K8301 v.16 07.25.2014 1
QUESTIONS? CALL U.S. & CANADA (TOLL–FREE): 1-877-276-7340; INTERNATIONAL (TOLL): 503-520-4400; OR VISIT www.FreightForwardCase.com 01-CA4855
FREIGHT FORWARDERS SETTLEMENT
C/O FREIGHT FORWARDERS CLAIMS ADMINISTRATOR PO BOX 3747
PORTLAND, OR 97208-3747 U.S.A
CLAIM FORM
GENERAL INSTRUCTIONS
This Claim Form relates to Precision Associates, Inc., et al. v. Panalpina World Transport (Holding) LTD, et al.,
08 Civ. 0042 (JG) (VVP) in the United States District Court for the Eastern District of New York.
To be eligible to share in the Settlement Fund for the Settlement Class in the above-named class action, you must have (1) directly purchased Freight Forwarding Services; (2) from any of the Settling or Non-Settling Defendants, their subsidiaries, or affiliates; (3) from January 1, 2001 through September 14, 2012; (4) in the U.S., or outside the U.S. for shipments within, to, or from the U.S.
“Freight Forwarding Services” means freight forwarding, transportation, or logistics services for shipments, including services relating to the organization or transportation of items via air, ocean, rail, and road, both nationally and internationally, and related activities such as customs clearance, warehousing, and ground services.
If you fit this description you are a member of the Settlement Class and are entitled to submit a claim to share in the Settlement Fund. Excluded from the Settlement Class are all Defendants, their subsidiaries and affiliates, and their co-conspirators. Also excluded from the Settlement Class are all governmental entities.
Settlement Class Members who seek payment from the Settlement Fund must complete and return this Claim Form.
Completed Claim Forms must be mailed to the Freight Forwarders Claims Administrator (“Claims Administrator”) at
the above address or can be submitted via the Settlement website, www.FreightForwardCase.com. Claim Forms must
be POSTMARKED OR SUBMITTED ONLINE NO LATER THAN AUGUST 24, 2015. You should save all
relevant documents supporting your claim as you may be required to provide them later.
All inquiries regarding your claim should be made (1) in writing to the Claims Administrator at the address above, (2) by visiting the settlement website, www.FreightForwardCase.com, (3) via e-mail at [email protected], or (4) by calling the information helpline: U.S. & Canada (Toll-Free) 1-877-276-7340; International (Toll) (503) 520-4400. Before you complete and submit this Claim Form by mail or online, you should read and be familiar with the Notice of Proposed Class Action Settlement (“the Notice”) available at www.FreightForwardCase.com. Defined terms (with initial capitals) used in these General Instructions have the same meaning as set forth in the Notice. By submitting this Claim Form, you acknowledge that you have read and understand the Notice, and you agree to the Releases included as a material term of each settlement agreement.
K8302 v.16 07.25.2014 2
QUESTIONS? CALL U.S. & CANADA (TOLL–FREE): 1-877-276-7340; INTERNATIONAL (TOLL): 503-520-4400; OR VISIT www.FreightForwardCase.com 02-CA4855
from the Settlement Fund. If you are a member of the Settlement Class and you do not timely and validly seek exclusion from the Settlement Class, you will be bound by any judgment entered by the Court approving the Settlements regardless of whether you submit a Claim Form.
To receive the most current information and regular updates, please submit your Claim Form on the settlement website at www.FreightForwardCase.com. On the settlement website, you will be able to submit web claims and receive future
notices via email. Accordingly, if you prefer to receive all future notices by mail only, please check here.
SECTION A – CLAIMANT INFORMATION
Claimant Name(s) (As you would like the name(s) to appear on the check, if eligible for payment):
First Name MI Last Name
Business Name
Name Of The Person You Would Like The Claims Administrator To Contact Regarding This Claim (if different from the Claimant Name(s) listed above):
First Name MI Last Name
Claimant Or Representative Contact Information: The Claims Administrator will use this information for all
communications relevant to this Claim (including the check, if eligible for payment). If this information changes, you
MUST notify the Claims Administrator in writing at the address above or online at www.FreightForwardCase.com.
