O'Bannon, Jr. v. National Collegiate Athletic Association et al

Filing 288

Joint Filing of Amended Settlement Agreements and Exhibits Thereto by Samuel Michael Keller (Attachments: #1 Exhibit 1, #2 Exhibit 2, #3 Exhibit 3, #4 Exhibit 4, #5 Exhibit 5)(Carey, Robert) (Filed on 7/24/2014) Modified on 7/25/2014 (cpS, COURT STAFF).

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EXHIBIT 5 Must Be Submitted By _______________ CLAIM FORM: Electronic Arts (“EA”) and NCAA Videogame Settlements To Be Eligible to Receive Benefits under the Settlements Described in the Enclosed Notice, You Must Complete this Claim Form by __________. Please read this Claim Form and the enclosed Notice carefully. If you would like to receive a payment under the EA and/or NCAA Videogame Settlements, you must submit this Claim Form according to the instructions. REQUESTING OR RECEIVING A PAYMENT UNDER THESE SETTLEMENTS WILL NOT AFFECT YOUR NCAA ELIGIBILITY. You can submit one Claim Form for both settlements. You do not need to submit a separate Claim Form for each settlement in which you wish to make a Claim. See Question 2 (below) for more details. You have two options for submitting a Claim Form—Online or By Mail: Submit a Claim Form Online: Submit a Claim Form by Mail: You may submit a claim online by visiting www._______________settlement.com and filling out this Claim Form by __________________. You may submit a claim by completing this Claim Form, signing it, and mailing it so that it is postmarked by _________________ to the following address: [TBD] If you need any help with this Claim Form, or with any other questions regarding these settlements, please call the Settlement Administrator at 1-___-___-___ toll-free, visit www.________________settlement.com, or e-mail ______________________settlement.com. After your claim is processed, you will receive a letter telling you whether you are eligible for a payment and, if so, the letter will include a check for the amount of the payment. The letter will also explain the process and deadlines to resolve any disagreement you may have with the decision about your eligibility for a payment. Please be patient, as this process could take some time. PLEASE DO NOT CALL THE COURT, THE JUDGE, THE CLERK OF COURT, EA, OR THE NCAA REGARDING THIS MATTER. QUESTIONS? CALL 1-___-___-____ TOLL-FREE OR VISIT www.___________ settlement.com. Must Be Submitted By _____________ CLAIMANT ID BARCODE WILL APPEAR HERE 1: PROVIDE CLASS MEMBER INFORMATION. Last Name: First Name: Middle Initial: Mailing Address: City: State: Daytime Phone: — Zip Code: Evening Phone: — — — E-Mail Address: 2. DO YOU WANT TO MAKE A CLAIM IN BOTH SETTLEMENTS? If you send in a Claim Form, we will assume that you want to make a claim in BOTH the EA Settlement and the NCAA Settlement, unless you tell us otherwise by checking one of the boxes below. Please remember that you may not submit a claim in a settlement in which you have excluded yourself. If you exclude yourself from a settlement, you will not get a payment from that settlement. See Question __ of the enclosed Notice for more details. If you want to make a claim in both Settlements, skip to Question 3, below. If you want to make a claim in only one of the Settlements, please check below: o I want to make a claim ONLY in the EA Settlement. o I want to make a claim ONLY in the NCAA Settlement. The only way to get a payment under these settlements is to submit a claim. If you decide NOT to make a claim in either settlement and you do not exclude yourself, you will NOT get any payment from that settlement AND you will be giving up legal rights. QUESTIONS? CALL 1-___-___-____ TOLL-FREE OR VISIT www._____________________settlement.com. Must Be Submitted By _____________ CLAIMANT ID BARCODE WILL APPEAR HERE 3. PROVIDE SOME INFORMATION ABOUT YOURSELF FOR EACH COLLEGE OR UNIVERSITY YOU ATTENDED, PLEASE PROVIDE THE FOLLOWING INFORMATION. If you don’t know whether you were on the team roster, include the years that you attended school and played NCAA Division I men’s basketball or football. If you need more space, feel free to include additional pages with your Claim Form. COLLEGE  OR  UNIVERSITY   YEAR(S)  LISTED  ON  NCAA     THE  SPORT(S)  FOR   D-­‐1  MEN’S  BASKETBALL  OR   WHICH  YOU  WERE   FOOTBALL  TEAM  ROSTER   LISTED  ON  A  ROSTER   POSITION(S)  AND   JERSEY  NUMBER(S)     YOUR  HOME  STATE     (as  listed  on  school   roster—NOT  your   current  home  state)   4. PROVIDE ADDITIONAL INFORMATION, IF YOU KNOW If you know, list all seasons/editions of an NCAA-Branded Videogame published by EA—(1) “NCAA Football,” (2) “NCAA Basketball,” or (3) “NCAA March Madness” (any videogame platform)—in which you believe that your jersey number and/or photograph appears. This information is not necessary to make a claim, but it may help us in processing your claim. If you need more space, feel free to include additional pages with your Claim Form. NAME  OF  VIDEOGAME   SEASON/EDITION/   YEAR  OF  VIDEOGAME   DOES  YOUR  JERSEY  NUMBER   APPEAR  IN  THIS  VIDEOGAME?   DOES  YOUR  PHOTOGRAPH     APPEAR  IN  THIS  GAME?   If you are the Class Member, DO NOT FILL OUT THE NEXT QUESTION (#5). INSTEAD, GO TO THE LAST PAGE (“CERTIFICATION”) AND SIGN YOUR CLAIM FORM. QUESTIONS? CALL 1-___-___-____ TOLL-FREE OR VISIT www._____________________settlement.com. Must Be Submitted By _____________ CLAIMANT ID BARCODE WILL APPEAR HERE If you are filling out this Claim Form on behalf of a Class Member (for example, if you have power of attorney over the Class Member’s affairs), fill out Step 5. 5. INFORMATION TO BE PROVIDED BY EXECUTORS, ADMINISTRATORS, GUARDIANS, PERSONAL REPRESENTATIVES, OR OTHERS LEGALLY AUTHORIZED TO PROVIDE CLASS MEMBER INFORMATION. (a) Are you the personal representative of a deceased Class Member? Yes O No O / If so, provide the date of the Class Member’s death: / (b) Are you a guardian, conservator, or attorney in fact of an incapacitated Class Member? Yes O No O (c) Are you the legally appointed representative (for example, through a power of attorney) responsible for handling the Class Member’s business affairs? Yes O No O Please provide YOUR information: Last Name First Name Mailing Address City Daytime Phone Number: State — Zip Code — E-Mail Address: IMPORTANT: If you are submitting this claim on behalf of the Class Member, please also submit with this Claim Form documents to prove that you are authorized to submit this Claim Form on behalf of that Class Member (for example, estate documents, powers of attorney, death certificates, etc.). QUESTIONS? CALL 1-___-___-____ TOLL-FREE OR VISIT www._____________________settlement.com. Must Be Submitted By _____________ CLAIMANT ID BARCODE WILL APPEAR HERE CERTIFICATION: I certify under penalty of perjury that I have read this Claim Form; I believe I am a Class Member or the Legally Authorized Representative of a Class Member; and all of the information on this Claim Form is true and correct to the best of my knowledge. Print Name Signature Date (MM) (DD) (YY) QUESTIONS? CALL 1-___-___-____ TOLL-FREE OR VISIT www._____________________settlement.com.

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