BBSWSettlement

CLAIMANT IDENTIFICATION

The Settlement Administrator will use this information for all communications relevant to this Claim Form. If this information changes, please notify the Settlement Administrator in writing. If you are a trustee, executor, administrator, custodian, or other nominee and are completing and signing this Claim Form on behalf of the Claimant, you must attach documentation showing your authority to act on behalf of the Claimant.

Section A – Claimant Information

Is the Beneficial Owner an Individual?

Is the Beneficial Owner an Entity?

Representative or Custodian Name (if different from Claimant[s] listed above):

Address 1: *

Address 2:

Country: *

City: *

State/Territory: *

Zip: *

Telephone Number (home or cell): *

Telephone Number (work):

Email Address (If you provide an email address, you authorize the Claims Administrator to use it in providing you with information relevant to this claim.):

* Denotes required field

Section B – Authorized Representative Information

Name of the person you would like the Claims Administrator to contact regarding this Claim (if different from the Claimant name listed above):

Telephone Number (home or cell):

Telephone Number (work):

Address 1:

Address 2:

Country:

City:

State/Territory:

Zip:

Email Address (If you provide an email address, you authorize the Claims Administrator to use it in providing you with information relevant to this claim.):

TABLE OF TRANSACTIONS IN SIBOR- AND/OR SOR-BASED DERIVATIVES

Complete this section if and only if you entered into transactions in BBSW-Based Derivatives from January 1, 2003 through August 16, 2016. Do not include information regarding instruments other than BBSW-Based Derivatives and do not include transactions in BBSW-Based Derivatives in which you acquired the instrument as an agent for another individual or entity.

List of Brokers or Nominees

Please list all brokers or nominees at which you maintained accounts in which you traded or held BBSW-Based Derivatives.

Broker Nominee Name:

Must click Add Entry to save your information.

Broker or Nominee

Action

List of Account Names and Account Numbers

Please provide a list of all account names and account numbers for each entity you listed in response above in which you traded or held BBSW-Based Derivatives.

Account Name:

Account Number:

Must click Add Entry to save your information.

Account Name

Account Number

Action

TABLE I-A – PURCHASE(S) AND SALE(S) OF SWAPTIONS, FRAS, AND SWAPS WITH A CONSTANT NOTIONAL VALUE DURING THE CLASS PERIOD

PURCHASE(S) AND SALE(S) OF SWAPTIONS, FRAS, AND SWAPS WITH A CONSTANT NOTIONAL VALUE DURING THE CLASS PERIOD

For each purchase or sale of a swaption, FRA, and/or swap with a notional value that remained constant during the contract period, provide the following information for each transaction.

Transaction Type: *

Trade Date: *

Applicable Rate (Tenor) In Months 1-12: *

Duration (Tenor): *

Notional Value (in AUD): *

Frequency Of Reset Dates In Months 1-12: *

Exit Date:

Location Of Transaction:

Counterparty Name:

Broker Name:

Confirm Proof Enclosed:

Must click Add to save your information.

Transaction Type

Trade Date

Applicable Rate (Tenor)

Duration (Tenor)

Notional Value (in AUD) for Interest Payment

Frequency of Reset Dates

Exit Date

Location of Transaction

Counterparty Name

Broker Name

Confirm Proof of Purchase Enclosed

Action

TABLE I-B – PURCHASE(S) AND SALE(S) OF SWAPS WITH A VARIABLE NOTIONAL VALUE DURING THE CLASS PERIOD

PURCHASE(S) AND SALE(S) OF SWAPS WITH A VARIABLE NOTIONAL VALUE DURING THE CLASS PERIOD

For each purchase or sale of a swap whose notional value fluctuated during the contract period, provide the following information for each interest payment for each transaction. If necessary, please add additional columns to reflect all interest payments associated with the transaction. For example, if there were ten interest payments for a particular transaction, list the dates of all ten interest payments, the notional value (in AUD) on which each interest payment was calculated, and the amount of each interest payment:

Swap Transaction Type: *

Swap Trade Date: *

Date of Interest Payment: *

Amount of Interest Payment (In AUD):

Notional Value (in AUD): *

Reference Interest Rate (Tenor) In Months 1-12: *

Duration (Tenor): *

Location Of Transaction:

Counterparty Name:

Broker Name:

Confirm Proof Enclosed:

Must click Add to save your information.

Swap Transaction Type

Swap Trade Date

Date of Interest Payment

Amount of Interest Payment

Notional Value (in AUD) for Interest Payment

Reference Interest Rate (Tenor)

Duration (Tenor)

Location of Transaction

Counterparty Name

Broker Name

Confirm Proof of Purchase Enclosed

Action

TABLE II – PURCHASE(S) AND SALE(S) OF FX FORWARDS AND FX SWAPS DURING THE CLASS PERIOD

PURCHASE(S) AND SALE(S) OF FX FORWARDS AND FX SWAPS DURING THE CLASS PERIOD

For a purchase or sale of a foreign exchange (“FX”) forward or FX swap, provide the following information for each transaction:

Transaction Type: *

Trade Date: *

Notional Value (in AUD): *

Date Position Opened: *

Date Position Closed: *

Notional Amount of Corresponding Currency: *

Day-Count Convention:

Location Of Transaction:

Counterparty Name:

Broker Name:

Confirm Proof Enclosed:

Must click Add to save your information.

Transaction Type

Trade Date

Notional Value (in AUD)

Date Position Opened

Date Position Closed

Notional Amount of Corresponding Currency

Day-Count Convention

Location of Transaction

Counterparty Name

Broker Name

Confirm Proof of Purchase Enclosed

Action

TABLE III – PURCHASE(S) AND SALE(S) OF 90-Day Bank Accepted Bill (“BAB”) or Australian Dollar Futures DURING THE CLASS PERIOD

Purchase(s) and Sale(s) of "BAB" or Australian Dollar Futures During the Class Period

For a purchase or sale of a futures contract, provide the following information for each transaction:

Open/Close Transaction Type: *

Number of Contracts Traded: *

Futures Identifier: *

Expiry Month: *

Date Position Opened:

Date Position Closed:

Number of Contracts Held Before Class Period:

Number of Contracts Held After Class Period:

Confirm Proof Enclosed:

Must click Add to save your information.

Open/Close Transaction Type

Number of Contracts Traded

Futures Identifier

Expiry Month

Date Position Opend

Date Position Closed

Number of Contracts Held Before Class Period

Number of Contracts Held After Class Period

Confirm Proof of Purchase Enclosed

Action

TABLE IV – PURCHASE(S) AND SALE(S) OF Options on 90-Day Bank Accepted Bill (“BAB”) or Australian Dollar Futures DURING THE CLASS PERIOD

Purchase(s) and Sale(s) of Option s on "BAB" or Australian Dollar Futures During the Class Period

For a purchase or sale of a options contract, provide the following information for each transaction:

Open/Close Transaction Type: *

Call/Put Option Type: *

Number of Options Traded: *

Contract Code:

Date Position Opened:

Date Position Closed:

Contract Month: *

ContractYear: *

Strike Price: *

Confirm Proof Enclosed:

Must click Add to save your information.

Open/Close Transaction Type

Call (C) or Put (P)

Number of Options Traded

Contract Code

Date Position Opend

Date Position Closed

Contract Month

Contract Year

Strike Price

Confirm Proof of Purchase Enclosed

Action

UPLOAD SUPPORTING DOCUMENTS

All supporting documentation for your positions and transactions should be uploaded to this page prior to moving on to the next step in your online claim submission.

Please use the browse option, by clicking on “Select Files” in the box below, to upload your supporting documentation being submitted to verify all of your positions and transactions.

Select files

Files To Be Uploaded	Size	Action

CLAIMANT’S CERTIFICATION & SIGNATURE

Certification

BY SIGNING AND SUBMITTING THIS CLAIM FORM, CLAIMANT OR CLAIMANT’S AUTHORIZED REPRESENTATIVE CERTIFIES ON CLAIMANT’S BEHALF AS FOLLOWS:

1. I (we) have read the Notice and Claim Form, including the descriptions of the Release and Covenant Not to Sue provided for in the Settlement Agreements;

2. I (we) am (are) a Class Member and am (are) not one of the individuals or entities excluded from the Settlement Class;

3. I (we) have not submitted a Request for Exclusion;

4. I (we) have made the transactions submitted with this Claim Form for myself (ourselves) and not as agents of another, and have not assigned my (our) Released Claims to another;

5. 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 the release or any other part or portion thereof;

6. I (we) have not submitted any other claim in this Action covering the same transactions and know of no other person having done so on his/her/its/their behalf;

7. I (we) hereby consent to the disclosure of, waive any protections provided by any applicable bank secrecy or data privacy laws (whether foreign or domestic), or any similar confidentiality protections with respect to, and instruct Settling Defendants or any authorized third party to disclose my (our) information and transaction data relating to my (our) trades for use in the claims administration process;

8. I (we) submit to the jurisdiction of the Court with respect to my (our) claim and for purposes of enforcing the releases set forth in any Final Judgment that may be entered in the Action;

9. I (we) agree to furnish such additional information with respect to this Claim Form as the Settlement Administrator or the Court may require; and

10. I (we) acknowledge that I (we) will be bound by and subject to the terms of the Judgment that will be entered in the Action if the Settlement is approved.

11. 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.

Signature

Please Read The Release, Consent To Disclosure And Certification, And Sign Below.

I (we) acknowledge that, as of the Effective Date of the Settlement, pursuant to the terms set forth in the Settlement Agreement, and by operation of law and the Final Judgment, I (we) shall be deemed to release and forever discharge and shall be forever enjoined from prosecuting the Released Claims against the Released Parties (as defined in the Settlement Agreement and/or Final Judgment).

By signing and submitting this Claim Form, I (we) consent to the disclosure of information relating to my (our) transactions in BBSW-Based Derivatives during the Class Period, and waive any protections provided by any applicable bank secrecy or data privacy laws (whether foreign or domestic), or any similar confidentiality protections with respect to information and transaction data relating to my (our) trades, for use in the claims administration process.

If signing as an Authorized Representative on behalf of an entity, I (we) certify that I (we) have legal rights and authorization from the entity to file this Claim Form on the entity’s behalf. UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, I (WE) CERTIFY THAT ALL THE INFORMATION PROVIDED BY ME (US) ON THIS CLAIM FORM IS TRUE, CORRECT, AND COMPLETE AND THAT THE DATA SUBMITTED IN CONNECTION WITH THIS CLAIM FORM ARE TRUE AND CORRECT COPIES OF WHAT THEY PURPORT TO BE.

NOTE: If you have been notified by the I.R.S. that you are subject to backup withholding, please strike out the language that you are not subject to backup withholding in the certification above.

Signature of Claimant (if Beneficial Owner is an individual filing on his or her own behalf): *

Authorized Representative Completing Claim Form (if any):

Capacity of Authorized Representative (if other than an individual, [e.g., trustee, executor, administrator, custodian, or other nominee]):

REMINDER: YOUR CLAIM FORM AND REQUIRED DATA MUST BE SUBMITTED ONLINE BY 11:59 P.M. EASTERN TIME ON JANUARY 16, 2023, OR POSTMARKED AND MAILED NO LATER THAN JANUARY 16, 2023.