Street Address
City State Zip Code/Postal Code
Country (Other than U.S.) Province
Daytime Telephone Number Evening Telephone Number Email Address
IF YOU FAIL TO SUBMIT A COMPLETE CLAIM BY
AUGUST 24, 2015
, YOUR CLAIM IS SUBJECT
TO REJECTION OR YOUR PAYMENT MAY BE DELAYED.
K 83 03 v .16 0 7.2 5.2 01 4 3 Q U E ST IO N S? C A L L U .S . & C A N A DA ( TO L L –F R EE ): 1 -8 77 -27 6-7 34 0; IN T ER N A T IO N A L ( TO L L): 5 03 -52 0-4 40 0; O R V IS IT w w w .F re igh tF or w ar dC as e. co m 03 -C A4 855
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Ple ase p ro vid e a s um m ary o f a ll F reig ht F orw ard ing S hip pin g S erv ice s tha t y ou h av e p urc ha se d f ro m a ny o f t he b elo w lis ted d efe nd an ts or t he ir subs idi ari es or affi lia tes : (1 ) fo r s hip m en ts w ith in , to , o r f ro m the U nit ed Sta tes or (2) in the U nit ed Sta tes for sh ipm en ts an yw he re in the w orl d, du rin g the pe rio d fro m Jan ua ry 1, 20 01 to Se pte m be r 1 4, 20 12 . P lea se ty pe or pri nt ne atly all in for m atio n an d ch ec k all tha t a pp ly. If yo u ne ed ad dit ion al sp ac e, ple ase c on tin ue o n a dd itio na l pag es, m ak e a n ote o f t he s am e o n t his C lai m F orm , a nd s ub m it y ou r a dd itio na l pag es w ith t his C lai m Fo rm . R ou nd t he tot al p urc ha se a m ou nt t o t he n ea res t d oll ar o r w ho le u nit o f t he c urr en cy f or w hic h y ou a re c lai m ing . P lea se i nd ica te t he c urr en cy y ou a re u sin g ( Ex am ple : U SD , E U R , C A D , J PY , C N Y ). P lea se a lso s pe cif y t he d ate (s) o f y ou r p urc ha se( s) a nd t he o rig in( s) a nd d est ina tio n(s ) o f y ou r s hip m en t(s) . Fr eig ht F or w ar de r (In dic ate A ll T ha t A pp ly) To tal P urc ha se A m ou nt Ja nu ar y 1 , 2 00 1 t hr ou gh Se pte m be r 1 4, 2 01 2 (A ll F rei gh t Ch ar ge s A nd S urc ha rg es, Ex clu din g T ax es O n T ho se Ch ar ge s) Sh ip pin g R out es C U R R ENC Y AM O UN T DA T E (S ) (M M D D Y Y ) O R IG IN (S ) D E ST INA T IO N (S ) A BX or S A IM A BA X G lob al D ac hs er D FDS o r DS V D H L, D an za s ( db a, D H L G lob al Fo rw ard ing ), or D eu tsc he P ost D H L J ap an , D H L G lob al F or w ard ing Jap an K .K ., D an za s M aru ze n, A irb or ne Ex pre ss, or A ir Ex pre ss In ter na tion al EG L o r E ag le Exe l Ex pe dit ors G eo dis o r G eo dis W ils on G eo -L og isti cs o r A gil ity04 v .16 0 7.2 5.2 01 4 4 Q U E ST IO N S? C A L L U .S . & C A N A DA ( TO L L –F R EE ): 1 -8 77 -27 6-7 34 0; IN T ER N A T IO N A L ( TO L L): 5 03 -52 0-4 40 0; O R V IS IT w w w .F re igh tF or w ar dC as e. co m 04 -C A4 855 C U R R ENC Y AM O UN T DA T E (S ) (M M D D Y Y ) O R IG IN (S ) D E ST INA T IO N (S ) H an ky u H an sh in Ex pre ss, H an ky u Tra ve l I nte rn at ion al or H an sh in A ir C argo H ell m an Jet S peed K ueh ne + N ag el or K üh ne + N ag el K int ets u W or ld Ex pre ss “K ” L ine L og isti cs M O L L og isti cs M orr ison E xp res s N ipp on E xp res s Ni sh i-Ni pp on Ni ssi n Pa na lpi na Sc he nk er or D eu tsc he B ah n SDV To ll or B alt ran s U PS S up ply C ha in So lut ion s I nc ., U nit ed P arc el S erv ice ( U PS ), M en lo W or ldw ide, or E me ry
K 83 05 v .16 0 7.2 5.2 01 4 5 Q U E ST IO N S? C A L L U .S . & C A N A DA ( TO L L –F R EE ): 1 -8 77 -27 6-7 34 0; IN T ER N A T IO N A L ( TO L L): 5 03 -52 0-4 40 0; O R V IS IT w w w .F re igh tF or w ar dC as e. co m 05 -C A4 855 C U R R ENC Y AM O UN T DA T E (S ) (M M D D Y Y ) O R IG IN (S ) D E ST INA T IO N (S ) U nit ed A irc arg o C on so lid ato rs U Ti W orl dw id e Va ntec Ya m ato Y use n A ir & S ea 1. Ple ase s tate t he s um t ota l o f f reig ht f orw ard ing s hip m en ts t ha t y ou m ad e w ith a ll D efe nd an ts o r a ffi lia tes o f t he D efe nd an ts f or e ach o f t he f ollo w ing : a. Fo r a ir s hip m en ts f ro m J apa n i nto t he U nit ed S tate s: To tal n um be r o f s hip me nts b etw ee n Se pte m be r 1 , 2 002 a nd N ov em be r 3 0, 2 00 7 To tal n um be r o f s hip me nts b etw ee n D ec em be r 1 , 2 00 7 a nd Se pte m be r 1 4, 2 01 2 b. Fo r a ir s hip m en ts f ro m a ny w he re i n t he w orl d ( ex ce pt J apa n) t o t he U nit ed S tate s: To tal n um be r o f s hip me nts f rom J an ua ry 1 , 2 00 3 t o N ov em be r 3 0, 2 00 7 To tal n um be r o f s hip me nts f rom D ec em be r 1 , 2 00 7 t o Se pte m be r 1 4, 2 01 2 c. Fo r o ce an s hip m en ts f ro m a ny w he re i n t he w orl d t o t he U nit ed S tate s: To tal n um be r o f s hip me nts b etw ee n Se pte m be r 1 , 2 002 a nd N ov em be r 3 0, 2 00 7 To tal n um be r o f s hip me nts b etw ee n D ec em be r 1 , 2 00 7 a nd Se pte m be r 1 4, 2 01 2 2. Ple ase sta te the su m tota l p ou nd ag e o f fr eig ht for w ard ing sh ipm en ts tha t y ou m ad e w ith all D efe nd an ts or affi lia tes of the D efe nd an ts for eac h of the foll ow ing : a. Fo r a ir s hip m en ts f ro m a ny w he re i n t he w orl d t o o r f ro m t he U nit ed S tate s: To tal p ou nd s o f s hip me nts b etw ee n O cto be r 1 , 2 00 1 a nd N ov em be r 3 0, 2 00 7 To tal p ou nd s o f s hip me nts b etw ee n D ec em be r 1 , 2 00 7 a nd Se pte m be r 1 4, 2 01 2 b. Fo r a ir s hip m en ts f ro m J apa n t o t he U nite d S tate s; o r f or a ir s hip m en ts p urc ha se d i n t he U nite d S tate s f or s hip m en t f ro m J apa n t o a ny w he re i n t he w orld : To tal p ou nd s o f s hip me nts b etw ee n Se pte m be r 1 , 2 002 a nd N ov em be r 3 0, 2 00 7 To tal p ou nd s o f s hip me nts f rom D ec em be r 1 , 2 00 7 t o Se pte m be r 1 4, 2 01 2
