Electronic Agreement

Your Email

Email address:

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Contact Details

Salutation:

First name:

Middle name:

Last name:

Company

Position

Country:

Address:

Suburb:

State/Territory:

Postcode:

Email address:

Telephone:

Mobile:

Please provide either a Telephone or Mobile number.

By registering my information, I declare that, to the best of my knowledge, the details provided above are true and correct and believe that I have, or represent someone who has or may have a claim with respect to the class action described above. I acknowledge that any information disclosed to me as part of this online sign up process may contain confidential information relating to the above class action (Confidential Information). I agree to hold any such Confidential Information in strict confidence and only use Confidential Information solely for the purposes of determining whether to join the class action and/or apply for an interest in any litigation funding scheme established for the class action.

Claimant Details

An Individual

The claimant is an individual.

Should you require any other capacity than individual, please contact [email protected].

Name:

Full name of claimant:

Claimant Address:

The claimant address is the same as the contact address (entered on the previous screen)

The claimant address is different from the contact address (entered on the previous screen)

Please note that P.O. boxes are not allowed in this section.

Country:

Address:

Suburb:

State/Territory:

Postcode:

Claimant declaration:

You are the Claimant, or are acting on behalf of and with authority of the Claimant.

Investment Details

In this section, we ask you to provide details of the claimant's trading history in the securities which form part of your claim.

It is important these details are accurate. We suggest you refer to trade confirmation forms and contract notes when completing this section.

Stock Exchange:
(if you have traded in multiple exchanges you are required to complete an additional registration)

Opening Balance:
Please provide the number of securities held as at close of trade on 18-Apr-2024. If you did not hold any securities as at 18-Apr-2024, please write "0"

Trade details:
In the sections below, list all transactions (buys and sells) in the trade collection period for the claim.

The Trade Collection Period for this claim is 19-Apr-2024 to 19-Apr-2024 (inclusive)

Trade Date	Type	Buy/Sell	Stock Code	Quantity	Total Net Amount in AUD (including brokerage)	Price

Investment details declaration:

I confirm the information provided is true and correct to the best of my knowledge.

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Claim Details

Please answer the following questions accurately in relation to your claim:

Omni Bridgeway Funding Agreement

This is the agreement between the Claimant and Omni Bridgeway Limited. To become a client of Omni Bridgeway you must review and accept the terms of the Omni Bridgeway Funding Agreement (Funding Agreement).

We ask that you review the Funding Agreement carefully before entering into the Funding Agreement. If you have any questions about the terms of the Funding Agreement, please contact us at [email protected].

If you enter into the Funding Agreement, you will not have to pay anything, unless the Claims are successfully resolved, in which case the fees are recovered from the Resolution Sum. Omni Bridgeway will pay the other side's legal costs if the class action is unsuccessful and the Claims are lost.

A copy of the Funding Agreement will be emailed to you on completion of this process.

We note that the Funding Agreement is subject to a 21-day cooling off period, in which time you may terminate it by following the notice requirements, as set out in the terms of the Funding Agreement. You may use this cooling off period to obtain separate legal advice about the Funding Agreement if you wish to do so.

Declaration:

By selecting the 'tick boxes' and typing my name below, I confirm that:

I am the Claimant or I am duly authorised to act and enter into the Funding Agreement on the Claimants behalf.

the Claimant has read the Omni Bridgeway Disclosure Statement.

the Claimant has read the Funding Agreement.

the Claimant accepts and agrees to be bound by the terms of the Funding Agreement with Omni Bridgeway.

I acknowledge that Omni Bridgeway will accept this Funding Agreement as containing my signature for the purposes of the relevant electronic transactions legislation.

the Claimant has been given the opportunity to obtain, and has obtained, all independent legal, financial and other professional advice in respect of this Agreement that the Claimant considers necessary.

I consent to the collection of the personal information requested in the Claimant Information Section, including sensitive information. In particular information requested in Parts 2 and 4 of the Litigation Funding Agreement that may be sensitive information. I understand that if I do not provide such information, I may be unable to take part in the Class Action as a funded group member.

I understand that the personal information I provide in the Claimant Information Section or provided separately may be sensitive information. Any supporting documentation reasonably requested by Omni Bridgeway may be sensitive information, and will be used, processed and disclosed by Omni Bridgeway for the primary purpose of funding and prosecuting the Class Action and for such secondary purposes as may be permitted by applicable law.

I consent to the personal information, including any sensitive information, being used, processed, and disclosed by Omni Bridgeway for the primary purpose of funding and prosecuting the Class Action and for such secondary purposes as may be permitted by applicable law.

Please type your name:

Position/Capacity:

Omni Bridgeway Product Disclosure Statement Acceptance

A copy of the Funding Agreement will be emailed to you on completion of this process.

Declaration:

By selecting the 'tick boxes' and typing my name below, I confirm that:

I am the Claimant or I am duly authorised to act and enter into the Funding Agreement on the Claimants behalf.

the Claimant has read the Omni Bridgeway Disclosure Statement.

the Claimant has read the Funding Agreement.

the Claimant accepts and agrees to be bound by the terms of the Funding Agreement with Omni Bridgeway.

I acknowledge that Omni Bridgeway will accept this Funding Agreement as containing my signature for the purposes of the relevant electronic transactions legislation.

Please type your name:

Position/Capacity:

Registration Acceptance

By electronically accepting the below conditions you will agree to register your potential claim for inclusion in the Allergan Class Action and for the purpose of any possible settlement.

A copy of the completed registration form will be emailed to you on completion of this registration process.

It is important that following your registration you send 3rd party supporting documentation, such as contract notes, for each of the share transactions included in your claim to [email protected].

Declaration:

I confirm that:

I am the Claimant, or I am duly authorised to act on the Claimants behalf.

I acknowledge that electronic acceptance has the same effect as signing a hard copy version of the registration form.

I acknowledge that Omni Bridgeway Limited will accept this registration form as containing my signature for the purposes of the relevant electronic transactions legislation.

Please type your name:

Position (if applicable):

Solicitor Retainer

This is the retainer agreement between the Claimant and the Lawyers ("Retainer Agreement").

As you have accepted the terms of funding set out in the PDS, you will not have to pay any Lawyer's fees if the class action proceeds, unless claims are successfully resolved, in which case the fees are recovered from the Resolution Sum. There are no "out of pocket" fees payable by you.

A copy of the Retainer Agreement will be emailed to you on completion of this registration process.

Declaration:

By selecting the 'tick boxes' below and typing my name below, I confirm that:

I am the Claimant or I am duly authorised to act and enter into the above Retainer Agreement on the Claimant’s behalf.

I have read and understood the terms of the Retainer Agreement with the Lawyers.

I accept and agree to be legally bound by the terms of the above Retainer Agreement with the Lawyers.

This electronic acceptance has the same effect as if I had signed a hard copy version of the Retainer Agreement.

I expressly consent to this method of acceptance of the terms of the Retainer Agreement in accordance with s10(1) of the Electronic Transactions Act 2011 (WA) or the relevant corresponding State or Territory legislation.

Please type your name:

Position (if applicable):

Claim Complete

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Your Email

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Contact Details

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Claimant Details

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Documents

Investment Details

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Documents

Claim Details

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Omni Bridgeway Funding Agreement

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Omni Bridgeway Product Disclosure Statement Acceptance

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Registration Acceptance

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Solicitor Retainer

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Claim Complete