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Your claim must <br />be postmarked or <br />received by: <br />December 17, 2018. <br />CLAIM FORM <br />Liquid Aluminum Sulfate Antitrust Litigation — GEO <br />Direct Purchaser Settlement <br />c/o Settlement Administrator <br />P.O. Box 30097 <br />Philadelphia, PA 19103 <br />1-855-338-6128 <br />info@LiquidAluminumDirectSettlement.com <br />www.LiquidAluminumDirectSettlement.com <br />PART II — CLAIMANT INFORMATION <br />The Settlement Administrator will use this information for all communications regarding this Claim Form. If <br />this information changes, you MUST notify the Settlement Administrator in writing at the address above. <br />Claimant Name(s) (as the names) should appear on check, if eligible for payment). Provide either a First and <br />Last Name or a Company Name (not both) to whom you would like a check made payable if your claim is <br />eligible for payment. If you provide both, we will use your First and Last Name, not the Company Name: <br />First Name: Last Name: <br />K. <br />Company Name: <br />Name of Person the Settlement Administrator Should Contact Regarding this Claim Form (Must Be Provided): <br />Mailing Address — Line 1: Street Address/P.O. Box: <br />Mailing Address — Line 2 (If Applicable): Apartment/Suite/Floor Number: <br />City: <br />State/Province: Zip Code: <br />Country: <br />Daytime Telephone Number: Evening Telephone Number: <br />7771 <br />Email address (E-mail address is not required, but if you provide it you authorize the Settlement Administrator to use it in providing you with <br />information relevant to this claim.): <br />YOU MUST COMPLETE AND RETURN THIS PAGE OF THE CLAIM FORM <br />76 <br />