Common use of APPOINTMENT OF SPECIAL MASTER Clause in Contracts

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx as Special Master to hear motions to dismiss claims that fail to comply with the terms of the Agreement, and to recommend to this Court rulings on any other motions, as specified in the Agreement. IT IS SO ORDERED this day of , 0000 XXXXXXXXX XXXXXX X. SIPPEL UNITED STATES DISTRICT JUDGE Appendix C Notice of Intent to Opt In Form for Unfiled Claims NOTICE OF INTENT TO OPT 41527 M FOR UNFILED CLAIMS IN FOR INSTRUCTIONS THIS FORM APPLIES TO INDIVIDUALS WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7, 2014 RESULTING FROM THE USE OF NUVARING, AND WHO HAD SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 7, 2014 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, BUT WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT. IF YOU WISH TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) AND TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER THE PROGRAM, YOU MUST SUBMIT THIS FORM, ALONG WITH THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. NOTICE OF INTENT TO OPT 41528 M FOR UNFILED CLAIMS IN FOR By timely submitting this form, you agree to be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and the Program contained therein. You acknowledge that you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in the Program, and that such election is irrevocable. I elect to participate in the NuvaRing Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury ATTORNEY INFORMATION (If Applicable) Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email CLAIMANT’S SIGNATURE IMPORTANT: This form must be signed by Claimant (the NuvaRing product user or the legal representative of a deceased or incapacitated product user). Attorneys may not sign on Claimant’s behalf. Signature Date / / (month) (day) (year) Printed Name First MI Last Appendix D Declaration of Counsel DECLARATION OF COUNSEL INSTRUCTIONS THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. CLAIMANT INFORMATION (NuvaRing Product User) Claimant Name Last First Middle ATTORNEY INFORMATION Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email ATTORNEY CERTIFICATION AND SIGNATURE I certify under penalty of perjury under the laws the United States that the foregoing is true and correct. Signature Date / / (month) (day) (year) Printed Name First MI Last 41532 Appendix E-1 Claim Form NUVARING RESO 41533 GRAM CLAIM FORM LUTION PRO INSTRUCTIONS The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety.

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx as Special Master to hear motions to dismiss claims that fail to comply with the terms of the Agreement, and to recommend to this Court rulings on any other motions, as specified in the Agreement. IT IS SO ORDERED this day of , 0000 XXXXXXXXX XXXXXX X. SIPPEL UNITED STATES DISTRICT JUDGE Appendix C Notice of Intent to Opt In Form for Unfiled Claims NOTICE OF INTENT TO OPT Notice of Intent to Opt 41527 M FOR UNFILED CLAIMS IN FOR m for Unfiled Claims In For INSTRUCTIONS THIS FORM APPLIES TO INDIVIDUALS WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7, 2014 RESULTING FROM THE USE OF NUVARING, AND WHO HAD SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 7, 2014 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, BUT WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT. IF YOU WISH TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) AND TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER THE PROGRAM, YOU MUST SUBMIT THIS FORM, ALONG WITH THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. NOTICE OF INTENT TO OPT Notice of Intent to Opt 41528 M FOR UNFILED CLAIMS IN FOR m for Unfiled Claims In For By timely submitting this form, you agree to be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and the Program contained therein. You acknowledge that you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in the Program, and that such election is irrevocable. I elect to participate in the NuvaRing Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury ATTORNEY INFORMATION (If Applicable) Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email CLAIMANT’S SIGNATURE IMPORTANT: This form must be signed by Claimant (the NuvaRing product user or the legal representative of a deceased or incapacitated product user). Attorneys may not sign on ClaimantXxxxxxxx’s behalf. Signature Date / / (month) (day) (year) Printed Name First MI Last Appendix D Declaration of Counsel DECLARATION OF COUNSEL Declaration of Counsel INSTRUCTIONS THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL Declaration of Counsel I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. CLAIMANT INFORMATION (NuvaRing Product User) Claimant Name Last First Middle ATTORNEY INFORMATION Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email ATTORNEY CERTIFICATION AND SIGNATURE I certify under penalty of perjury under the laws the United States that the foregoing is true and correct. Signature Date / / (month) (day) (year) Printed Name First MI Last 41532 Appendix E-1 Claim Form NUVARING RESO NuvaRing Reso 41533 GRAM CLAIM FORM LUTION PRO gram Claim Form lution Pro INSTRUCTIONS The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety.

