Exhibit A Submission

Instructions

PLEASE NOTE: Claimant Opt-In & Release forms will be populated based upon the information provided in the completed Exhibit A - List of Eligible Claimants. As such, the minimum data points below MUST be provided. Failure to provide these data points, or providing inaccurate or incomplete data, may result in processing delays and may necessitate claimants having to re-sign releases.

For All Claimants

Claimant Name
Claimant Date of Birth
Claimant E-Mail Address OR Phone Number (required for Electronic Opt-In & Release forms)

For Deceased and Incapacitated Claimants

Estate Representative / Releasor Information

For Filed Cases

Court Where Case is Pending / Filed
Filed Case Number
Date Case Filed

For Unfiled Claims

Date of Retention

For All Claimants

Claimant Electronic Notarization Election
- Notarization IS NOT REQUIRED for acceptance of the Opt-In & Release BUT WILL BE REQUIRED to receive any settlement proceeds. If you select the Electronic Notarization Election of YES for a claimant on Exhibit A - List of Eligible Claimants, the claimant can utilize a virtual notary service when executing the Opt-In & Release via Docusign®. Electronic Notarization, if elected on Exhibit A - List of Eligible Claimants, is being covered by J&J during this phase of the program, at no cost to the claimant or your firm. Claimants who are not initially enrolled in Electronic Notarization and later request to use this service may incur associated administrative fees. Additionally, if a traditional, wet-ink notary is used, firms and claimants bear the cost of this service.

In addition to the required fields listed above, firms are strongly encouraged to complete all fields in Exhibit A to avoid processing delays.