Pelletier v. Endo International plc, et al

Case No. 2:17-cv-05114-MMB

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF PENNSYLVANIA

Please click the link for CLAIM INSTRUCTIONS

To be eligible to receive a share of the Net Settlement Fund in connection with the Settlement of this Litigation, you must complete and sign this Proof of Claim Form (“Claim Form”) and mail it by first-class mail to the address below, postmarked no later than February 14, 2022 or submit it online on or before February 14, 2022.

Failure to submit your Claim Form by the date specified will subject your claim to rejection and may preclude you from being eligible to receive any money in connection with the Settlement.

Do not mail or deliver your Claim Form to the Court, the parties to the Litigation, or their counsel. Submit your Claim Form only to the Claims Administrator at the address set forth below.

PART I – INTRODUCTION

A. General Instructions

  1. To recover as a member of the Class based on your claims in the action entitled Pelletier v. Endo International plc, et al., No. 2:17-cv-05114-MMB (the “Litigation”), you must complete, and on page 6 hereof, sign this Proof of Claim and Release (“Claim Form”). If you fail to file a properly addressed (as set forth in paragraph 3 below) Claim Form, your claim may be rejected, and you may be precluded from any recovery from the Net Settlement Fund created in connection with the proposed settlement of the Litigation.
  2. Submission of this Claim Form, however, does not assure that you will share in the proceeds of settlement in the Litigation.
  3. YOU MUST MAIL OR SUBMIT ONLINE YOUR COMPLETED AND SIGNED CLAIM FORM ON OR BEFORE FEBRUARY 14, 2022, ADDRESSED AS FOLLOWS:

    By Mail:
    Endo Securities Litigation
    c/o Angeion Group, LLC
    1650 Arch Street, Suite 2210
    Philadelphia, PA 19103

    If you are NOT a member of the Class, as defined below and in the Notice of Pendency and Proposed Settlement of Class Action (the “Notice”), DO NOT submit a Claim Form.
  4. If you are a member of the Class and you do not timely and validly request exclusion from the Class, you are bound by the terms of any judgment entered in the Litigation, including the releases provided therein, WHETHER OR NOT YOU SUBMIT A CLAIM FORM.
  5. It is important that you completely read and understand the Notice that accompanies this Claim Form, including the Plan of Allocation of the Net Settlement Fund set forth in the Notice. The Notice describes the proposed Settlement, how Class Members are affected by the Settlement, and the manner in which the Net Settlement Fund will be distributed if the Settlement and Plan of Allocation are approved by the Court. The Notice also contains the definitions of many of the defined terms (which are indicated by initial capital letters) used in this Claim Form. By signing and submitting this Claim Form, you will be certifying that you have read and that you understand the Notice, including the terms of the releases described therein and provided for herein.

