholding enclosed in this packet. For benefit options E or F please make a state tax election. Pension Administration will mail you tax form W4-P with your first annuity check for federal tax election. PART V. MAILING ADDRESS For benefit options A, C, D, E and F All checks must be mailed to your home address. If your home address is different that what is on file at HP, please write it in the space provided. The address you write in will become your permanent address on file. HP will not mail checks to any place other than your home address. For benefit option B HP will deliver your check directly to Fidelity. The check stub will be mailed to you. If you have recently moved and wish to notify HP at this time, you may write your new home address in the space provided. PART VI. EMPLOYEE SIGNATURE For all benefit options please read the information in Part VI then write in your citizenship, sign and date the form. Payment must be requested and paid within 90 days of the date on the forms, otherwise your claim forms will be invalid. The completed form must be returned by mail or fax to: Pension Administration P.O. Box OR Fax 650/ Palo Alto, CA Please note: Benefit payments may be paid as early as the month following the month you terminated employment. Checks usually are issued the next-to-last working day of each month. Claims must be received by mid-month to be included in the month-end check run. To confirm deadlines and check-issue dates, call 650/ and listen to the greeting or pension@hp.com Always include your employee number when corresponding.

4 Please type or print in black ink. EMPLOYEE NAME (Last, First, M.I.) EMPLOYEE NUMBER TELEPHONE NUMBER (Non-HP No.) ADDRESS LAST DAY ON PAYROLL (Termination Date) PART I. MARITAL STATUS: Single Married* Legally Separated (attach Court Order) Internal use only: Lien Code *If you re married your spouse must consent by completing the Spousal Consent Form, unless the lump sum value of your benefit is $5,000 or less. PART II. DISTRIBUTION ELECTION: Deferred Profit-Sharing Plan Lump Sum (Go to Part III) Single Life Annuity (Go to Part IV) Joint & % Survivor (Go to Part IV) (Indicate 50%, 75% or 100% Survivor Annuity) MAKE ONE ELECTION FOR EACH PLAN Retirement Plan Lump Sum (Go to Part III) Single Life Annuity (Go to Part IV) Joint & % Survivor (Go to Part IV) (Indicate 50%, 75% or 100% Survivor Annuity) Joint Annuitant (JA) Name: JA Birth Date: JA Social Security No.: JA Relationship: PART III. PAYMENT OPTION: You must have a rollover form completed to have any portion of your benefit issued as a direct rollover. Any portion of your lump sum benefit that is made as a direct rollover will have NO federal or state income tax withheld. Deferred Profit-Sharing Plan MAKE ONE ELECTION For EACH PLAN Retirement Plan 100% Direct Rollover (GO TO PART V) 100% Direct Rollover (GO TO PART V) Partial Direct Rollover of % (GO TO PART IV) Partial Direct Rollover of % (GO TO PART IV) 100% Direct Payment to Participant (GO TO PART IV) 100% Direct Payment to Participant (GO TO PART IV) PART IV. TAXES: (For whole or partial direct payments to participants, or annuity options) HP CANNOT REFUND INCOME TAX ONCE IT HAS BEEN WITHHELD FEDERAL TAX will be withheld at a rate of 20% for any portion of a lump sum that is not issued as a direct rollover. If you elect an annuity option, Pension Administration will mail you a W4-P form with your first annuity check to make your federal tax election. STATE TAX Choose ONE of the following: (See State Tax Withholding, attached) DO NOT withhold state tax from my benefit WITHHOLD state tax from my benefit. Number of allowances and marital status: Single Married PART V. MAILING ADDRESS: Complete only for an address that is different from the address that is on file. (For example, if you have recently moved.) TAXCAP rollover checks will be delivered directly to Fidelity. All other checks must be sent to your home address. Send my benefit check to: Street City State Zip Code PART VI. EMPLOYEE SIGNATURE: I hereby consent to receipt of my DPSP/RP benefits at this time in the form elected above. I acknowledge the following: I have received and certify that I have read this form and instructions, the DPSP/RP Special Tax Notice Regarding Plan Payments, pertinent sections of Your Hewlett-Packard Benefits Summary, and a general description of the relative financial effect of electing alternate forms of benefits. I have a right to request, in writing, an estimate of the value of my DPSP/RP benefits in any form available under the plans. I have a right to defer receipt of benefits greater than $5,000 until age 70-1/2. I have a right to consider my decision to elect a benefit for a period of 30 days prior to when benefits are distributed. My submission of a Benefit Claim Form resulting in a distribution of benefits within 30 days of receipt of the form will be considered a waiver of this 30 day requirement. CITIZENSHIP (Indicate Country of Citizenship) SIGNATURE DATE** **Payment must be requested and paid within 90 days of the date on this form, otherwise your claim for benefits will be invalid. Mail to: Hewlett-Packard Company, Pension Administration, P.O. Box 50604, Palo Alto, CA or Fax 650/ Page 1 of 1 The scanned copy of this form in OFIS is the official document of record. The original paper copy will be destroyed after the required retention period.

5 State Tax Withholding (For partial direct rollovers, direct payments to participants and annuitants) You have the right to choose whether or not to have state income tax withheld from your benefit from either Plan. You also have the right to change your state tax withholding election at any time until the benefit check is issued. This benefit may be subject to state income tax. If you elect NOT to have withholding apply to your benefit, or if you do not have enough state income tax withheld from your benefit, you may be responsible for payment of estimated state tax. Also, you may incur penalties under the state estimated tax rules if your withholding and estimated state tax payments are not sufficient. HP will withhold tax in accordance with those states requiring an election at the time of termination. If the state to which the check is being mailed does not require HP to withhold tax, HP will not withhold any tax even if you elect to have state tax withheld. The benefit, however, will be reported as income, and you will be responsible to satisfy any state tax liability. States Requiring a Withholding Election on Retirement Distributions at the Time of Termination STATE TAX WILL NOT BE WITHHELD FOR STATES OTHER THAN THOSE LISTED BELOW California * Rate table based on allowances and marital status Connecticut * Rate table: minimum of $10 withheld Delaware * Follows federal rules (20%) Georgia * Requires withholding with no ability to elect out of withholding: 6% flat rate Indiana * Amount upon request of employee Iowa * 5% flat rate Maine * Requires withholding if federal tax is withheld: 5% flat rate Massachusetts * Rate table based on allowances and marital status Montana * Requires withholding with no ability to elect out of withholding: 4% flat rate Minnesota * 7% flat rate New Jersey * Rate Table New Mexico * 8.5% flat rate Oregon * 8% flat rate South Carolina * 7% flat rate Vermont * 28% of federal tax withheld Virginia * 4% flat rate Financial Effect of Electing Alternate Benefit Forms from the Deferred Profit-Sharing and Retirement Plans The following table shows the monthly dollar value of a single life annuity and Joint and 50% Survivor annuity payable at the indicated age equivalent to a $1,000 DPSP or RP lump sum benefit payable at the same age. The value of the annuity depends on the age when benefits begin as well as the applicable interest rate used to convert the lump sum. Since the interest rate used for conversion is defined by the Internal Revenue Code and can change each month, a range of interest rates is shown. Note: The joint and 50% survivor annuity assumes the joint annuitant is the same age as the participant. If the joint annuitant is a different age, the value of the joint and 50% survivor annuity will change. Table Abbreviations: SLA = Single Life Annuity J & 50% S = Joint & 50% Survivor Annuity Interest Rate 5% 5% 6% 6% 7% 7% 8% 8% Age Lump Sum SLA J & 50% S SLA J & 50% S SLA J & 50% S SLA J & 50% S 70 $1, $1, $1, $1, $1, $1, $1, $1, $1, $1,