06 v .16 0 7.2 5.2 01 4 6 Q U E ST IO N S? C A L L U .S . & C A N A DA ( TO L L –F R EE ): 1 -8 77 -27 6-7 34 0; IN T ER N A T IO N A L ( TO L L): 5 03 -52 0-4 40 0; O R V IS IT w w w .F re igh tF or w ar dC as e. co m 06 -C A4 855 3. Ple ase sta te the su m tot al do lla r P urc ha se A m ou nt tha t y ou pa id for fre igh t fo rw ard ing sh ipm en ts to all D efe nd an ts or affi lia tes of the D efe nd an ts du rin g t he f ollo w ing t im e p eri od s o n t he f ollo w ing ro ute s: a. Fro m J uly 5 , 2 00 5 t o D ec em be r 3 1, 2 00 6 f ro m C hin a t o t he U nit ed S tate s: C U R R ENC Y AM O UN T DA T E (S ) (M M D D Y Y ) O R IG IN (S ) D E ST INA T IO N (S ) b. Fro m H on g K on g t o t he U nit ed S tate s d uri ng ( i) A ug ust 2 00 5 t o J an ua ry 1 , 2 00 6; ( ii) A ug ust 2 00 6 t o J an ua ry 1 , 2 00 7; ( iii) A ug ust 2 00 7 t o Jan ua ry 1 , 2 00 8 t im e pe rio d; or f or s hip m en ts f ro m H on g K on g t o a ny w he re in t he w orl d t ha t w ere pu rch ase d i n t he U nit ed S tate s f or t he sam e pe rio ds o f t im e: C U R R ENC Y AM O UN T DA T E (S ) (M M D D Y Y ) O R IG IN (S ) D E ST INA T IO N (S ) If yo u kn ow tha t y ou ha ve m ad e sh ipm en ts w ith D efe nd an ts w ith in the tim efr am es ab ov e, bu t ca nn ot sta te yo ur pu rch ase s w ith sp ec ifi cit y, ple ase sta te the r ea so ns w hy y ou ca nn ot p ro vid e t he i nfo rm atio n r eq ue ste d:
K8307 v.16 07.25.2014 7
QUESTIONS? CALL U.S. & CANADA (TOLL–FREE): 1-877-276-7340; INTERNATIONAL (TOLL): 503-520-4400; OR VISIT www.FreightForwardCase.com 07-CA4855
SECTION C – SUBMISSION TO JURISDICTION OF THE COURT
By signing below, you are submitting to the jurisdiction of the United States District Court for the Eastern District of New York.
SECTION D – CERTIFICATION UNDER PENALTY OF PERJURY
I hereby certify under penalty of perjury that:1. The information provided in this Claim Form is accurate and complete to the best of my knowledge, information and belief;
2. I agree to provide additional information to Settlement Class Counsel or the Claims Administrator to support my claim, if necessary;
3. I am either (a) a member of the Settlement Class and did not request to be excluded from the Settlement Class or (b) the assignee or transferee of, or the successor to, the claim of a member of the Settlement Class and did not request to be excluded from the Settlement Class;
4. I have not entered into a settlement for any of the claims set forth in this Claim Form; 5. I am neither a Defendant, nor a parent, employee, subsidiary or affiliate of a Defendant; 6. I am not a government entity; and
7. I have not submitted any other claim for the same purchases of Freight Forwarding Shipping Services and have not authorized any other person or entity to do so, and know of no other person or entity having done so on my behalf.
Signature Date – –
MM DD YY
Class Member (Print your name)
First Name MI Last Name
Business Name
Claimant Name (if different from above)
First Name MI Last Name
Social Security Number Taxpayer ID
– – OR –