B. Claimant Identification

  1. If you purchased or acquired Endo ordinary shares and held the certificate(s) in your name, you are the beneficial purchaser or acquirer as well as the record purchaser or acquirer. If, however, the certificate(s) were registered in the name of a third party, such as a nominee or brokerage firm, you are the beneficial purchaser and the third party is the record purchaser.
  2. Use Part II of this form entitled “Claimant Identification” to identify the beneficial owner(s) of Endo ordinary shares. The complete name(s) of the beneficial owner(s) must be entered. If you held the eligible Endo ordinary shares in your own name, you are the beneficial owner as well as the record owner. If, however, your shares of eligible Endo ordinary shares were registered in the name of a third party, such as a nominee or brokerage firm, you are the beneficial owner of these shares, but the third party is the record owner. THIS CLAIM MUST BE FILED AND SIGNED BY THE ACTUAL BENEFICIAL PURCHASER(S) OR ACQUIRER(S) OR THE LEGAL REPRESENTATIVE OF SUCH PURCHASER(S) OR ACQUIRER(S) OF ENDO ORDINARY SHARES UPON WHICH THIS CLAIM IS BASED.
  3. All joint purchasers must sign this Claim Form and be identified in Part II. The Social Security (or taxpayer identification) number and telephone number of the beneficial owner may be used in verifying the claim. Failure to provide the foregoing information could delay verification of your claim or result in rejection of the claim.
  4. One Claim Form should be submitted for each separate legal entity. Separate Claim Forms should be submitted for each separate legal entity (e.g., a claim from joint owners should not include separate transactions of just one of the joint owners, and an individual should not combine his or her IRA transactions with transactions made solely in the individual’s name). Conversely, a single Claim Form should be submitted on behalf of one legal entity including all transactions made by that entity on one Claim Form, no matter how many separate accounts that entity has (e.g., a corporation with multiple brokerage accounts should include all transactions made in all accounts on one Claim Form).
  5. Agents, executors, administrators, guardians, and trustees must complete and sign the Claim Form on behalf of persons represented by them, and they must:
    1. expressly state the capacity in which they are acting;
    2. identify the name, account number, Social Security Number (or taxpayer identification number), address, and telephone number of the beneficial owner of (or other person or entity on whose behalf they are acting with respect to) the Endo ordinary shares; and
    3. furnish herewith evidence of their authority to bind to the Claim Form the person or entity on whose behalf they are acting. (Authority to complete and sign a Claim Form cannot be established by stockbrokers demonstrating only that they have discretionary authority to trade securities in another person’s accounts.)
  6. By submitting a signed Claim Form, you will be swearing that you:
    1. own or owned the Endo ordinary shares you have listed in the Claim Form; or
    2. are expressly authorized to act on behalf of the owner thereof.

C. Claim Form

  1. Use Part III of this form entitled “Schedule of Transactions in Endo Ordinary Shares” to supply all required details of your transaction(s) in Endo ordinary shares. 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.
  2. On the schedules, provide all of the requested information with respect to all of your purchases and acquisitions and all of your sales of Endo ordinary shares that took place at any time on or between and including March 2, 2015 and May 26, 2017, whether such transactions resulted in a profit or a loss. Failure to report all such transactions may result in the rejection of your claim. Also, list the number of Endo ordinary shares held at the close of trading on March 1, 2015, February 27, 2017, and May 26, 2017.
  3. List each transaction in the Class Period 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.
  4. You are required to submit genuine and sufficient documentation for all of your transactions in and holdings of Endo ordinary shares set forth in the Claim Form. Documentation may consist of copies of brokerage confirmation slips or monthly brokerage account statements, or an authorized statement from your broker containing the transactional and holding information found in a broker confirmation slip or account statement. The parties and the Claims Administrator do not independently have information about your investments in Endo ordinary shares. IF SUCH DOCUMENTS ARE NOT IN YOUR POSSESSION, PLEASE OBTAIN COPIES OF THE DOCUMENTS OR EQUIVALENT DOCUMENTS FROM YOUR BROKER. FAILURE TO SUPPLY THIS DOCUMENTATION MAY RESULT IN THE REJECTION OF YOUR CLAIM. DO NOT SEND ORIGINAL DOCUMENTS. Please keep a copy of all documents that you send to the Claims Administrator. Also, do not highlight any portion of the Claim Form or any supporting documents.
  5. The above requests are designed to provide the minimum amount of information necessary to process the simplest claims. The Claims Administrator may request additional information as required to efficiently and reliably calculate your losses. In the event the Claims Administrator cannot perform the calculation accurately or at a reasonable cost to the Class with the information provided, the Claims Administrator may condition acceptance of the claim upon the production of additional information and/or the claimant’s responsibility for any increased costs due to the nature and/or scope of the claim.
  6. If the Court approves the Settlement, payments to eligible Authorized Claimants pursuant to the Plan of Allocation (or such other plan of allocation as the Court approves) will be made after any appeals are resolved, and after the completion of all claims processing. The claims process will take substantial time to complete fully and fairly. Please be patient.
  7. PLEASE NOTE: As set forth in the Plan of Allocation, each Authorized Claimant shall receive his, her or its pro rata share of the Net Settlement Fund. If the prorated payment to any Authorized Claimant calculates to less than $10.00, it will not be included in the calculation and no distribution will be made to that Authorized Claimant.
  8. If you have questions concerning the Claim Form, or need additional copies of the Claim Form or the Notice, you may contact the Claims Administrator, Angeion Group, LLC, at the address on the first page of the Claim Form, by email at info@EndoSecuritiesLitigation.com, or by toll-free phone at 1-855-895-5522, or you can visit the website, www.EndoSecuritiesLitigation.com, where copies of the Claim Form and Notice are available for downloading.
  9. NOTICE REGARDING ELECTRONIC FILES: Certain claimants with large numbers of transactions may request, or may be requested, to submit information regarding their transactions in electronic files. To obtain the mandatory electronic filing requirements and file layout, you may visit the Settlement website at www.EndoSecuritiesLitigation.com or you may email the Claims Administrator’s electronic filing department at info@EndoSecuritiesLitigation.com. Any file not in accordance with the required electronic filing format will be subject to rejection. Only one claim should be submitted for each separate legal entity (see ¶B.4 above) and the complete name of the beneficial owner(s) of the securities must be entered where called for (see ¶B.2 above). No electronic files will be considered to have been submitted unless the Claims Administrator issues an email to that effect. Do not assume that your file has been received until you receive this email. If you do not receive such an email within 10 days of your submission, you should contact the electronic filing department at info@EndoSecuritiesLitigation.com to inquire about your file and confirm it was received.

IMPORTANT: PLEASE NOTE

YOUR CLAIM IS NOT DEEMED FILED UNTIL YOU RECEIVE AN ACKNOWLEDGEMENT POSTCARD OR EMAIL. THE CLAIMS ADMINISTRATOR WILL ACKNOWLEDGE RECEIPT OF YOUR CLAIM FORM BY MAIL OR EMAIL, WITHIN 60 DAYS. IF YOU DO NOT RECEIVE AN ACKNOWLEDGEMENT POSTCARD OR EMAIL WITHIN 60 DAYS, CALL THE CLAIMS ADMINISTRATOR TOLL FREE AT 1-855-895-5522 OR EMAIL info@EndoSecuritiesLitigation.com

PART II – CLAIMANT IDENTIFICATION
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* Required Fields
PART III – SCHEDULE OF TRANSACTIONS IN ENDO ORDINARY SHARES

Please be sure to include proper documentation with your Claim Form as described in detail in ¶C.4 of the Instructions. Do not include information regarding securities other than Endo ordinary shares.

B. Purchases or acquisitions of Endo ordinary shares (March 2, 2015 - May 26, 2017 inclusive) (Must be documented.):

Date of Purchase/ Acquisition (Trade Date) Mo. / Day / Year Number of Shares Purchased or Acquired Purchase / Acquisition Price Per Share Total Purchase or Acquisition Price (excluding any taxes, commissions, and fees) Check this box if Purchase was to cover a short sale

Date of Purchase/ Acquisition (Trade Date) Mo. / Day / Year 1

Number of Shares Purchased or Acquired 1

Purchase / Acquisition Price Per Share 1

Total Purchase or Acquisition Price (excluding any taxes, commissions, and fees) 1

Check this box if Purchase was to cover a short sale 1

Date of Purchase/ Acquisition (Trade Date) Mo. / Day / Year 2

Number of Shares Purchased or Acquired 2

Purchase / Acquisition Price Per Share 2

Total Purchase or Acquisition Price (excluding any taxes, commissions, and fees) 2

Check this box if Purchase was to cover a short sale 2

Date of Purchase/ Acquisition (Trade Date) Mo. / Day / Year 3

Number of Shares Purchased or Acquired 3

Purchase / Acquisition Price Per Share 3

Total Purchase or Acquisition Price (excluding any taxes, commissions, and fees) 3

Check this box if Purchase was to cover a short sale 3

Date of Purchase/ Acquisition (Trade Date) Mo. / Day / Year 4

Number of Shares Purchased or Acquired 4

Purchase / Acquisition Price Per Share 4

Total Purchase or Acquisition Price (excluding any taxes, commissions, and fees) 4

Check this box if Purchase was to cover a short sale 4

+ Add Transaction

C. Sales of Endo ordinary shares (March 2, 2015 - May 26, 2017, inclusive) (Must be documented.):

Trade Date Mo. / Day / Year Number of Shares Sold Sale Price Per Share Total Sales Price (not deducting any taxes, commissions, and fees)

Trade Date Mo. / Day / Year 1

Number of Shares Sold 1

Sale Price Per Share 1

Total Sales Price (not deducting any taxes, commissions, and fees) 1

Trade Date Mo. / Day / Year 2

Number of Shares Sold 2

Sale Price Per Share 2

Total Sales Price (not deducting any taxes, commissions, and fees) 2

Trade Date Mo. / Day / Year 3

Number of Shares Sold 3

Sale Price Per Share 3

Total Sales Price (not deducting any taxes, commissions, and fees) 3

Trade Date Mo. / Day / Year 4

Number of Shares Sold 4

Sale Price Per Share 4

Total Sales Price (not deducting any taxes, commissions, and fees) 4

+ Add Transaction


If you require additional space, upload extra schedules in the same format as above. Sign and print your name on each additional page.

YOU MUST READ AND SIGN THE RELEASE BELOW. FAILURE TO SIGN THE RELEASE MAY RESULT IN A DELAY IN PROCESSING OR THE REJECTION OF YOUR CLAIM.

Upload Supporting Documentation

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

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    PART IV – SUBMISSION TO JURISDICTION OF COURT AND ACKNOWLEDGMENTS

    I (We) submit this Claim Form under the terms of the Stipulation of Settlement dated October 15, 2021 (“Stipulation”) described in the Notice. I (We) also submit to the jurisdiction of the United States District Court for the Eastern District of Pennsylvania, with respect to my (our) claim as a Class Member (as defined in the Notice) and for purposes of enforcing the release set forth herein. I (We) further acknowledge that I am (we are) bound by and subject to the terms of any judgment that may be entered in the Litigation. I (We) agree to furnish additional information to Lead Counsel and/or the Claims Administrator to support this claim if required to do so. I (We) have not submitted any other claim covering the same purchases, acquisitions, or sales of Endo ordinary shares during the Class Period and know of no other Person having done so on my (our) behalf.

    PART V – RELEASE
    1. I (We) hereby acknowledge full and complete satisfaction of, and do hereby fully, finally and forever settle, release, relinquish and discharge all of the Released Claims (including Unknown Claims) against each and all of the Released Defendant Parties, all as defined herein and in the Notice and Stipulation.
    2. This release shall be of no force or effect unless and until the Court approves the Stipulation and it becomes effective on the Effective Date.
    3. I (We) hereby warrant and represent that I (we) have not assigned or transferred or purported to assign or transfer, voluntarily or involuntarily, any matter released pursuant to this release or any other part or portion thereof and have not submitted any other claim covering the same purchases of Endo ordinary shares and know of no other person having done so on my (our) behalf.
    4. I (We) hereby warrant and represent that I (we) have included all requested information about all of my (our) purchases or acquisitions of Endo ordinary shares between and including March 2, 2015 and May 26, 2017, as well as the number of securities held at the close of trading on March 1, 2015, February 27, 2017, and May 26, 2017.
    5. The number(s) shown on this form is (are) the correct SSN/TIN(s).
    6. I (We) waive the right to trial by jury, to the extent it exists, and agree to the determination by the Court of the validity or amount of this claim, and waive any right of appeal or review with respect to such determination.
    7. I (We) certify that I am (we are) NOT subject to backup withholding under the provisions of Section 3406(a)(1)(C) of the Internal Revenue Code.

      I (We) declare under penalty of perjury under the laws of the United States of America that the foregoing information supplied by the undersigned is true and correct.

    Your Claim Form has been submitted successfully.

    HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: info@EndoSecuritiesLitigation.com.

    Please print this page for your records.

    Your Claim Details

    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    Beneficial Owner’s Name
    Street Address
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    Telephone Number (Home)
    Telephone Number (Mobile)
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at info@EndoSecuritiesLitigation.com