Settlement Claim form v3

* 312 130 0 000 000*3 1 2 1 3 0 0 0 0 0 0 0 0 United States District Court for the Southern District of New York Hesse, et al. v. Godiva Chocolatier, Inc., Case No. 1:19-cv-00927-AJNMAILED Claim FORM AND INSTRUCTIONSIf you purchased one or more Godiva Chocolate Products* at any time from January 31, 2015 through October 26, 2021, you can complete this Claim Form to be eligible to receive a cash payment under the Settlement .*Godiva Chocolate Products include any product manufactured and sold by Godiva, or sold under the Godiva brand, which contains chocolate.

baking mixes, melting chocolates, gift baskets, etc). * 3 1 2 1 3 * * C F * * P a g e 2 o f 3 * 31213 CF Page 2 of 3. SECTION 3: MARK THE BOX STATING YOUR PREFERRED METHOD OF PAYMENT Payment via a paper check Payment via prepaid Mastercard SECTION 4: SIGN AND DATE THE AFFIRMATION BELOW ...

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