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx Xxxxxxxxx Xxxxxxx Xxxxxxxxx as Special Master to hear motions to dismiss claims that fail to comply with the terms of the Agreement, and to recommend to this Court rulings on any other such motions, as specified in the Agreement. IT IS SO ORDERED this day of Date: Xxxxxxxxx Xxxxx X. Herndon Chief Judge, 0000 XXXXXXXXX XXXXXX X. SIPPEL United States District Court UNITED STATES DISTRICT JUDGE Appendix C Notice of Intent to Opt In Form for Unfiled Claims COURT SOUTHERN DISTRICT OF ILLINOIS ) IN RE: XXXXXX AND YAZ (DROSPIRENONE) ) MARKETING, SALES PRACTICES AND PRODUCTS ) LIABILITY LITIGATION ) 3:09-md-02100-DRH-PMF MDL No. 2100 NOTICE OF INTENT TO OPT 41527 M FOR UNFILED OUT FORM ALL MDL PLAINTIFFS WITH PERSONAL INJURY CLAIMS ALLEGING GALLBLADDER DISEASE AND/OR GALLBLADDER INJURIES, EITHER ALONE OR IN FOR INSTRUCTIONS THIS FORM APPLIES TO INDIVIDUALS WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7COMBINATION WITH ANOTHER INJURY, 2014 RESULTING FROM THE USE OF NUVARINGFILED AND SERVED ON OR BEFORE MARCH 25, AND WHO HAD SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 7, 2014 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, BUT WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT. IF YOU WISH TO PARTICIPATE 2013 ARE AUTOMATICALLY ENROLLED IN THE NUVARING MDL GALLBLADDER RESOLUTION PROGRAM (the “Program”) UNLESS: (1) THE CASE ALLEGES A GALLBLADDER INJURY AND A VENOUS THROMBOEMBOLISM (INCLUDING, BUT NOT LIMITED TO, DEEP VEIN THROMBOSIS OR PULMONARY EMBOLISM) OR ARTERIAL THROMBOEMBOLISM (INCLUDING, BUT NOT LIMITED TO, HEART ATTACK OR ARTERIAL THROMBOEMBOLIC STROKE) INJURY, PENDING IN MDL DOCKET NO. 2100; OR (2) THE PLAINTIFF SUBMITS THIS FORM OPTING OUT OF THE PROGRAM. IF YOU DO NOT WISH TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER PARTICIPATE IN THE GALLBLADDER RESOLUTION PROGRAM, YOU MUST SUBMIT THIS FORM, ALONG WITH THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, ON OR BEFORE 11:59 p.m. CT C.T. ON MARCH 10APRIL 29, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. NOTICE OF INTENT 2013 (UNLESS EXTENDED TO OPT 41528 M FOR UNFILED CLAIMS IN FOR By timely submitting this form, you agree to be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and the Program contained therein. You acknowledge that you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in the Program, and that such election is irrevocable. I elect to participate in the NuvaRing Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury ATTORNEY INFORMATION (If Applicable) Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email CLAIMANT’S SIGNATURE IMPORTANT: This form must be signed by Claimant (the NuvaRing product user or the legal representative of a deceased or incapacitated product user). Attorneys may not sign on Claimant’s behalf. Signature Date / / (month) (day) (year) Printed Name First MI Last Appendix D Declaration of Counsel DECLARATION OF COUNSEL INSTRUCTIONS THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS LATER DATE PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY TERMS OF THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 SETTLEMENT AGREEMENT) AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. CLAIMANT INFORMATION (NuvaRing Product User) Claimant Name Last First Middle ATTORNEY INFORMATION Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email ATTORNEY CERTIFICATION AND SIGNATURE I certify under penalty of perjury under the laws the United States that the foregoing is true and correct. Signature Date / / (month) (day) (year) Printed Name First MI Last 41532 Appendix E-1 Claim Form NUVARING RESO 41533 GRAM CLAIM FORM LUTION PRO INSTRUCTIONS The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety.:

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx Xxxxxxxxx Xxxxxxx Xxxxxxxxx as Special Master to hear motions to dismiss claims that fail to comply with the terms of the Agreement, and to recommend to this Court rulings on any other such motions, as specified in the Agreement. IT IS SO ORDERED this day of Date: Xxxxxxxxx Xxxxx X. Herndon Chief Judge, 0000 XXXXXXXXX United States District Court XXXXXX X. SIPPEL UNITED STATES DISTRICT JUDGE Appendix C Notice of Intent to Opt In Form for Unfiled Claims XXXXXX XXXXXXXX XXXXX XXXXXXXX XXXXXXXX XX XXXXXXXX ) IN RE: XXXXXX AND YAZ (DROSPIRENONE) ) MARKETING, SALES PRACTICES AND PRODUCTS ) LIABILITY LITIGATION ) 3:09-md-02100-DRH-PMF MDL No. 2100 NOTICE OF INTENT TO OPT 41527 M FOR UNFILED OUT FORM ALL MDL PLAINTIFFS WITH PERSONAL INJURY CLAIMS ALLEGING GALLBLADDER DISEASE AND/OR GALLBLADDER INJURIES, EITHER ALONE OR IN FOR INSTRUCTIONS THIS FORM APPLIES TO INDIVIDUALS WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7COMBINATION WITH ANOTHER INJURY, 2014 RESULTING FROM THE USE OF NUVARINGFILED AND SERVED ON OR BEFORE MARCH 25, AND WHO HAD SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 7, 2014 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, BUT WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT. IF YOU WISH TO PARTICIPATE 2013 ARE AUTOMATICALLY ENROLLED IN THE NUVARING MDL GALLBLADDER RESOLUTION PROGRAM (the “Program”) UNLESS: (1) THE CASE ALLEGES A GALLBLADDER INJURY AND A VENOUS THROMBOEMBOLISM (INCLUDING, BUT NOT LIMITED TO, DEEP VEIN THROMBOSIS OR PULMONARY EMBOLISM) OR ARTERIAL THROMBOEMBOLISM (INCLUDING, BUT NOT LIMITED TO, HEART ATTACK OR ARTERIAL THROMBOEMBOLIC STROKE) INJURY, PENDING IN MDL DOCKET NO. 2100; OR (2) THE PLAINTIFF SUBMITS THIS FORM OPTING OUT OF THE PROGRAM. IF YOU DO NOT WISH TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER PARTICIPATE IN THE GALLBLADDER RESOLUTION PROGRAM, YOU MUST SUBMIT THIS FORM, ALONG WITH THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, ON OR BEFORE 11:59 p.m. CT C.T. ON MARCH 10APRIL 29, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. NOTICE OF INTENT 2013 (UNLESS EXTENDED TO OPT 41528 M FOR UNFILED CLAIMS IN FOR By timely submitting this form, you agree to be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and the Program contained therein. You acknowledge that you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in the Program, and that such election is irrevocable. I elect to participate in the NuvaRing Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury ATTORNEY INFORMATION (If Applicable) Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email CLAIMANT’S SIGNATURE IMPORTANT: This form must be signed by Claimant (the NuvaRing product user or the legal representative of a deceased or incapacitated product user). Attorneys may not sign on Claimant’s behalf. Signature Date / / (month) (day) (year) Printed Name First MI Last Appendix D Declaration of Counsel DECLARATION OF COUNSEL INSTRUCTIONS THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS LATER DATE PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY TERMS OF THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 SETTLEMENT AGREEMENT) AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. CLAIMANT INFORMATION (NuvaRing Product User) Claimant Name Last First Middle ATTORNEY INFORMATION Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email ATTORNEY CERTIFICATION AND SIGNATURE I certify under penalty of perjury under the laws the United States that the foregoing is true and correct. Signature Date / / (month) (day) (year) Printed Name First MI Last 41532 Appendix E-1 Claim Form NUVARING RESO 41533 GRAM CLAIM FORM LUTION PRO INSTRUCTIONS The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety.:

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx Xxxxxxxxx to serve as Special Master to hear motions under the terms of Agreement, and directs that all applications to dismiss claims that fail for a failure to comply with the terms of the AgreementAgreement shall be heard by Judge Corodemus, and to recommend who shall make a recommendation to this Court rulings on the resolution of any other motions, as motions specified in the this Agreement. IT IS SO ORDERED THUS DONE AND SIGNED in Camden, New Jersey, this 1st day of August, 0000 2017. XXXXXXXXX XXXXXX X. SIPPEL KUGLER UNITED STATES DISTRICT JUDGE Appendix C Notice of Intent to Opt In Form for Unfiled Claims COURT NOTICE OF INTENT TO OPT 41527 M IN FORM FOR UNFILED CLAIMS IN FOR INSTRUCTIONS THIS FORM APPLIES TO INDIVIDUALS INDIVIDUALS: 1. WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7, 2014 RESULTING FROM THE USE COMMENCING PRIOR TO MAY 1, 2015 OF NUVARINGOLMESARTAN PRODUCTS IN THE UNITED STATES, AND 2. WHO HAD ALSO SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 711:59 P.M. ET ON AUGUST 23, 2014 2017 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN THE INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, OLMESARTAN PRODUCTS; 3. BUT WHO DO DID NOT HAVE A LEGAL CASE RELATING TO NUVARING OLMESARTAN PRODUCTS PENDING IN STATE OR FEDERAL COURTCOURT ON OR BEFORE AUGUST 1, 2017. IF YOU WISH TO PARTICIPATE IN THE NUVARING OLMESARTAN PRODUCTS RESOLUTION PROGRAM (the “Program”) AND TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER THE PROGRAM, YOU MUST SUBMIT THIS FORM, ALONG WITH FORM AS PART OF THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, OPT IN PACKAGE FOR UNFILED CLAIMS ON OR BEFORE 11:59 p.m. CT ON MARCH 10ET SEPTEMBER 15, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx2017 (UNLESS EXTENDED TO A LATER DATE PURSUANT TO THE TERMS OF THE SETTLEMENT AGREEMENT), which is the official website of the Claims Administrator, and follow the instructions provided thereIN ACCORDANCE WITH SUBMISSION INSTRUCTIONS PROVIDED BY THE CLAIMS ADMINISTRATOR. The date of submission will be the date the form is provided onlineSEE WWW. NOTICE OF INTENT TO OPT 41528 M FOR UNFILED CLAIMS IN FOR By timely submitting this form, you agree to be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and the Program contained thereinXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.XXX. You acknowledge that you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in the Program, and that such election is irrevocable. I elect to participate in the NuvaRing Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury ATTORNEY INFORMATION (If Applicable) Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email CLAIMANT’S SIGNATURE IMPORTANT: This form must be signed by Claimant (the NuvaRing product user or the legal representative of a deceased or incapacitated product user). Attorneys may not sign on Claimant’s behalf. Signature Date / / (month) (day) (year) Printed Name First MI Last Appendix D Declaration of Counsel DECLARATION OF COUNSEL INSTRUCTIONS THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. CLAIMANT INFORMATION (NuvaRing Product User) Claimant Name Last First Middle ATTORNEY INFORMATION Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email ATTORNEY CERTIFICATION AND SIGNATURE I certify under penalty of perjury under the laws the United States that the foregoing is true and correct. Signature Date / / (month) (day) (year) Printed Name First MI Last 41532 Appendix E-1 Claim Form NUVARING RESO 41533 GRAM CLAIM FORM LUTION PRO INSTRUCTIONS The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety.CLAIMS

APPOINTMENT OF SPECIAL MASTER. The Court, by this Order, appoints Judge Xxxxxx Xxxxx Xxxxxxxxx Xxxxxxx Xxxxxxxxx as Special Master to hear motions to dismiss claims that fail to comply with the terms of the Agreement, and to recommend to this Court rulings on any other such motions, as specified in the Agreement. IT IS SO ORDERED this day of Date: Xxxxxxxxx Xxxxx X. Herndon Chief Judge, 0000 XXXXXXXXX United States District Court XXXXXX X. SIPPEL UNITED STATES DISTRICT JUDGE Appendix C Notice of Intent to Opt In Form for Unfiled Claims XXXXXX XXXXXXXX XXXXX XXXXXXXX XXXXXXXX XX XXXXXXXX ) IN RE: YASMIN AND YAZ (DROSPIRENONE) ) MARKETING, SALES PRACTICES AND PRODUCTS ) LIABILITY LITIGATION ) 3:09-md-02100-DRH-PMF MDL No. 2100 ) NOTICE OF INTENT TO OPT 41527 M FOR UNFILED OUT FORM ALL MDL PLAINTIFFS WITH PERSONAL INJURY CLAIMS ALLEGING GALLBLADDER DISEASE AND/OR GALLBLADDER INJURIES, EITHER ALONE OR IN FOR INSTRUCTIONS THIS FORM APPLIES TO INDIVIDUALS WHO ALLEGE AN INJURY OCCURRING PRIOR TO FEBRUARY 7COMBINATION WITH ANOTHER INJURY, 2014 RESULTING FROM THE USE OF NUVARINGFILED AND SERVED ON OR BEFORE MARCH 25, AND WHO HAD SIGNED A RETAINER AGREEMENT WITH AN ATTORNEY OR LAW FIRM PRIOR TO FEBRUARY 7, 2014 FOR LEGAL REPRESENTATION OF SAID INDIVIDUAL RELATING TO AN INJURY ALLEGEDLY RESULTING FROM THE USE OF NUVARING, BUT WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT. IF YOU WISH TO PARTICIPATE 2013 ARE AUTOMATICALLY ENROLLED IN THE NUVARING MDL GALLBLADDER RESOLUTION PROGRAM (the “Program”) UNLESS: (1) THE CASE ALLEGES A GALLBLADDER INJURY AND A VENOUS THROMBOEMBOLISM (INCLUDING, BUT NOT LIMITED TO, DEEP VEIN THROMBOSIS OR PULMONARY EMBOLISM) OR ARTERIAL THROMBOEMBOLISM (INCLUDING, BUT NOT LIMITED TO, HEART ATTACK OR ARTERIAL THROMBOEMBOLIC STROKE) INJURY, PENDING IN MDL DOCKET NO. 2100; OR (2) THE PLAINTIFF SUBMITS THIS FORM OPTING OUT OF THE PROGRAM. IF YOU DO NOT WISH TO BE POTENTIALLY ELIGIBLE FOR AN AWARD UNDER PARTICIPATE IN THE GALLBLADDER RESOLUTION PROGRAM, YOU MUST SUBMIT THIS FORM, ALONG WITH THE ACCOMPANYING DECLARATION OF COUNSEL FORM SIGNED BY YOUR ATTORNEY, ON OR BEFORE 11:59 p.m. CT C.T. ON MARCH 10APRIL 29, 2014 AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. NOTICE OF INTENT 2013 (UNLESS EXTENDED TO OPT 41528 M FOR UNFILED CLAIMS IN FOR By timely submitting this form, you agree to be bound by the terms of the Master Settlement Agreement and the jurisdiction of the Special Master and the MDL Court or the New Jersey Coordinated Proceeding Court with regard to all matters pertaining to the Master Settlement Agreement and the Program contained therein. You acknowledge that you will not be eligible for an award unless you also timely submit a completed Claim Package that meets the requirements set forth in the Master Settlement Agreement. You agree that the Special Master will hear motions to dismiss claims that fail to comply with the Settlement Agreement and make recommendations to the court in which those cases are pending. You also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Settlement Agreement will be resolved by the Special Master and that the Special Master’s decisions will be binding on the parties. You acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By checking the box below and executing this form, you acknowledge that you have been fully advised of your rights under the Master Settlement Agreement and elect to participate in the Program, and that such election is irrevocable. I elect to participate in the NuvaRing Resolution Program. CLAIMANT AND CLAIM INFORMATION (NuvaRing Product User) Claimant Name Last First Middle Social Security Number | | | | - | | | - | | | | | Xxxxxxx Xxxxxx Xxxx Xxxxx Xxx Xxxxxxx Telephone Number ( ) - Email Alleged Injury (check all that apply) VTE (e.g. pulmonary embolism or deep vein thrombosis) ATE (e.g., heart attack or stroke) Wrongful Death Other (Define) Date of Alleged Injury (Month/Day/Year) / / Dates of NuvaRing Usage State of Residence at Time of Injury ATTORNEY INFORMATION (If Applicable) Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email CLAIMANT’S SIGNATURE IMPORTANT: This form must be signed by Claimant (the NuvaRing product user or the legal representative of a deceased or incapacitated product user). Attorneys may not sign on Claimant’s behalf. Signature Date / / (month) (day) (year) Printed Name First MI Last Appendix D Declaration of Counsel DECLARATION OF COUNSEL INSTRUCTIONS THIS FORM APPLIES TO ATTORNEYS REPRESENTING INDIVIDUALS WHO DO NOT HAVE A LEGAL CASE RELATING TO NUVARING PENDING IN STATE OR FEDERAL COURT, BUT WHO ELECT TO PARTICIPATE IN THE NUVARING RESOLUTION PROGRAM (the “Program”) BY SUBMITTING A NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS LATER DATE PURSUANT TO THE PROGRAM. THIS DECLARATION FORM MUST BE COMPLETED AND SIGNED BY TERMS OF THE ATTORNEY REPRESENTING SUCH INDIVIDUAL IN CONNECTION WITH HER NUVARING INJURY CLAIM. THIS DECLARATION MUST BE SUBMITTED, ALONG WITH THE NOTICE OF INTENT TO OPT IN FORM FOR UNFILED CLAIMS SIGNED BY THE CLAIMANT, ON OR BEFORE 11:59 p.m. CT ON MARCH 10, 2014 SETTLEMENT AGREEMENT) AS FOLLOWS: Online: Go to xxx.xxxxxxxxxxxxxxxxxxxxxxxxxx.xxx, which is the official website of the Claims Administrator, and follow the instructions provided there. The date of submission will be the date the form is provided online. 41531 DECLARATION OF COUNSEL I, , hereby certify as follows: I am an attorney in good standing who is admitted to practice law in the State of . I hereby certify that the Claimant identified below had executed a retainer agreement prior to February 7, 2014 (the Execution Date) with me or with my law firm for legal representation of said Claimant relating to an injury allegedly resulting from the use of NuvaRing. CLAIMANT INFORMATION (NuvaRing Product User) Claimant Name Last First Middle ATTORNEY INFORMATION Attorney Name Last First Middle Firm Name Address Street City State Zip Country Telephone Number ( ) - Facsimile ( ) - Email ATTORNEY CERTIFICATION AND SIGNATURE I certify under penalty of perjury under the laws the United States that the foregoing is true and correct. Signature Date / / (month) (day) (year) Printed Name First MI Last 41532 Appendix E-1 Claim Form NUVARING RESO 41533 GRAM CLAIM FORM LUTION PRO INSTRUCTIONS The Claim Package, including a completed copy of this Claim Form, must be submitted no later than the Claim Package Deadline for all Claimants, including unrepresented (pro se) Claimants, in the NuvaRing Resolution Program (the “Program”) outlined in the Master Settlement Agreement of February 7, 2014 (the “Agreement”). Counsel for Claimants may complete this Claim Form, but the Claimant must personally sign the Certification and Authorization in Section VII. All Pro Se Claimants must complete this Claim Form in its entirety.: