WORTHINGTON INDUSTRIES, INC. CONFLICT MINERALS QUESTIONNAIRE AND CERTIFICATION INSTRUCTIONS 1. This Conflict Minerals Questionnaire and Certification (“Questionnaire”) was prepared to assist Worthington Industries, Inc. (“we”, “our” or “us”) in connection with the due diligence that we are required to perform to comply with U.S. Securities and Exchange Commission regulations. 2. You are being asked to complete this Questionnaire because you supply us with materials or components that we use in our products. The purpose of this Questionnaire is to determine whether any of the materials or components that you supply to us contain tin, tantalum, tungsten or gold (“conflict minerals”), and if so, to determine the origin of such minerals. 3. If any of the materials or components that you supply to us contain tin, tantalum, tungsten or gold, we ask that you provide the information requested in this Questionnaire with respect to the processing facilities (i.e., the smelters or refineries) and origins of such minerals. 4. If you do not have sufficient information to provide a complete response to any of the Questions, we ask that you obtain that information from the applicable processing facilities. If you do not source directly from such processing facilities, we ask that you obtain the requested information from your suppliers. 5. If you require more space to answer a Question than what is provided, please attach separate sheets as required. On each attached sheet, please write your company’s name and the Question number at the top. 6. Please return the completed Questionnaire, signed by an authorized representative of your company, by no later than the date indicated on the correspondence accompanying this Questionnaire. All returns should be sent electronically to Renate Wallner ([email protected]), by fax to +43 7485 606 100, or by mail to Worthington Cylinders, Beim Flaschenwerk 1, A-3291 Kienberg, Austria. QUESTIONS 1. Company Information Please provide the following information about your company. Legal Name of Company: Authorized Company Representative with respect to this Questionnaire: Name: Title: Phone: E-Mail: 1 2. Materials, Components and Products Supplied Do any of the materials, components or products that you supply to us contain any of the following minerals – tin, tantalum, tungsten or gold? Yes No If your answer to this Question is “Yes”, please complete Questions 3 through 6 below. If your answer to this Question is “No”, you are not required to complete the remaining Questions and may proceed directly to the certification contained at the end of this Questionnaire. 3. Conflict Minerals in Materials, Components and Products Supplied. Please identify each of the materials, components and products that you supply to us that contain tin, tantalum, tungsten or gold, and indicate which minerals are contained in each such material, component and product. # Material, Component or Product Supplied Tin (Sn) Conflict Mineral Tantalum Tungsten (Ta) (W) Gold (Au) 1 2 3 4 5 6 7 8 9 10 2 4. Conflict Minerals from Recycled or Scrap Sources Do you know or have reason to believe that the minerals contained in any of the materials, components and products identified in Question 3 came from recycled or scrap sources? Yes No If your answer to this Question is “Yes”, please complete the table below with respect to such minerals. If you are unable to complete the table, please make inquiries with your suppliers and provide us with additional information when obtained. Cross Reference to # of Material/Product Identified in Question 3 Applicable Conflict Mineral(s) Name and Location of Smelter/Refinery Where Conflict Mineral is Processed 5. Conflict Minerals from Covered Countries Do you know or have reason to believe that the conflict minerals contained in any of the materials and products identified in Question 3 originated from any of the following countries in Africa (the “covered countries”)? (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) Yes the Democratic Republic of the Congo Angola Burundi the Central African Republic the Republic of Congo Rwanda South Sudan Tanzania Uganda Zambia No If your answer to this Question is “Yes”, please complete the table below with respect to such conflict minerals. If you are unable to complete the table, please make inquiries with your suppliers and provide us with additional information when obtained. Cross Reference to # of Material/Product Identified in Question 3 Applicable Conflict Mineral(s) Name of Covered Country 3 Name and Location of Smelter/Refinery Where Conflict Mineral is Processed Cross Reference to # of Material/Product Identified in Question 3 Applicable Conflict Mineral(s) Name of Covered Country Name and Location of Smelter/Refinery Where Conflict Mineral is Processed 6. Other Conflict Minerals For each of the materials, components and products identified in Question 3 (other than those materials, components and products identified in Questions 4 and 5), please identify the smelter or refinery where the conflict minerals contained in such materials and products were processed. For each material or product that contains conflict minerals but that you do not know the smelter or refinery at which such conflict minerals were processed, please make inquiries with your suppliers and provide us with additional information when obtained. Cross Reference to # of Material/Product Identified in Question 3 Applicable Conflict Mineral(s) Name and Location of Smelter/Refinery Where Conflict Mineral is Processed CERTIFICATION The undersigned, being a duly authorized representative of the company identified below, hereby certifies for and on behalf of said company that all of the answers and information provided to Worthington Industries, Inc. in this Conflict Mineral Questionnaire and Certification are true, complete and accurate to the best of my knowledge and belief as of the date written below. Name of Company: ___________________________________ Signature: ___________________________________ Print Name: ___________________________________ Title: ___________________________________ Date: ___________________________________ 4
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