Anwar et al v. Fairfield Greenwich Limited et al

Filing 1533

SETTLEMENT AGREEMENT with PwC Defendants. Document filed by Harel Insurance Company, Ltd., Pacific West Health Medical Center, Inc. Employee's Retirement Trust, Securities & Investment Company Bahrain, St. Stephen's School. (Attachments: #1 Exhibit A, #2 Exhibit A-1, #3 Exhibit A-2, #4 Exhibit A-3, #5 Exhibit B)(Barrett, David)

EXHIBIT A-3
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF NEW YORK
PASHA ANWAR, et al.,
Plaintiffs,
v.

Master File No. 09-cv-118 (VM) (FM)

FAIRFIELD GREENWICH LIMITED, et al.,
Defendants.
PROOF OF CLAIM AND RELEASE
I.

GENERAL INSTRUCTIONS

1.
The accompanying Notice of Proposed Partial Settlement of Class Action and Settlement Fairness Hearing, and
Motion for Attorneys’ Fees and Expenses (the “Notice”) contains important information about your rights, defines certain
settlement terms and eligibility criteria, and describes the proposed settlement and the manner in which the settlement will be
distributed if the settlement is granted final approval by the Court. It is important that you read the Notice.
2.
To recover as a member of the Settlement Class (as defined in the Notice) based on your claims in the action
entitled Pasha Anwar, et al. v. Fairfield Greenwich Limited, et al., Master File No. 09-cv-118 (VM) (the “Action”), you must
review, complete and, on page X hereof, sign this Proof of Claim and Release (“Proof of Claim”). If you fail to submit a Proof of
Claim by the deadline, your claim may be rejected and you may be precluded from receiving any recovery from the settlement
fund created in connection with the proposed settlement of the Action (the “Settlement”).
3.

Submission of a Proof of Claim does not assure that you will share in the proceeds of the Settlement.

4.
The Settlement Class consists of all beneficial owners of shares or limited partnership interests in Fairfield
Sentry Limited, Fairfield Sigma Limited, Fairfield Lambda Limited, Greenwich Sentry, L.P. and Greenwich Sentry Partners, L.P.
(the “Funds”) as of December 10, 2008 (whether as holders of record or traceable to a shareholder or limited partner account of
record) (“Beneficial Owners”), who suffered a Net Loss of principal invested in the Funds (the “Settlement Class”). Net Loss
means the total cash investment made by a Beneficial Owner in a Fund, directly or indirectly through one or more intermediaries,
less the total amount of any redemptions or withdrawals or recoveries (by whatever means and from any other sources,
excluding the Fairfield Greenwich (“FG”), Citco, and GlobeOp settlements in this Action) by that Beneficial Owner from or with
respect to such investment in that Fund. If you fail to file a timely and properly addressed Proof of Claim, your claim may be
rejected and you may be precluded from any recovery from the settlement fund created in connection with the Settlement. Even
if you do not fill out this Proof of Claim, any and all claims you may have against the PwC Defendants (as defined in the Notice)
in this Action will be released by virtue of your being a non-excluded member of the Settlement Class.
5.
YOU MUST SUBMIT YOUR COMPLETED AND SIGNED PROOF OF CLAIM SO THAT IT IS RECEIVED ON
OR BEFORE _________, 2016, ADDRESSED AS FOLLOWS:
Fairfield Greenwich Limited Litigation
c/o Rust Consulting, Inc.
P.O. Box 2874
Faribault, MN 55021-8674
6.
You should complete this Proof of Claim only if you are a member of the Settlement Class. If you are NOT a
member of the Settlement Class, DO NOT submit a Proof of Claim. IF YOU ARE A MEMBER OF THE SETTLEMENT CLASS
AND YOU DO NOT FILE A PROOF OF CLAIM, YOU WILL NOT RECEIVE ANY PAYMENT FROM THE SETTLEMENT FUND
BUT YOU WILL NEVERTHELESS BE BOUND BY THE ORDER FINALLY APPROVING THE SETTLEMENT AND THE

JUDGMENT DISMISSING THIS ACTION AS AGAINST THE PwC DEFENDANTS, AND ALL ORDERS AND RELEASES
THEREIN, UNLESS YOU PROPERLY EXCLUDE YOURSELF FROM THE SETTLEMENT CLASS.
II.

CLAIMANT IDENTIFICATION

1.
If you purchased or acquired shares or limited partnership interests in one or more of the Funds registered in
your name, you are the Beneficial Owner as well as the record owner. If, however, the shares or limited partnership interests
were registered in the name of a third party, such as a nominee, bank or brokerage firm through which you purchased the shares
or limited partnership interests, you are the Beneficial Owner and the third party is the record owner. Where a fund, trust, or
similar investment vehicle was a registered shareholder or limited partner of record or otherwise invested in a Fund, the fund,
trust or similar investment vehicle is the Beneficial Owner for purposes of this Settlement, not the underlying investors in the
fund, trust or similar investment vehicle. Only one Proof of Claim or request for exclusion can be submitted with respect to each
share or limited partnership interest in each of the Funds.
2.
Use Part I of this form entitled “Claimant Identification” to identify each owner of record (“nominee”), if different
from the Beneficial Owner of the Fund shares or limited partnership interests. THIS PROOF OF CLAIM MUST BE FILED BY
THE ACTUAL BENEFICIAL OWNER, OR THE LEGAL REPRESENTATIVE OF SUCH OWNER OF THE SHARES OR
PARTNERSHIP INTERESTS UPON WHICH THIS CLAIM IS BASED.
3.
All joint owners must sign this Proof of Claim. Executors, administrators, guardians, conservators, or other legal
representatives must complete and sign this Proof of Claim on behalf of Persons represented by them and documentation
showing their authority must accompany this Proof of Claim and their titles or capacities must be stated. The actual name and
last four digits of the Social Security (or other U.S. or foreign taxpayer identification) number and telephone number of the
Beneficial Owner must be used to verify and avoid duplicative claims. Failure to provide the foregoing information could delay
verification of your claim or result in rejection of the claim.
III.

INSTRUCTIONS FOR THE PROOF OF CLAIM FORM

1.
In the space provided in Part II of this form entitled “Schedule of Transactions in Fund Common Shares or
Limited Partnership Interests,” supply all required details of your transaction(s) in Fund shares or partnership interests. If you
need more space or additional schedules, attach separate sheets giving all of the required information in substantially the same
form. Sign and print or type your name on each additional sheet. If you are a Beneficial Owner of more than one of the Funds in
which you have a Net Loss of principal, make a copy (or copies) of the Schedule of Transactions and complete a Schedule
separately for each Fund.
2.
Please provide all of the requested information with respect to all of your transactions in the Fund from your first
investment to the present date, inclusive, whether such transactions resulted in a profit or a loss. Failure to report all
transactions may result in the rejection of your claim. List each transaction separately and in chronological order, by trade date,
beginning with the earliest. You must accurately provide the month, day and year of each transaction you list.
3.
You must also submit supporting documentation concerning all of your transactions in the Fund. In most cases,
confirmations of subscriptions and redemptions will be sufficient. If you do not have such documentation, you may also attach
any documents or schedules that you attached to any tax return that reflect transactions in the Fund. Failure to provide this
documentation will delay verification or result in rejection of your claim.
4.
If you received any recoveries in respect of your investments in the Fund other than through redemptions,
withdrawals, or sales of shares or limited partnership interests in the Fund, such as through settlement of any legal claims or any
other source of recovery, please identify that recovery in the Schedule of Transactions, with supporting documentation. If you
have not received any such compensation, mark “None.” You are not required to provide information on recoveries from the FG,
Citco, and GlobeOp settlements because the Claims Administrator already has that information and in any event all Settlement
Class members participated in or had the opportunity to participate in those settlements. The above materials are designed to
provide the minimum amount of information necessary to process many claims. Rust Consulting, Inc. (the “Claims
Administrator”) may request from you or any nominee, custodian or similar person who invested on your behalf additional
information as required to efficiently and reliably verify your claims and calculate your Net Loss. In some cases where the
Claims Administrator cannot perform the calculation accurately or at a reasonable cost to the Settlement Class with the

2

information provided, the Claims Administrator may condition acceptance of the Proof of Claim upon the production of additional
information that it may, in its discretion, require to process the claim.

