Certification
BY SIGNING AND SUBMITTING THIS CLAIM FORM, CLAIMANT OR CLAIMANT’S AUTHORIZED REPRESENTATIVE CERTIFIES ON CLAIMANT’S BEHALF AS FOLLOWS:
1. I (we) have read the Notice and Claim Form, including the descriptions of the Release and Covenant Not to Sue provided for
in the Settlement Agreements;
2. I (we) am (are) a Class Member and am (are) not one of the individuals or entities excluded from the Settlement Class;
3. I (we) have not submitted a Request for Exclusion;
4. I (we) have made the transactions submitted with this Claim Form for myself (ourselves) and not as agents of another, and have
not assigned my (our) Released Claims to another;
5. I (we) hereby warrant and represent that I (we) have not assigned or transferred or purported to assign or transfer, voluntarily
or involuntarily, any matter released pursuant to the release or any other part or portion thereof;
6. I (we) have not submitted any other claim in this Action covering the same transactions and know of no other person having done
so on his/her/its/their behalf;
7. I (we) hereby consent to the disclosure of, waive any protections provided by any applicable bank secrecy or data privacy laws
(whether foreign or domestic), or any similar confidentiality protections with respect to, and instruct Settling Defendants or any
authorized third party to disclose my (our) information and transaction data relating to my (our) trades for use in the claims
administration process;
8. I (we) submit to the jurisdiction of the Court with respect to my (our) claim and for purposes of enforcing the releases set
forth in any Final Judgment that may be entered in the Action;
9. I (we) agree to furnish such additional information with respect to this Claim Form as the Settlement Administrator or the Court
may require; and
10. I (we) acknowledge that I (we) will be bound by and subject to the terms of the Judgment that will be entered in the Action if
the Settlement is approved.
11. I (we) certify that I am (we are) not subject to backup withholding under the provisions of Section 3406(a)(1)(C) of the Internal
Revenue Code.
Signature
Please Read The Release, Consent To Disclosure And Certification, And Sign Below.
I (we) acknowledge that, as of the Effective Date of the Settlement, pursuant to the terms set forth in the Settlement Agreement,
and by operation of law and the Final Judgment, I (we) shall be deemed to release and forever discharge and shall be forever
enjoined from prosecuting the Released Claims against the Released Parties (as defined in the Settlement Agreement and/or Final
Judgment).
By signing and submitting this Claim Form, I (we) consent to the disclosure of information relating to my (our) transactions in
BBSW-Based Derivatives during the Class Period, and waive any protections provided by any applicable bank secrecy or data privacy
laws (whether foreign or domestic), or any similar confidentiality protections with respect to information and transaction data
relating to my (our) trades, for use in the claims administration process.
If signing as an Authorized Representative on behalf of an entity, I (we) certify that I (we) have legal rights and authorization
from the entity to file this Claim Form on the entity’s behalf.
UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, I (WE) CERTIFY THAT ALL THE INFORMATION PROVIDED BY
ME (US) ON THIS CLAIM FORM IS TRUE, CORRECT, AND COMPLETE AND THAT THE DATA SUBMITTED IN CONNECTION WITH THIS CLAIM FORM ARE
TRUE AND CORRECT COPIES OF WHAT THEY PURPORT TO BE.
REMINDER: YOUR CLAIM FORM AND REQUIRED DATA MUST BE SUBMITTED ONLINE BY 11:59 P.M.
EASTERN TIME ON JANUARY 16, 2024, OR POSTMARKED AND MAILED NO LATER THAN JANUARY 16, 2024.
GBP LIBOR Class Action Settlement
c/o A.B. Data, Ltd.
P.O. Box 173111
Milwaukee, WI 53217
Do not submit your claim to the Court.