Register as a class member

I hereby register as a class member in the class action set out below. I confirm that I have a proper interest in the matter as identified in this form.

Submission of this form constitutes confirmation that I wish to maintain the claim and that I agree to the terms and conditions of Class Justice.

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Full Name (Given, Middle, Surname)

First

Middle

Last

Email Address

Phone

Class ActionFirst ChoiceSecond ChoiceThird Choice

Association to ClassCustomer / ConsumerPatientPolicyholder (insurance)InvestorShareholderBorrower (loan / finance)Tenant (rental / housing)Employee / Former employeeContractor / SubcontractorSupplier / VendorFranchiseeLicenseeResident (affected by environment / location)Family member / RelativeOther

Description of 'Other'

Account, invoice, reference, employee or other identification number

Consent to Terms and Conditions

• I agree to the Terms and Conditions as set out at classjustice.com.au/terms-conditions.

Consent to Waiver

• I consent to the Waiver as set out at classjustice.com.au/waiver.

Consent to Management Agreement

• I consent to the Management Agreement as set out at classjustice.com.au/management-agreement.

Consent to Privacy Policy

• I consent to the Privacy Policy as set out at classjustice.com.au/privacy-policy.

Important Information

• I have read the Important Information set out at classjustice.com.au/important-information and acknowledge the same.

Other Relevant Information

Register for Class Action