Step 1 of 2 50% CommentsThis field is for validation purposes and should be left unchanged.80/20 ERISA Settlement Electronic Funds Transfer (“EFT”) FormThis field is hidden when viewing the formHidden Claimant ID*This field is hidden when viewing the formHidden Last Name*PART 1: INSTRUCTIONSIn order to receive your share of the Settlement by Electronic Funds Transfer (“EFT”), Class Members must complete this form 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. Payments made directly to Settlement Class Members by EFT are subject to automatic tax withholding and tax reporting, as determined by the Settlement Administrator. Any tax withheld by the Settlement Administrator may not constitute all tax that you may owe in connection with your settlement payment. You will be responsible for determining and paying any tax that is due but was not automatically withheld in connection with your settlement payment. Participant InformationPART 2: SETTLEMENT CLASS MEMBER INFORMATIONClaimant ID*Your Name* First Middle Last Phone Number*Email Address* PART 3: PAYMENT ELECTION This field is hidden when viewing the formPayment Token*Payment Method*PART 4: SIGNATURE AND CONSENTSignature checkbox* UNDER PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, I CERTIFY THAT ALL OF THE INFORMATION PROVIDED ON THIS EFT FORM IS TRUE, CORRECT, AND COMPLETE AND THAT I SIGNED THIS EFT FORM. I am a U.S. person (including a U.S. resident alien). Printed Signature*Date*ClaimFormNo
