Labriola v. Bank of America, National Association

Filing 64

AMENDED ORDER GRANTING PRELIMINARY APPROVAL OF CLASS SETTLEMENT. Signed by Judge Claudia Wilken on 8/29/2013. (Attachments: #1 Exhibit A - Notice, #2 Exhibit B - Claim Form, #3 Exhibit C - Exclusion Form)(ndr, COURT STAFF) (Filed on 8/29/2013)

Case4:12-cv-00079-CW Document60-2 Filed08/07/13 Page1 of 2

CLAIM FORM
LaBriola v. Bank of America, National Association; Merrill Lynch, Pierce, Fenner & Smith Incorp.;
Bank Of America Corporation; and Does 3-50, inclusive, Case No. 12-79 (N.D. Cal.)
[Name]
[Address]
[Address]
This form must be postmarked or faxed by __________________. You may mail this form to the
following address: ___________________________________________________________________
or fax it to 503-350-7895.
According to Merrill Lynch’s records:
o
You left the employment of Merrill Lynch on
o
You left the employment of Merrill Lynch [voluntarily/involuntarily].
o
You received your final incentive compensation check on
.
Your total Eligible Days as defined in the Class Notice is
days.
Your total Daily Rate as defined in the Class Notice is
per day.
If the Court awards attorneys’ fees in the amount of 25% of the gross fund value, the Individual
Claim Ratio for every member of the class is anticipated to be approximately:
.
Your estimated Individual Settlement Share is
Days] *

(

[Individual Claim Ratio] =

[Daily Rate] *

[Eligible

.)

PLEASE CHECK ONE:
I agree that the foregoing information is correct. I wish to receive my share of the settlement fund.
My check should be sent the address reflected at the top of this claim form. If that address is no longer
correct, my correct current address is as follows:
The foregoing information from Merrill Lynch’s records is not correct. A description of the
error(s) and supporting evidence is enclosed herewith.
Dated:
[Name]
If you wish to challenge any of the foregoing factual information, then you must submit with your
Claim Form a written, signed challenge under penalty of perjury, along with any supporting documents
to the Settlement Administrator at the address or fax number provided above, postmarked or faxed by
______________________________________. No dispute will be considered timely if postmarked or
faxed after this date. Counsel for the parties may stipulate to a compromise or stipulate to allow the
Settlement Administrator to resolve the challenge and make a final and binding determination without
hearing or right of appeal. The Settlement Administrator will inform you whether your dispute was
resolved in your favor within ten (10) days after the challenge is made. In the case of a dispute, you
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Case4:12-cv-00079-CW Document60-2 Filed08/07/13 Page2 of 2

will have the burden of proof to show that Merrill Lynch’s records are incorrect. If any other dispute
arises with regard to the propriety of a Claim Form, counsel for the Parties may stipulate to a
compromise or stipulate to allow the Settlement Administrator to resolve the dispute and make a final
and binding determination without hearing or right of appeal. Engaging in the dispute process set forth
in this paragraph does not extend the time to opt out of the class.
TAXPAYER IDENTIFICATION NUMBER CERTIFICATION
Enter the last four digits of your Social Security number: XXX-XX-_ _ _ _
I certify that this form correctly states the last four digits of my Social Security number.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
Signature of Class Member

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