CLAIMANT IDENTIFICATION. 4. If you purchased or otherwise acquired the publicly traded common stock of Liquidity Services, Inc. (“LSI”) during the period from February 1, 2012, through May 7, 2014, inclusive (the “Class Period”), use Part I of this form, entitled “Claimant Identification,” to list your name, mailing address, and account information if relevant (such as for a claim submitted on behalf of an XXX, Trust, or estate account). Please list the most current claimant or account name, because these will appear on the settlement check, if the claim is eligible for payment. Please also provide a telephone number and/or e-mail address, as the Claims Administrator may need to contact you. If your Claimant Identification information changes, please notify the Claims Administrator in writing at the address above.
CLAIMANT IDENTIFICATION. If you (i) held Orbital Sciences Corporation (“Orbital Sciences”) stock as of December 16, 2014 and exchanged shares of Orbital Sciences stock for shares of Orbital ATK, Inc. (“Orbital ATK”) common stock in connection with the merger of Alliant Techsystems Inc. (“Alliant”) and Orbital Sciences, and/or (ii) purchased or otherwise acquired Orbital ATK common stock during the period from May 28, 2015 through and including August 9, 2016, and held the Orbital ATK common stock in your name, you are the beneficial purchaser, acquirer or seller as well as the record purchaser, acquirer or seller. If, however, you purchased, otherwise acquired or sold Orbital ATK common stock that was registered in the name of a third party, such as a nominee or brokerage firm, you are the beneficial purchaser, acquirer or seller and the third party is the record purchaser, acquirer or seller. Use Part I of this form entitled “Claimant Identification” to identify each purchaser, acquirer or seller of record (“nominee”), if different from the beneficial purchaser, acquirer or seller of the Orbital ATK common stock which form the basis of this claim. THIS CLAIM MUST BE FILED BY THE ACTUAL BENEFICIAL PURCHASER(S), ACQUIRER(S) OR SELLER(S) OR THE LEGAL REPRESENTATIVE OF SUCH PURCHASER(S), ACQUIRER(S) OR SELLER(S) OF THE SHARES UPON WHICH THIS CLAIM IS BASED. All joint purchasers, acquirers and/or seller(s) must sign this claim. Executors, administrators, guardians, conservators and trustees must complete and sign this claim on behalf of persons represented by them and their authority must accompany this claim and their titles or capacities must be stated. The Social Security (or taxpayer identification) number and telephone number of the beneficial owner may be used in verifying the claim. Failure to provide the foregoing information could delay verification of your claim or result in rejection of the claim. If you are acting in a representative capacity on behalf of a Class Member (for example, as an executor, administrator, trustee, or other representative), you must submit evidence of your current authority to act on behalf of that Class Member. Such evidence would include, for example, letters testamentary, letters of administration, or a copy of the trust documents. NOTICE REGARDING ELECTRONIC FILES: Certain claimants with large numbers of transactions may request to, or may be requested to, submit information regarding their transactions in electronic files. All such claimants M...
CLAIMANT IDENTIFICATION. The Claims Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Claims Administrator in writing at the address above. Complete names of all persons and entities must be provided. Beneficial Owner’s First Name MI Beneficial Owner’s Last Name Co-Beneficial Owner’s First Name MI Co-Beneficial Owner’s Last Name Entity Name (if claimant is not an individual) Representative or Custodian Name (if different from Beneficial Owner(s) listed above) Address1 (street name and number) Address2 (apartment, unit, or box number) City State ZIP/Postal Code Foreign Country (only if not USA) Foreign County (only if not USA) Social Security Number (last four digits only) Taxpayer Identification Number (last four digits only) Telephone Number (home) Telephone Number (work) Email address Account Number (if filing for multiple accounts, file a separate Claim Form for each account) Claimant Account Type (check appropriate box): Individual (includes joint owner accounts) Pension Plan Trust Corporation Estate IRA/401K Other (please specify)
CLAIMANT IDENTIFICATION. You may submit a Claim if you are a member of the Class. You are a member of the Class if at any time between November 1, 2015 and the present, you were a Cryptsy account holder, and held at Cryptsy Bitcoins, alternative cryptocurrencies, or any other form of monies or currency that you are unable to access, trade or otherwise obtain. (You are not a Class Member, and cannot make a claim, if you are or were an employee of Cryptsy, including its shareholders, officers and directors and members of their immediate families, or if you opened an account at Cryptsy after the date that Coinbase closed the Coinbase accounts of Cryptsy and Xxxx Xxxxxx, which was October 4, 2015.) Use Part A of this form entitled “Claimant Identification” to identify yourself. You must sign this claim. Executors, administrators, guardians, conservators, and trustees must complete and sign this claim on behalf of persons represented by them and their authority must accompany this claim and their titles or capacities must be stated. Failure to provide the foregoing information could delay verification of your claim or result in rejection of the claim.
CLAIMANT IDENTIFICATION. If you purchased or acquired OneMain Holdings, Inc. (“OneMain”) common stock and held the certificate(s) in your name, you are the beneficial purchaser or acquirer as well as the record purchaser or acquirer. If, however, you purchased or acquired OneMain common stock and the certificate(s) were registered in the name of a third party, such as a nominee or brokerage firm, you are the beneficial purchaser or acquirer and the third party is the record purchaser or acquirer. Use Part I of this form entitled “Claimant Identification” to identify each beneficial purchaser or acquirer of OneMain common stock that forms the basis of this claim, as well as the purchaser or acquirer of record if different. THIS CLAIM MUST BE FILED BY THE ACTUAL BENEFICIAL PURCHASER(S) OR ACQUIRER(S) OR THE LEGAL REPRESENTATIVE OF SUCH PURCHASER(S) OR ACQUIRER(S) OF THE ONEMAIN COMMON STOCK UPON WHICH THIS CLAIM IS BASED. All joint purchasers or acquirers must sign this claim. Executors, administrators, guardians, conservators, and trustees must complete and sign this claim on behalf of persons represented by them and their authority must accompany this claim and their titles or capacities must be stated. The Social Security (or taxpayer identification) number and telephone number of the beneficial owner may be used in verifying the claim. Failure to provide the foregoing information could delay verification of your claim or result in rejection of the claim.
CLAIMANT IDENTIFICATION. Instructions: Fill out each section of this Form, sign where indicated, carefully tear at perforation, and drop in the mail. Name (First, Last): Street Address: City: State: Zip Code: Foreign Country (only if not USA): Contact Phone #: ( ) - Part II: Claim. Unqiue Identifier: <<ClaimID>> Phone number(s) at which you received calls from Monitronics, an Authorized Dealer, or a sub-dealer or lead generator of a dealer: Phone 1: ( ) – Phone 2: ( ) – Phone 3 ( ) –
CLAIMANT IDENTIFICATION. 1. If you purchased or acquired Terex common stock and held the certificate(s) in your name, you are the beneficial owner as well as the record holder. If, however, the certificate(s) were registered in the name of a third party, such as a brokerage firm or other nominee, you are the beneficial owner and the third party is the record holder.
CLAIMANT IDENTIFICATION. [PRE-POPULATED]. If you have an address change, please handwrite the new address. Name (First, Last): , Street Address: City: State: ZIP Code: Contact Phone #: ( ) – Part II: Certification. By submitting this Claim Form, I certify that I received a call from Venture Data, LLC on the following cellular telephone number: [PRE-POPULATED] . Signature: Date: / / Print Name: WHO IS A CLASS MEMBER? You may be in the Settlement Class if, on June 11, August 19, or September 9, 2014, Venture Data placed a call to your cellular telephone line, using the Pro-T-S or CFMC dialer, and as part of a Public Opinion Strategies survey. If you are receiving this notice by mail, our records indicate that you are a class member. SETTLEMENT TERMS Defendants will pay $2,100,000 into a fund that will cover: (1) cash payments to eligible Settlement Class Members who submit Claim Forms; (2) attorneys’ fees to Class Counsel not to exceed one-third of the total fund, plus expenses; (3) a court-approved service payment of $15,000 to the Class Representative; and (4) the costs of administering the settlement. Your share of the fund will depend on the number of claims made. However, Class Counsel estimate you will receive approximately $160, less Court- approved deductions for settlement expenses, the service award, and attorneys’ fees and costs.
CLAIMANT IDENTIFICATION. 1. If you purchased or acquired GS Group common stock and held the certificate(s) in your name, you are the beneficial purchaser as well as the record purchaser. If, however, the certificate(s) were registered in the name of a third party, such as a nominee or brokerage firm through which you purchased the stock, you are the beneficial purchaser and the third party is the record purchaser.
