U.S. Treasury Futures or Options Class Action

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 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 U.S. TREASURY FUTURES OR OPTIONS ON U.S. TREASURY FUTURES

Complete this Part IV if and only if you entered into transactions in U.S. Treasury Futures on U.S. Treasury Futures from April 1, 2008 through January 31, 2016. Do not include information regarding instruments other than U.S. Treasury Futures or Options on U.S. Treasury Futures and do not include transactions in U.S. Treasury Futures or Options on U.S. Treasury Futures in which you acquired the instrument as an agent for another individual or entity.

TABLE I - PURCHASE(S) AND SALE(S) OF U.S. TREASURY FUTURES CONTRACTS DURING THE SETTLEMENT CLASS PERIOD

For each purchase or sale of U.S. Treasury Futures on a United States-based exchange, provide the following information for each transaction:

Contract Traded (Description or Code) *

Contract Month

Contract Year:

U.S.-based Exchange:

Trade Date: *

Number of Contracts: *

Transaction Price: *

Purchase Or Sale: *

Brokerage Firm in Which Transaction Was Made:

Account Number in Which Transaction Was Made:

Must click Add Transaction to save your information.

Contract Traded (Description or Code)

Contract Month

Contract Year

U.S.-based Exchange

Trade Date

Number of Contracts

Transaction Price

Purchase or Sale

Brokerage Firm

Brokerage Account Number

Action

TABLE OF TRANSACTIONS IN U.S. TREASURY FUTURES OR OPTIONS ON U.S. TREASURY FUTURES

Complete this Part IV if and only if you entered into transactions in U.S. Treasury Options on U.S. Treasury Futures from April 1, 2008 through January 31, 2016. Do not include information regarding instruments other than U.S. Treasury Futures or Options on U.S. Treasury Futures and do not include transactions in U.S. Treasury Futures or Options on U.S. Treasury Futures in which you acquired the instrument as an agent for another individual or entity.

TABLE II - PURCHASE(S) AND SALE(S) OF OPTIONS ON U.S. TREASURY FUTURES DURING THE SETTLEMENT CLASS PERIOD

For each purchase or sale of an Option on U.S. Treasury Futures on a United States-based exchange, provide the following information for each transaction:

Contract Traded (Description or Code): *

Contract Month

Contract Year:

Trade Date: *

OptionType: *

Expiry Type: *

Strike Price: *

Option Premium (price): *

Settlement/Exercise Date:

Number of Contracts: *

Traded Price (price of futures contract):

Purchase Or Sale: *

Brokerage Firm in Which Transaction Was Made:

Account Number in Which Transaction Was Made:

Must click Add Transaction to save your information.

Contract Traded (Description or Code)

Contract Month

Contract Year

Trade Date

Option Type (Call/Put)

Expiry Type

Strike Price

Option Premium

Settlement/ Exercise Date

Number of Contracts

Traded Price (price of futures contract)

Purchase or Sale

Brokerage Firm

Brokerage Account Number

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 PARTICIPATION IN THE U.S. DEPARTMENT OF JUSTICE VICTIM COMPENSATION AMOUNT

1. Did you submit a Victim Impact Statement to the U.S. Department of Justice related to U.S. Treasury Futures or Options on U.S. Treasury Futures in connection with JPMorgan’s Deferred Prosecution Agreement in the case United States v. JPMorgan Chase & Co., No. 3:20-cr-00175 (D. Conn.)?

Yes No

2. If yes, did the U.S. Department of Justice award you a payment related to U.S. Treasury Futures or Options on U.S. Treasury Futures?

Yes No Awaiting Determination

3. If yes, what was the amount of the payment you received from the U.S. Department of Justice related to U.S. Treasury Futures or Options on U.S. Treasury Futures? :

4. If you did not yet submit a Victim Impact Statement to the U.S. Department of Justice, do you intend to do so related to U.S. Treasury Futures or Options on U.S. Treasury Futures?

Yes No

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 Agreement;

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 JPMorgan 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.

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 U.S. Treasury Futures or Options on U.S. Treasury Futures 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.

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 JUNE 30, 2022, OR POSTMARKED AND MAILED NO LATER THAN JUNE 30, 2022.