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APV - allerganproxyviolationsecuritieslitigation.com

Allergan Proxy Violation Securities Litigationc/o Box 10436 Dublin, OH 43017-4036 Toll-Free Number: (855) 474-3851 Email: *P-APV-POC/1*APVI mportant - This form should be completed IN CAPITAL LETTERS using BLACK or DARK BLUE ballpoint/fountain pen. Characters and marks used should be similar in the style to the following:ABCDEFGHIJKLMNOPQRSTUVWXYZ1234 5670 Must be Postmarked No Later ThanAugust 7, 2018 Claim Number:Control Number:PROOF OF CLAIM AND RELEASE FORMTo be eligible to receive a share of the Net Settlement Fund in connection with the Settlement of this Action, you must complete and sign this Proof of Claim and Release Form ( Claim Form ) and mail it by first-class mail to the above address, postmarked no later than August 7, 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 not mail or deliver your Claim Form to the Court, the parties to the Action, or their counsel.

4 *P-APV-POC/4* PART II - GENERAL INSTRUCTIONS CONT’D 8. One claim should be submitted for each separate legal entity. Separate Claim Forms should be submitted

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