Rollover Form

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In order to receive your share of the Settlement by direct rollover to a qualified individual retirement account, Class Members must complete this form with a postmark on or before July 14, 2026. Please review the instructions below carefully. If you have questions regarding this form, you may contact the Settlement Administrator at 1-800-416-6807.

PART 1: INSTRUCTIONS FOR COMPLETING ROLLOVER FORM

1. If you would like to receive your share of the Settlement by direct rollover to a qualified individual retirement account (commonly called an “IRA”) or a qualified employer plan (such as a 401(k) plan), please complete this Rollover Form.

It is your responsibility to ensure the Settlement Administrator has timely received your Rollover Form.

2. Other Reminders:

You must provide your 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 complete a direct rollover and fail to provide all required rollover information in Part 4 below, payment will be made to you by check.
If you change your address after submitting your Rollover Form, please provide your new address to the Settlement Administrator.
Timing of Payments to Eligible Settlement Class Members. The timing of the distribution of Settlement payments is conditioned on several matters, including the Court’s final approval of the Settlement and the finality of that approval without appeal. An appeal of the final approval order may take several years. If the Settlement is approved and no appeals are filed, distribution will likely occur within four months of the Court’s Final Approval Order.

3. Questions? If you have any questions about this Rollover Form, please call the Settlement Administrator at 1‑800‑416‑6807. The Settlement Administrator can provide assistance only regarding completion of this form and does not provide financial, tax, or other advice regarding the Settlement or your individual circumstances. You may wish to consult your financial or tax advisor. Information about the status of Settlement approval and administration is available here.

PART 2: SETTLEMENT CLASS MEMBER INFORMATION

Claimant ID*

Your Name*

First Middle Last

Address*

Address Address 2 City State Zip Code

Home Phone*

Work Phone or Cell Phone*

Participant's Social Security Number*

Participant's Date of Birth*

Email Address*

PART 3: BENEFICIARY OR ALTERNATE PAYEE INFORMATION (IF APPLICABLE)

Is Beneficiary

Check here if you are the surviving spouse or other beneficiary for the Settlement Class Member and the Settlement Class Member is deceased. Documentation must be provided showing current authority of the representative to file on behalf of the deceased. Please complete the information below and then continue on to Parts 4 and 5 on the next page.

Is Alternate Payee

Check here if you are an alternate payee under a qualified domestic relations order (QDRO). The Settlement Administrator may contact you with further instructions. Please complete the information below and then continue on to Parts 4 and 5 on the next page.

Upload supporting documentation which substantiates your authority to act on behalf of the deceased Class Member

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