PROOF OF CLAIM AND RELEASE FORM. GENERAL INSTRUCTIONS
PROOF OF CLAIM AND RELEASE FORM. To be eligible to receive a share of the Net Settlement Fund in connection with the Settlement of this Action, you must be a Class Member and complete and sign this Proof of Claim and Release Form (“Claim Form”) and either mail it by first-class mail to the above address or submit it online at www. , no later than , 2018. Failure to submit your Claim Form by the date specified will subject your claim to rejection and may preclude you from being eligible to recover any money in connection with the Settlement. TABLE OF CONTENTS PAGE # 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. Beneficial Owner’s First Name Beneficial Owner’s Last Name Co-Beneficial Owner’s First Name Co-Beneficial Owner’s Last Name Entity Name (if Beneficial Owner 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 Code Country Last four digits of Social Security Number or Taxpayer Identification Number Telephone Number (home) Telephone Number (work) Email address (E-mail address is not required, but if you provide it you authorize the Claims Administrator to use it in providing you with information relevant to this claim.): Account Number (where securities were traded): Claimant Account Type (check appropriate box): Individual (includes joint owner accounts) Pension Plan Trust Corporation Estate IRA/401K Other (please specify)
PROOF OF CLAIM AND RELEASE FORM. TO BE POTENTIALLY ELIGIBLE TO RECEIVE A SHARE OF THE NET SETTLEMENT FUND IN CONNECTION WITH THE SETTLEMENT OF THIS ACTION, YOU MUST COMPLETE AND SIGN THIS PROOF OF CLAIM AND RELEASE FORM (“CLAIM FORM”) AND MAIL IT BY PREPAID, FIRST-CLASS MAIL TO THE ABOVE ADDRESS, POSTMARKED NO LATER THAN , 2016. FAILURE TO SUBMIT YOUR CLAIM FORM BY THE DATE SPECIFIED WILL SUBJECT YOUR CLAIM TO REJECTION AND MAY PRECLUDE YOU FROM BEING ELIGIBLE TO RECEIVE ANY MONEY IN CONNECTION WITH THE SETTLEMENT. TABLE OF CONTENTS PAGE #
PROOF OF CLAIM AND RELEASE FORM. To be eligible to receive a share of the Net Settlement Fund from the proposed Settlement of the action captioned Washtenaw County Employees’ Retirement System v.
PROOF OF CLAIM AND RELEASE FORM. 2 To be eligible to receive a cash distribution from the Settlement Fund, you must timely 3 complete, sign and submit a Proof of Claim and Release Form (“Proof of Claim”). A Proof of Claim 4 may be downloaded at xxx.XxxxXxxxxxxxxxXxxxxxxxxx.xxx. Only one Proof of Claim is required to 5 participate in the settlements of both this State Action and the Federal Action. Read the instructions 6 carefully, fill out the Proof of Claim, include all the documents the form asks for, sign it, and mail or 7 submit it online so that it is postmarked (if mailed) or received (if filed electronically) no later than 8 , 2020. The claim form may be submitted online at xxx.XxxxXxxxxxxxxxXxxxxxxxxx.xxx. If 9 you do not submit a valid Proof of Claim form with all of the required information, you will not receive
PROOF OF CLAIM AND RELEASE FORM. To be eligible to receive a share of the Net Settlement Fund in connection with the Settlement of this Action, you must complete and sign this Proof of Claim and Release Form (“Claim Form”) and mail it by first-class mail to the above address, postmarked no later than , 2017. Failure to submit your Claim Form by the date specified will subject your claim to rejection and may preclude you from being eligible to receive any money in connection with the Settlement. TABLE OF CONTENTS PAGE #
PROOF OF CLAIM AND RELEASE FORM. To be eligible to receive a share of the Net Settlement Fund in connection with the Settlement of this Action, you must complete and sign this Proof of Claim and Release Form (“Claim Form”) and mail it by first-class mail to the address below, or submit it online at xxx.XxxxxxxxxXxxxxxxxxxXxxxxxxxxx.xxx, with supporting documentation, postmarked (or received) no later than , 202_. Failure to submit your Claim Form by the date specified will subject your claim to rejection and may preclude you from being eligible to receive a payment from the Settlement. TABLE OF CONTENTS PAGE # COGNIZANT COMMON STOCK (CTSH, CUSIP: 000000000) 6