3

MUST BE RECEIVED
NO LATER THAN
XXXXXXXXX XX, 2016

Pasha Anwar et al. v. Fairfield Greenwich Limited, et al.
Master File No. 09-cv-118 (VM) (FM)
PROOF OF CLAIM

For Official Use Only

01

Please Type or Print - Use Blue or Black Ink Only
Page 1 of 6

*0123456789*
PART I. CLAIMANT IDENTIFICATION - Complete either Section A or B and then proceed to Section C.

A. Complete this Section ONLY if the Beneficial Owner is an individual, joint, UGMA, UTMA or IRA account. Otherwise, proceed to B.
Last Name (Beneficial Owner)

First Name (Beneficial Owner)

Last Name (Joint Beneficial Owner, if applicable)

First Name (Joint Beneficial Owner)

Name of Custodian, if applicable
If this account is an UGMA, UTMA or IRA, please include “UGMA”, “UTMA”, or “IRA” in the “Last Name” box above (e.g., Jones IRA).
B. Complete this Section ONLY if the Beneficial Owner is an entity; i.e., corporation, trust, estate, etc. Then, proceed to C.
Entity Name
Name of Representative (Executor, administrator, trustee, corporate officer, etc.)

C. Account/Mailing Information:
Specify one of the following:




Individual(s)

 Corporation  Private Pension Fund

 IRA, Keogh

 Partnership  Estate  Trust

Other:

Number and Street or P.O. Box
City

State

Zip Code

Foreign Province and Postal Code

Foreign Country

Telephone Number (Day)

Telephone Number (Evening)

E-mail Address*

Account Number

*Email address is not required, but if provided, you authorize the Claims Administrator to use it in providing you with information concerning this claim.

Enter Taxpayer Identification Number below for the Beneficial Owner(s)1
Social Security or Foreign Taxpayer Identification No.
or

Employer Identification No.

The taxpayer identification number (TIN), consisting of a valid Social Security number (SSN) for individuals or employer identification number (EIN) for
business entities, trusts, estates, etc., (or other foreign taxpayer identification number) and telephone number of the Beneficial Owner(s) may be used in
verifying this claim.
1

4

*XXXX*

*CF*

*RUST*

5

PART I. CLAIMANT IDENTIFICATION - Continued

I authorize you to contact, if necessary, the following record owner or nominee for the shares or limited partnership interests
identified in this Proof of Claim to verify any of the information that I have provided:
Name of Record Owner or Nominee

Address of Record Owner or Nominee

City

State

Zip Code

Foreign Province and Postal Code

Foreign Country

Telephone Number (Day)

Telephone Number (Evening)

E-mail Address*

Account Number

*Email address is not required, but if provided, you authorize the Claims Administrator to use it in providing you with information concerning this claim.

Responsible Person to Contact at Record Owner or Nominee

Telephone Number of Record Owner or Nominee

Email Address of Record Owner or Nominee

Wiring Instructions
If you would like your distribution of Settlement proceeds to be wired to your bank or custodian, please provide us with your wire
instructions here
Bank Name

Bank City/St — Bank Country

Bank Contact

Bank Phone

Bank Account Name

6

Account Number/Iban Number

Routing Number/Swift Code

Further Credit To (If Applicable)

Special Instructions

.

Page 2 of 6

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PART II: SCHEDULE OF TRANSACTIONS IN FUND SHARES OR LIMITED PARTNERSHIP INTERESTS
If you previously submitted a Proof of Claim form in connection with the FG, Citco, or GlobeOp Settlement in this
Action, and that Proof of Claim form (with any supplemental documents or information submitted to the Claims
Administrator) is still complete and accurate, you are not required to complete Part II A, B, or C below or to
resubmit supporting documentation with respect to those Parts. You may proceed to Part II D by checking the box
below and identifying your FG, Citco, or GlobeOp Settlement Proof of Claim Number. The Proof of Claim Number is
on the postcard mailed to you by the Claims Administrator as confirmation of receipt of your FG or GlobeOp
Settlement Proof of Claim. All Claimants however are required to complete Part II D and to affirm whether the
Claimant has received any recoveries from investments or ownership of Fund shares or limited partnership
interests, such as through settlement or sale of legal claims or distributions from liquidation or bankruptcy
proceedings (excluding recoveries from the FG and GlobeOp Settlements in this Action).
BOX FG, Citco or GlobeOp Settlement Proof of Claim Number: _______
If you did not file a FG, Citco or GlobeOp Proof of Claim or want to resubmit your trading data and supporting
documentation, you need complete the balance of Part II below.
Identify the Fund below that is the subject matter of this Proof of Claim. If you invested in and suffered a Net Loss in more
than one Fund, you should submit multiple schedules of your transactions.



A.

Fairfield Sentry Limited



Greenwich Sentry, L.P.



Fairfield Lambda Limited



Fairfield Sigma Limited

Greenwich Sentry Partners, L.P.

Purchases or acquisitions of Fund Shares or Limited Partnership Interests:
Trade Date
Month Day Year

Total Purchase or Acquisition
Price/Currency

1. __________________

1. ____________________

1. ___________________

2. __________________

2. ____________________

2. ___________________

3. __________________

3. ____________________

3. ___________________

4. __________________

4. ____________________

4. ___________________

5. __________________
B.

Number of Shares/Interests
Purchased or Acquired

5. ____________________

5. ___________________

Sales of Fund Shares or Limited Partnership Interests:
Trade Date
Month Day Year

Number of
Shares/Interests Sold

Total Sales
Price/Currency

1. __________________

1. ____________________

1. ___________________

2. __________________

2. ____________________

2. ___________________

3. __________________

3. ____________________

3. ___________________

4. __________________

4. ____________________

4. ___________________

5. __________________

5. ____________________

5. ___________________

C.

Number of Fund Shares or Limited Partnership Interests currently held: _________________.

D.

Prior Recoveries

8

I have already received the following recoveries with respect to the Net Loss that I incurred from my investments or ownership
Fund shares or limited partnership interests, such as through settlement or sale of legal claims or distributions from liquidation or
bankruptcy proceedings (excluding recoveries from the FG, Citco, and GlobeOp Settlements in this Action) (or mark “None”):



None

If you require additional space, attach extra schedules in the same format as above. Sign and print your name on each
additional page.
YOU MUST READ AND SIGN THE RELEASE ON PAGE __________.
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PART III. REPRESENTATIONS
I (We) _________________ submit this Proof of Claim under the terms of the Order Preliminarily Approving Settlement
filed _________, 2015 (the “Order”).
1.

I (We) am (are) a Settlement Class Member (as defined in the Notice), that I am (we are) not one of the persons

or entities excluded from the Settlement Class, that I am (we are) not acting on behalf of any such excluded person or entity, that
I (we) have not requested to be excluded from the Settlement Class, that I (we) believe that I am (we are) eligible to receive a
distribution under the terms and conditions of the Plan of Allocation as defined and set forth in the Notice, and that I (we) have
not submitted any other Proof of Claim in this Action covering the same holdings in the Fund(s) and know of no other person
having done so on my (our) behalf.
2.

I (We) hereby acknowledge that I (we) submit to the jurisdiction of the United States District Court for the

Southern District of New York with respect only to the subject matter of my (our) claim as a Settlement Class Member (as
defined in the Notice) and for purposes of enforcing the release set forth in any judgments or orders which may be entered in the
Action and all determinations made by this Court thereon and I (we) shall not be deemed to have submitted to the
jurisdiction of this Court or of any court in the United States for any other matter on account of such submission
3.

I (We) hereby warrant and represent that I (we) have read the Notice and the Stipulation of Settlement

(“Stipulation”) and understand that, pursuant to ¶ 16 of the Stipulation and through operation of the final judgment to be entered
by the Court, I (we) shall have fully, finally and forever released, relinquished and discharged claims against the Released
Parties as set forth in ¶ 16 of the Stipulation and the defined terms set forth therein. I (We) further acknowledge and agree that I
am (we are) bound by and subject to the terms of any judgment that may be entered in the Action, including without limitation,
the release of claims against the Released Parties as set forth in ¶ 16 of the Stipulation and the defined terms set forth therein.
4.

I (We) hereby warrant and represent that as to any claim for Net Loss that I (we) are making, I (we) have

included information about all of my (our) holdings in the Fund(s) and all of my (our) transactions relating to those holdings in the
Fund(s). I (We) agree to furnish additional information to Plaintiffs’ Lead Counsel (as defined in the Notice) or the Claims
Administrator to support this Proof of Claim if required to do so. I (We) authorize any nominee, custodian or similar person who
is the registered shareholder or limited partner of record with respect to the shares or limited partnership interest in a Fund for
which I am (we are) the Beneficial Owner to disclose to the Claims Administrator my (our) status as the Beneficial Owner and
information regarding transactions related to my (our) holdings in the Fund.

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PART VI. CERTIFICATION
Under penalty of perjury, I (we) hereby certify and represent that:
I (WE) am (are) NOT subject to backup withholding under the provisions of Section 3406(a)(1)(C) of the Internal
Revenue Code because: (i) the claimant(s) is (are) exempt from backup withholding; or (ii) the claimant(s) has (have) not been
notified by the IRS that he/she/it/they is (are) subject to backup withholding as a result of a failure to report all interest or
dividends; or (iii) the IRS has notified the claimant(s) that I (WE) am (are) no longer subject to backup withholding. If the IRS has
notified the claimant(s) that he/she/it/they is (are) subject to backup withholding, please strike out the language in the
preceding sentence indicating that the claim is not subject to backup withholding in the certification above.
I (WE) DECLARE UNDER THE PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF
AMERICA THAT ALL OF THE FOREGOING INFORMATION SUPPLIED ON THIS PROOF OF CLAIM FORM BY THE
UNDERSIGNED IS TRUE AND CORRECT. BY EXECUTING THIS CERTIFICATION, I (WE) ACKNOWLEDGE AND
AGREE TO BE BOUND BY ANY FINAL JUDGMENT IN THE ACTION RELATING TO THE SETTLEMENT, INCLUDING
WITHOUT LIMITATION ANY RELEASE CONTAINED THEREIN.

Signature of Claimant

Signature of Joint Claimant, if any

Print Name of Claimant

Print Name of Joint Claimant, if any

Date

Date

If claimant is other than an individual, or is not the person completing this form, the following also must be provided:
Signature of Person Completing Form

Print Name of Person Completing Form

Date

Capacity of person signing on behalf of claimant, if other than an individual, e.g., executor, president, custodian, etc.

Page 5 of 6

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ACCURATE CLAIMS PROCESSING TAKES A
SIGNIFICANT AMOUNT OF TIME.
THANK YOU FOR YOUR PATIENCE.
REMINDER CHECKLIST:
1.

Please sign the claim form on page __ above.

2.

Remember to attach supporting documentation for all transactions in the Fund(s).

3.

Keep a copy of your claim form and supporting documentation for your records.

4.

The Claims Administrator will acknowledge receipt of your Proof of Claim by mail or email

within 45 days of receipt. Your claim is not deemed filed until you receive such an acknowledgment. If you do
not receive an acknowledgment within 45 days, please contact the Claims Administrator by telephone toll free
at 888-265-0241 or, from non-United States telephones, at 1-xxx-yyy-zzzz or by email
[e-mail].
5.

If you move or change your telephone number or email address, please submit the new

information to the Claims Administrator, as well as any other information that will assist us in contacting you.

THIS PROOF OF CLAIM MUST BE RECEIVED BY THE CLAIMS ADMISTRATOR
NO LATER THAN -------------------, 2016 AT THE FOLLOWING ADDRESS:
Fairfield Greenwich Limited Litigation
c/o Rust Consulting, Inc.
P.O. Box 2874
Faribault, MN 55021-8674
Telephone: [phone]
Email: [e-mail]
Website: www.farifieldgreenwichlitigation.com

Page 6 of 6

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