REQUEST FOR EXCLUSION FORM

General Instructions

If you exclude yourself from the Class (also called “opting out”), you will not benefit from a favorable judgment or be bound by an unfavorable judgment, but you will retain any rights you may have to bring your own, separate lawsuit about the issues in the present lawsuit named Miley v. Belkin International, Inc., Case No. 20STCV00033 (Superior Court of California, Los Angeles County) (the “Class Action”). You can exclude yourself on an individual basis only; so-called “mass” or “class” opt outs are not allowed.

Please provide your name and contact information below. You must notify the Claims Administrator if your contact information changes after you submit this form.

Request for Exclusion Statement & Signature

I hereby elect to be excluded from the Class in Miley v. Belkin International, Inc., Case No. 20STCV00033 (Superior Court of California, Los Angeles County) and from any judgment entered in the Class Action. I do not wish to be a Class Member. I understand that by excluding myself from the Class, I will not benefit from a favorable judgment or be bound by an unfavorable judgment resulting from the Class Action.