owner contact information form - pxd.com

Pxd.com- ‘Operations and Innovation’- ‘Royalty Owners’

Please return the completed form to the address listed below or you may fax this information to (432) 571-5255 or email it to the email address below.

Pioneer Natural Resources USA, Inc. Attn: Division Order Department

P O Box 3178 Midland, TX 79702

ownerrelationsinquiry@pxd.com

OWNER CONTACT INFORMATION FORM

Owner Number:

Name on Account

Tax ID or SSN

Phone No.:

Email:

DOB (optional):

Current Address:

Signature of Owner/Agent:

Print Owner Name:

Date:

*Second signature is for accounts listed with more than one owner (i.e. John and June Smith); both signatures are required.

Please Note:

IF AN INDIVIDUAL: Requests must be executed by the person or agent listed on the account.

IF A CORPORATION, LLC, TRUST, ESTATE OR ANY ENTITY OTHER THAN AN INDIVIDUAL: The person signing this request form must have the authority to make the request, and documentation verifying said authority must accompany this form in order to make any changes.

IF ALL FIELDS ARE NOT COMPLETED OR DO NOT MATCH OUR RECORDS, NO CHANGES WILL BE MADE.