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PO Box 6063 Sioux Falls, SD 57117-6063

Important information regarding your account

ACCOUNT NUMBER 5466160037417977

October 8, 2011


Dear MAJA MILOVIC ANGELOV Why we're writing you Important steps if fraud identified We are providing you with a Declaration of Unauthorized Use for the security closed card number listed above. If your card was used fraudulently and unauthorized transactions appear on your billing statements, please follow the steps below to assist us in investigating the disputed transactions. 1. 2. 3. 4. 5. 6. How to contact us Complete the enclosed Declaration of Unauthorized Use. Have all users sign. Circle the date, merchant name, and dollar amount of the disputed transactions and indicate “fraud” next to the transaction on the billing statement or on your letter. Include any additional information that may aid in the investigation. For example, a police report, suspect information, how the compromise took place, etc. Retain a copy of all documentation for your personal records. Return the Declaration and billing statement as soon as you identify any fraudulent transactions. Remember that you must continue to make the minimum payment due on the portion of your balance that is not being disputed.

For faster service, you may fax all of the documentation requested above to 1-866-799-5580 or mail it to: Citibank, N.A. Security Services PO Box 6063 Sioux Falls, SD 57117-6063 We will investigate the fraudulent activity and make any necessary adjustments to your account. Thank you for contacting us regarding your account. Sincerely, Your Customer Service Team

AmericanAirlines and AAdvantage are trademarks of American Airlines, Inc.

Enclosure 0/L0/880185/001/ZZ/SY/ZP/8000/SYSTEMB/I2011100870004751/49548/49548/16 1

Return this form only if you notice unauthorized activity.

Listed below is the name on any card that was lost/stolen/never received: _____________________________________________________________________________________ 6. Neither I. nor anyone with my knowledge or consent received or expect to receive any benefits or value as a result of this transaction(s). I understand that Security Services investigates alleged fraudulent or unauthorized credit card usage and may refer the same to the appropriate law enforcement agency. 4. ________________________________________the undersigned. do hereby state and declare as follows: 1. 2. __________________________________ primary cardholder signature _____________________ date A FALSE DECLARATION TO A FEDERALLY INSURED FINANCIAL INSTITUTION MAY BE A VIOLATION OF FEDERAL AND/OR STATE LAW. This declaration concerns the above Citi® Platinum Select® / AAdvantage® World MasterCard account number. Never Received c. Lost/Stolen. 3.Declaration of Unauthorized Use ACCOUNT NUMBER 5466160037417977 Please return this declaration only if you are reporting unauthorized charges I. . Send this document and the billing statement(s) which clearly indicate disputed transactions to: Citibank. Police report filed? Y/N If yes: Case #______________________City______________________ Precinct___________________ Phone Number______________________________Detective Name_____________________________ b. Date:______________ Location:_____________________ If Stolen. All cards were in my possession at the time of fraudulent use. SD 57117-6063 Fax: 1-866-799-5580 *AWOD5466160037417977* *AWOD5466160037417977* Return this form only if you notice unauthorized activity. Security Services PO Box 6063 Sioux Falls. I HAVE INDICATED ON THE ATTACHED DOCUMENT THOSE TRANSACTIONS THAT ARE FRAUDULENT AND INCLUDED WITH THIS DECLARATION. I have reason to believe the following individual(s) utilized the credit card(s) described above or had access to my card number without my authorization: Name(s)________________________________________________________________________________ Address(es) Street________________________________________________________________________ City__________________________________________State____________________ Zip Code_________________ Reason:________________________________________________________________________________ 7. Other circumstances:____________________________________________________________________ 5. (Continue on the back of this form if additional space is needed. I agree to cooperate in any prosecution of individuals charged with fraudulent or unauthorized credit card usage.) a. My card was (circle one). nor anyone authorized by me. The signatures set forth below are the signatures of ALL AUTHORIZED USERS ON THIS ACCOUNT (continue additional authorized user signatures on the back): PRINT NAME ____________________________________ ____________________________________ ____________________________________ SIGNATURE ____________________________________ ____________________________________ ____________________________________ 8.A. N.