PART II – CLAIMANT INFORMATION
The Claims Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Claims Administrator in writing at the address on the “Contact Us” tab. Complete names of all persons and entities must be provided.
Country: *
Please select a country
United States
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Africa
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Costa Rica
Côte d'Ivoire, Republic of
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
São Tomé and Príncipe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Surinone
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
State: *
Please select a state
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Select Option below then enter correct data in field below: *
Claimant Account Type: *
Specify one of the following:
Corporation
Individual
Other
PART III – SCHEDULE OF TRANSACTIONS IN GLOBAL PAYMENTS COMMON STOCK
The only eligible security is Global Payments Inc. common stock (Ticker (NYSE): GPN, CUSIP: 37940X102). Do not include information regarding securities other than Global Payments common stock. Please include proper documentation with your Claim Form as described in detail in Part I – General Instructions, paragraph 6.
1. HOLDINGS AS OF OCTOBER 31, 2019
– State the total number of shares of Global Payments common stock held as of the opening of trading on October 31, 2019. (Must be documented.) If none, write “zero” or “0.” *
2. PURCHASES/ACQUISITIONS FROM OCTOBER 31, 2019 THROUGH JANUARY 18, 2023
– Separately list each and every purchase or acquisition (including free receipts) of Global Payments common stock from after the opening on October 31, 2019 through the close of trading on January 18, 2023. (Must be documented.)
Date of Purchase/ Acquisition
(Trade Date)
Mo. / Day / Year
Number of Shares Purchased or Acquired
Purchase / Acquisition
Price Per Share
Total Purchase or Acquisition Price
(excluding any taxes, commissions, and fees)
Confirm Proof of Purchase Enclosed
Action
3. SALES FROM OCTOBER 31, 2019 THROUGH JANUARY 18, 2023
– Separately list each and every sale or disposition (including free deliveries) of Global Payments common stock from after the opening of trading on October 31, 2019 through the close of trading on January 18, 2023. (Must be documented.)
Date of Sale
(List Chronologically)
(Month/Day/Year)
Number of
Shares Sold
Sale Price
Per Share
Total Sales Price
(not deducting taxes, commissions, and fees)
Confirm Proof of Position Enclosed
Action
4. HOLDINGS AS OF JANUARY 18, 2023
– State the total number of shares of Global Payments common stock held as of close of trading on January 18, 2023. (Must be documented.) If none, write “zero” or “0.” *
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.
Files To Be Uploaded
Size
Action
PART IV – RELEASE OF CLAIMS AND SIGNATURE
YOU MUST ALSO READ THE RELEASE AND CERTIFICATION AND ELECTRONICALLY SIGN BELOW.
I (We) hereby acknowledge that, pursuant to the terms set forth in the Stipulation, without further action by anyone, upon the Effective Date
of the Settlement, I (we), on behalf of myself (ourselves) and my (our) (the claimant(s)’) heirs, executors, administrators, predecessors,
successors and assigns, in their capacities as such, shall be deemed to have, and by operation of law and of the judgment shall have, fully,
finally, and forever compromised, settled, released, resolved, relinquished, waived, and discharged each and every Released Plaintiffs’ Claim
(including, without limitation, any Unknown Claims) against the Defendants’ Releasees; and shall covenant not to, and shall forever be barred
and enjoined from, commencing, instituting, prosecuting, or continuing to prosecute any action or other proceeding in any court of law or equity,
arbitration tribunal, or administrative forum asserting any or all of the Released Plaintiffs’ Claims against any of the Defendants’ Releasees.
CERTIFICATION
By electronically signing and submitting this Claim Form, the claimant(s) or the person(s) who represent(s) the claimant(s) agree(s) to the
release above and certifies (certify) as follows:
1. that I (we) have read and understand the contents of the Notice and this Claim Form, including the releases provided for in the Settlement
and the terms of the Plan of Allocation;
2. that the claimant(s) is a (are) Settlement Class Member(s), as defined in the Notice, and is (are) not excluded by definition from the
Settlement Class as set forth in the Notice;
3. that the claimant(s) did not submit a request for exclusion from the Settlement Class;
4. that I (we) own(ed) the Global Payments common stock identified in the Claim Form and have not assigned the claim against any of the
Defendants or any of the other Released Defendant Persons to another, or that, in electronically signing and submitting this Claim Form,
I (we) have the authority to act on behalf of the owner(s) thereof;
5. that the claimant(s) has (have) not submitted any other claim covering the same purchases of Global Payments common stock and knows (know)
of no other person having done so on the claimant’s (claimants’) behalf;
6. that the claimant(s) submit(s) to the jurisdiction of the Court with respect to claimant’s (claimants’) claim and for purposes of enforcing
the releases set forth herein;
7. that I (we) agree to furnish such additional information with respect to this Claim Form as Co-Lead Counsel, the Claims Administrator, or the
Court may require;
8. that the claimant(s) waive(s) the right to trial by jury, to the extent it exists, and agree(s) to the determination by the Court of the
validity or amount of this Claim, and waives any right of appeal or review with respect to such determination;
9. that I (we) acknowledge that the claimant(s) will be bound by and subject to the terms of any judgment(s) that may be entered in the Action;
and
10. that the claimant(s) is (are) NOT subject to backup withholding under the provisions of Section 3406(a)(1)(C) of the Internal Revenue Code
because (i) the claimant(s) is (are) exempt from backup withholding or (ii) the claimant(s) has (have) not been notified by the IRS that he,
she, or it is subject to backup withholding as a result of a failure to report all interest or dividends or (iii) the IRS has notified the
claimant(s) that he, she, or it is no longer subject to backup withholding.
UNDER THE PENALTIES OF PERJURY, I (WE) CERTIFY THAT ALL OF THE INFORMATION PROVIDED BY ME (US) ON THIS CLAIM FORM IS TRUE, CORRECT, AND COMPLETE,
AND THAT THE DOCUMENTS SUBMITTED HEREWITH ARE TRUE AND CORRECT COPIES OF WHAT THEY PURPORT TO BE.
If the claimant is other than an individual, or is not the person completing this form, the following also must be provided: