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UÐInreMercedes-BenzEmissionsLitigationE.-ClassActionSettlementClaimFormGBDDV3G5YB7MDClaimFormInstructionsInstructionsforCompletingtheEnclosedClaimFormYoumustcomplete,sign,andreturntheenclosedClaimFormtoreceiveapaymentundertheClassActionSettlements.'PleasereadthefullLongFormNotice,whichisavailableattheSettlementWebsite,mbbluetecsettlement.com,beforecompletingyourClaimForm.IfyouhavequestionsaboutthisClaimForm,pleasevisittheSettlementWebsite,call1-877-313-0170toll-freeoremailinfo@mbbluetecsettlement.com.CLAIMSUBMISSIONINSTRUCTIONSANDDEADLINES:•ToreceiveaClassMemberPayment,youmustsubmitacompletedandsignedClaimForm,includingallrequireddocumentation,bythedeadlinethatappliestoyou.ThesedeadlinesaresetforthindetailattheSettlementWebsite,mbbluetecsettlement.com.Tosummarize:o\fyouareanEligibleCurrentOwner/Lessee,yourclaimmustbesubmittedonlineorpostmarkedbyOctober1,2022.oIfyouareanEligibleFormerOwner/Lessee,yourclaimmustbesubmittedonlineorpostmarkedbyJuly12,2021,orbythedatetheCourtfinallyapprovestheMercedesClassActionSettlement(ifafterJuly12,2021).Pleasevisitmbbluetecsettlement.comforupdatesaboutthedeadlinetosubmityourclaim.oYoumaysubmityourcompletedClaimFormandallrequireddocumentsonlineatmbbluetecsettlement.com.YoumayalsomailyourcompletedClaimFormanddocumentationto:MBBlueTecSettlementcloJNDLegalAdministrationPOBox91310Seattle,WA98111•YoushouldnotwaituntilclosetothedeadlinetosubmityourClaimForm.AllClaimFormsrequireinformationanddocumentationthatyoumightneedtimetocollect,andallEligibleCurrentOwners/LesseesmusthavescheduledandcompletedinstallationoftheAEMfortheirvehiclebeforesubmittingtheirClaimForm.•Thefollowingdocumentationisrequiredtosubmitaclaim:oAcompletedandsignedClaimFormoProofofcurrentorformerownershiporlease,includingdatesofownershiporlease,foryourSubjectVehicleoProofofvehicleregistrationforyourSubjectVehicleoFullyexecutedIndividualRelease(acopyoftheindividualReleaseisincludedwiththisClaimForm)1The"ClassActionSettlements"aretheseparateclasssettlementswiththeMercedesDefendants(the"MercedesClassActionSettlement")andwiththeBoschDefendants(the"BoschClassActionSettlement"),whichcanbefoundatmbbluetecsettlement.com.AllcapitalizedtermsinthisClaimFormaredefinedintheMercedesClassActionSettlement.Ifyouhavequestionsaboutfillingoutthisform,pleasevisitmbbluetecsettlement.comorcall1-877-313-0170ToviewJND'sprivacypolicy,pleasevisithttps://www.indla.com/privacy-policy