Common use of Required Affirmations Clause in Contracts

Required Affirmations. IF SUBMITTED ELECTRONICALLY:  I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. IF SUBMITTED BY U.S. MAIL: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Dated: Signature: SETTLEMENT ADMINISTRATOR ADDRESS (where to send the completed form if submitting by mail): AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. This Claim Form may be submitted in one of three ways: 1. Electronically through www.[xxx].com. 2. Via email to [xxx]@[xxx].com. Please fill out the enclosed pages, scan the document in its entirety, and include the form as an attachment. 3. Mail to: AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. To be effective as a Claim under the proposed settlement, this form must be completed, signed, and sent, as outlined above, no later than [Month] [Day] [Year]. If this Form is not postmarked or received by this date, you will remain a member of the Settlement Class but will not receive any payment from the Settlement.

Required Affirmations. IF SUBMITTED ELECTRONICALLY:  I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. IF SUBMITTED BY U.S. MAIL: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Dated: Signature: SETTLEMENT ADMINISTRATOR ADDRESS (where to send the completed form if submitting by mail): AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. EXHIBIT 6 OPT-OUT FORM Only use this Form if you want to request exclusion from (i.e., opt-out) of the proposed settlement class. For more information on the proposed settlement, please visit www.[xxx].com. Section I - Instructions This Claim Form may form must be submitted in one of three ways:received by the Settlement Administrator no later than [Month] [Day], [Year]. 1. Electronically through www.[xxx].comwww.[xxx]com. 2. Via email to [xxx]@[xxx].com. Please fill out the enclosed pages, scan the document in its entirety, and include the form Form as an attachment. 3. Mail to: AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. To be effective as a Claim under an opt-out from the proposed settlement, this form must be completed, signed, and sent, as outlined above, no later than [Month] [Day] ], [Year]. If this Form form is not postmarked or received by this date, you will remain a member of the Settlement Class. Opting out of the Settlement Class but is not the same as objecting to the Settlement Agreement. If you request exclusion from the Settlement Class prior to [Month] [Day], [Year], you will not receive any payment from be bound by the Settlementterms of the Settlement Agreement and therefore cannot argue that the Settlement Agreement should not be approved. More information about objecting to the Settlement is available at www.[xxx].com. Section II - Settlement Class Member Information

Required Affirmations. IF SUBMITTED ELECTRONICALLY:  🞎 I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. IF SUBMITTED BY U.S. MAIL: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Dated: Signature: SETTLEMENT ADMINISTRATOR ADDRESS Settlement Administrator Address (where to send the completed form if submitting by mail): AAG SBM TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇, individually and on behalf of a class of all persons and entities similarly situated, Plaintiff vs. NORTH STAR INSURANCE ADVISORS LLC, TORCHLIGHT TECHNOLOGY GROUP LLC and RAPID RESPONSE MARKETING LLC Defendants. Case No. 2:22-cv-827 [Proposed] Final Approval Order And Judgment On (month) (day), 2024, this Court heard the motion for final approval of the class action settlement and for entry of judgment filed by Plaintiff.1 This Claim Form may be submitted in one of three waysCourt reviewed: 1. Electronically through www.[xxx].com. 2. Via email to [xxx]@[xxx].com. Please fill out (a) the enclosed pagesmotion and the supporting papers, scan the document in its entirety, and include the form as an attachment. 3. Mail to: AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. To be effective as a Claim under the proposed settlement, this form must be completed, signed, and sent, as outlined above, no later than [Month] [Day] [Year]. If this Form is not postmarked or received by this date, you will remain a member of including the Settlement Class but will not receive Agreement and Release (“Settlement Agreement”); (b) any payment from objections filed with or presented to the SettlementCourt; (c) the Parties’ responses to any objections; and (d) counsel’s arguments. Based on this review and the findings below, the Court found good cause to grant the motion.

Required Affirmations. IF SUBMITTED ELECTRONICALLY:  I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. IF SUBMITTED BY U.S. MAIL: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Dated: Signature: SETTLEMENT ADMINISTRATOR ADDRESS (where to send the completed form if submitting by mail): AAG Divvydose TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. This Claim EXHIBIT 6 OPT-OUT FORM Only use this Form may be submitted in one if you want to request exclusion from (i.e., opt-out) of three ways:the proposed Settlement Class. For more information on the proposed settlement, please visit www.[xxx].com. Section I - Instructions 1. Electronically through www.[xxx].comthe www.[xxx]com. 2. Via email to [xxx]@[xxx].com. Please fill out the enclosed pages, scan the document in its entirety, and include the form Form as an attachment. 3. Mail to: AAG Divvydose TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. To be effective as a Claim under the proposed settlement, this form must be completed, signed, and sent, as outlined above, no later than [Month] [Day] [Year]. If this Form is not postmarked or received by this date, you will remain a member of the Settlement Class but will not receive any payment from the Settlement.