CLAIMANT INFORMATION
(Please read General Instructions below before completing this page.)
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 above.
Country: *
Please select a country
Afghanistan
Africa
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
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
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
Estate
Individual (Includes joint owner accounts)
IRA/401K
Other
Pension Plan
Trust
1 If the account number is unknown, you may leave blank. If the same legal entity traded through more than one account you may write
“multiple.” Please see paragraph 11 of the General Instructions for more information on when to file separate Claim Forms for multiple
accounts, i.e., when you are filing on behalf of distinct legal entities.
SCHEDULE OF TRANSACTIONS IN TENARIS ADS
Complete this Part 2 if and only if you purchased/acquired Tenaris ADS during the period from May 1, 2014, through and including December 5, 2018.
Please include proper documentation with your Claim Form as described in detail in paragraph 10 of the General Instructions. Do not include
information in this section regarding securities other than Tenaris ADS purchased
1. BEGINNING HOLDINGS: State the total number of shares of Tenaris ADS held as of the close of trading on April 30, 2014. (Must be documented.) If none, enter “0.”
2. PURCHASES/ACQUISITIONS DURING THE SETTLEMENT CLASS PERIOD THROUGH MARCH 4, 2019:
Separately list each and every purchase/acquisition (including free receipts) of Tenaris
ADS from after the opening of trading on May 1, 2014, through and including the close of trading on March 4, 2019. (Must be document.) If none, enter “0”.
Trade Date (Month/Day/Year)
Number of Shares Purchased/Acquired
Purchase/ Acquisition
Price Per Share
Total Purchase/
Acquisition Price
Confirm Proof of Purchase Enclosed
Action
3. SALES DURING THE SETTLEMENT CLASS PERIOD THROUGH MARCH 4, 2019:
Separately list each and every sale/disposition (including free deliveries) of
Tenaris ADS from after the opening of trading on May 1, 2014, through and including
the close of trading on March 4, 2019. (Must document.) If none, enter “0”.
Trade Date (Month/Day/Year)
Number of
Shares Sold
Sale Price
Per Share
Total Sales Price
(not deducting taxes, commissions, and fees)
Confirm Proof
of Sale Enclosed
Action
4. ENDING HOLDINGS:
State the total number of shares of Tenaris ADS held as of the close of trading on March 4, 2019. (Must document.) If none, enter “0”
2 Please note: Information requested with respect to your purchases/acquisitions of Tenaris ADS from December 6, 2018,
through and including March 4, 2019, is needed in order to balance your claim; purchases/acquisitions during this period, however, are not
eligible under the Settlement and will not be used for purposes of calculating your Recognized Loss pursuant to the Plan of Allocation.
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
RELEASE OF CLAIMS AND SIGNATURE
YOU MUST ALSO READ THE RELEASE AND CERTIFICATION BELOW AND SIGN THIS CLAIM FORM.
I (we) hereby acknowledge that as of the Effective Date of the Settlement, pursuant to the terms set forth in the Stipulation,
I (we), on behalf of myself (ourselves) and any other person or entity legally entitled to bring Released Plaintiffs’ Claims
(as defined in the Stipulation and in the Settlement Notice) on my (our) behalf, in such capacity only, 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, dismissed, and discharged each and every Released Plaintiffs’ Claim (as defined in the Stipulation and
in the Settlement Notice) against the Defendants and the other Defendants’ Releasees (as defined in the Stipulation and in the
Settlement Notice) and shall forever be barred and enjoined from commencing, instituting, maintaining, prosecuting or continuing
to prosecute any or all of the Released Plaintiffs’ Claims against any of the Defendants or the other Defendants’ Releasees.
Certification
YOU MUST READ AND SIGN THE RELEASE BELOW.
1. that I (we) have read and understand the contents of the Settlement 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 Settlement Notice and in paragraph 2 on
page 3 of this Claim Form, and is (are) not excluded from the Class by definition or pursuant to request as set forth in the
Settlement Notice and in paragraph 3 on page 3 of this Claim Form;
3. that I (we) own(ed) the Tenaris ADS identified in the Claim Form and have not assigned the claim against the Defendants’
Releasees to another, or that, in signing and submitting this Claim Form, I (we) have the authority to act on behalf of the owner(s) thereof;
4. that the Claimant(s) has (have) not submitted any other claim covering the same purchases/acquisitions of Tenaris ADS and knows (know)
of no other person having done so on the Claimant’s (Claimants’) behalf;
5. 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;
6. that I (we) agree to furnish such additional information with respect to this Claim Form as Lead Counsel,
the Claims Administrator or the Court may require;
7. that the Claimant(s) waive(s) the right to trial by jury, to the extent it exists, and agree(s) to the Court’s
summary disposition of the determination of the validity or amount of the claim made by this Claim Form;
8. 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
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
9. 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 (a) the Claimant(s) is (are) exempt from backup withholding or (b) the Claimant(s)
has (have) not been notified by the IRS that he/she/it is subject to backup withholding as a result of a failure to report
all interest or dividends or (c) the IRS has notified the Claimant(s) that he/she/it is no longer subject to backup withholding.
If the IRS has notified the Claimant(s) that he, she or it is subject to backup withholding, please strike out the language in the
preceding sentence indicating that the claim is not subject to backup withholding in the certification above.
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.
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: