Common use of INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM Clause in Contracts

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form postmarked no later than XXXXXXXX to the Settlement Administrator at the following address: If you prefer to file your claim electronically, you may use the claims portal on the website ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇. It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form. 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment will be made to the Former Participant. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.

Appears in 2 contracts

Sources: Class Action Settlement Agreement, Class Action Settlement Agreement

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form postmarked no later than XXXXXXXX , 2021 to the Settlement Administrator at the following address: If you prefer to file your claim electronically, you may use the claims portal on the website ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇. It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form. 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment will be made to the Former Participantparticipant. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.

Appears in 2 contracts

Sources: Class Action Settlement Agreement, Class Action Settlement Agreement

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records. 2. Mail your completed Former Participant Claim Form postmarked no later than XXXXXXXX , 2023 to the Settlement Administrator at the following address: If you prefer to file your claim electronically, you may use the claims portal on the website ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇[INSERT]. It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form. 3. Other Reminders: • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is attached as Part 5 to this form. • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment will be made to the Former Participant. • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.

Appears in 1 contract

Sources: Class Action Settlement Agreement