Opt-Out Form

OPT-OUT FORM

To Exclude Yourself From Being A Class Member and a Part of the Class Action Settlement In Greenberg, et al. v. Colvin, et al., No. 1:13-cv-01837-RMC

(U.S. Dist. Court for D.C.)

This is NOT a Claim Form. It EXCLUDES you from the Settlement Agreement in this Class Action. DO NOT use this Form if you wish to remain IN the Settlement Agreement and a part of the Class.

Name of Class Member:____________________________________________________________________

Address:_________________________________________________________________________________

Street City State/Province Postal Code Country

Telephone:________________________________________________________________________________

Country Code (if not U.S. phone number) Area Code/Phone No. (Ext. if applicable)

Email address:____________________________________________________________________________

United States Social Security Number of Class Member: ___________ - __________ -___________

I understand that by opting out, I will not be eligible to receive any monetary or other relief provided pursuant to the Settlement Agreement of this lawsuit. I further understand that by opting out, I retain whatever right that I might have to assert my own claim against the defendants named in the lawsuit relating to the subject matter of the complaint that has been filed in the lawsuit.

If you wish to opt out of this Class Action, please check the box below:

 By checking this box, I affirm that I wish to be excluded

from the Class and Settlement Agreement.

__________ _________________________________________________

Date Signed Signature of Class Member, or Executor, Administrator

or Personal Representative of Class Member

To be effective as an election to opt-out of the Settlement of this Class Action, this Opt-Out Form must be completed in full, signed and sent by regular mail, postmarked, or delivered by hand, no later than [INSERT DATE], to the address listed below.

The consequences of returning this Form are explained in the Notice of Proposed Class Action Settlement.

If you choose to opt out, you must mail this Opt-Out Form to Class Counsel at the following address, in an envelope postmarked NO LATER THAN [INSERT DATE] or deliver the Form by hand to Class Counsel at the following address postmarked NO LATER THAN [INSERT DATE]:

KELLEY DRYE & WARREN LLP

Attn: Greenberg Lawsuit Opt-Out

3050 K Street, N.W., Suite 400

Washington, DC 20007-5108 USA

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