Aegean Securities Litigation

CLAIMANT INFORMATION


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.



1If the account number is unknown, you may leave blank. If filing for more than one account for the same legal entity, 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.


PART III – SCHEDULE OF TRANSACTIONS IN AEGEAN SECURITIES


Complete this Part III if, and only if, you purchased or otherwise acquired Aegean Securities (or sold Aegean put options) during the Settlement Class Period. Please include proper documentation with your Claim Form as described in detail in Part II – General Instructions, Paragraph 10, above. Do not include information in this section regarding securities other than the following Aegean Securities: (i) Aegean Common Stock; (ii) Aegean 4.00% Convertible Unsecured Senior Notes (the “4.00% Notes”) (CUSIP: Y0020QAA9); (iii) Aegean 4.25% Convertible Unsecured Senior Notes (the “4.25% Notes”) (CUSIPs: 00773VAB2, 00773VAA4 (prior to February 12, 2018)); and/or (iv) purchased call option contracts or sold put option contracts on Aegean Common Stock (collectively referred to as the “Aegean Securities”) within the Settlement Class Period.


1. HOLDINGS OF AEGEAN COMMON STOCK AS OF FEBRUARY 26, 2014 – State the total number of shares of Aegean common stock (Tickers: ANW, ANWWQ) currently held as of the close of trading on February 26, 2014. (Must be documented.)
If none, enter "0."


2. PURCHASES/ACQUISITIONS OF AEGEAN COMMON STOCK FROM FEBRUARY 27, 2014 THROUGH FEBRUARY 4, 2019 – Separately list each and every purchase/acquisition of Aegean common stock (Tickers: ANW, ANWWQ) made from after the opening of trading on February 27, 2014, through and including the close of trading on February 4, 2019. (Must be documented.)



Must click Add Purchase to submit your transactions.


Date of Purchase/ Acquisition (List Chronologically) (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 OF AEGEAN COMMON STOCK FROM FEBRUARY 27, 2014 THROUGH FEBRUARY 4, 2019 – Separately list each and every sale/disposition of Aegean common stock (Tickers: ANW, ANWWQ) that were purchased or otherwise acquired from after the opening of trading on February 27, 2014, through and including the close of trading on February 4, 2019. (Must be documented.)



Must click Add Sale to submit your transactions.


Date of Sale (List Chronologically) (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. HOLDINGS OF AEGAN COMMON STOCK AS OF FEBRUARY 4, 2019 – State the total number of shares of Aegean common stock (Tickers: ANW, ANWWQ) currently held as of the close of trading on February 4, 2019. (Must be documented.)
If none, enter "0."




SCHEDULE OF TRANSACTIONS IN AEGEAN 4.00% NOTES


5. HOLDINGS OF AEGEAN 4.00% NOTES AS OF FEBRUARY 26, 2014 – State the total number of $100 par Aegean 4.00% Notes (CUSIP: Y0020QAA9) currently held as of the close of trading on February 26, 2014. (Must be documented.)
If none, enter "0."


6. PURCHASES/ACQUISITIONS OF AEGEAN 4.00% NOTES FROM FEBRUARY 27, 2014 THROUGH FEBRUARY 4, 2019 – Separately list each and every purchase/acquisition of Aegean $100 par 4.00% Notes (CUSIP: Y0020QAA9)) made from after the opening of trading on February 27, 2014, through and including the close of trading on February 4, 2019. (Must be documented.)



Must click Add Purchase to submit your transactions.


Date of Purchase/ Acquisition (List Chronologically) (Month/Day/Year) Number of 100 Par Notes Purchased/ Acquired Purchase/Acquisition Price Per Note Total Purchase/Acquisition Price (excluding taxes, commissions, and fees) Confirm Proof of Purchase Enclosed Action



7. SALES OF AEGEAN 4.00% NOTES FROM FEBRUARY 27, 2014 THROUGH FEBRUARY 4, 2019 – Separately list each and every sale/disposition of $100 par Aegean 4.00% Notes (CUSIP: Y0020QAA9) that were purchased or otherwise acquired from after the opening of trading on February 27, 2014, through and including the close of trading on February 4, 2019.



Must click Add Sale to submit your transactions.


Date of Sale (List Chronologically) (Month/Day/Year) Number of Notes Sold Sale Price Per Note Total Sale Price (excluding taxes, commissions, and fees) Confirm Proof of Sale Enclosed Action



8. HOLDINGS OF AEGEAN 4.00% NOTES AS OF FEBRUARY 4, 2019 – State the total number of $100 par Aegean 4.00% Notes (CUSIP: Y0020QAA9) currently held as of the close of trading on February 4, 2019. (Must be documented.)
If none, enter "0."




SCHEDULE OF TRANSACTIONS IN AEGEAN 4.25% NOTES


9. HOLDINGS OF AEGEAN 4.25% NOTES AS OF FEBRUARY 26, 2014 – State the total number of $100 par Aegean 4.25% Notes (CUSIPs: 00773VAB2, 00773VAA4 (prior to February 12, 2018)) currently held as of the close of trading on February 26, 2014. (Must be documented.)
If none, enter "0."


10. PURCHASES/ACQUISITIONS OF AEGEAN 4.25% NOTES FROM FEBRUARY 27, 2014 THROUGH FEBRUARY 4, 2019 – Separately list each and every purchase/acquisition of Aegean $100 par 4.25% Notes (CUSIPs: 00773VAB2, 00773VAA4 (prior to February 12, 2018)) made from after the opening of trading on February 27, 2014, through and including the close of trading on February 4, 2019. (Must be documented.)



Must click Add Purchase to submit your transactions.


Date of Purchase/ Acquisition (List Chronologically) (Month/Day/Year) Number of 100 Par Notes Purchased/ Acquired Purchase/Acquisition Price Per Note Total Purchase/Acquisition Price (excluding taxes, commissions, and fees) Confirm Proof of Purchase Enclosed Action



11. SALES OF AEGEAN 4.25% NOTES FROM FEBRUARY 27, 2014 THROUGH FEBRUARY 4, 2019 – Separately list each and every sale/disposition of $100 par Aegean 4.25% Notes (CUSIPs: 00773VAB2, 00773VAA4 (prior to February 12, 2018)) that were purchased or otherwise acquired from after the opening of trading on February 27, 2014, through and including the close of trading on February 4, 2019.



Must click Add Sale to submit your transactions.


Date of Sale (List Chronologically) (Month/Day/Year) Number of Notes Sold Sale Price Per Note Total Sale Price (excluding taxes, commissions, and fees) Confirm Proof of Sale Enclosed Action



12. HOLDINGS OF AEGEAN 4.25% NOTES AS OF FEBRUARY 4, 2019 – State the total number of $100 par Aegean 4.25% Notes (CUSIPs: 00773VAB2, 00773VAA4 (prior to February 12, 2018)) currently held as of the close of trading on February 4, 2019. (Must be documented.)
If none, enter "0."




SCHEDULE OF TRANSACTIONS IN AEGEAN CALL OPTIONS


13. HOLDINGS OF CALL OPTION CONTRACTS ON AEGEAN COMMON STOCK – Separately list each Aegean Call Option held as of the close of trading on February 26, 2014. (Must be documented.) If none, enter "0."


Must click Add to submit your transactions.


Strike Price of Call Option Contract Expiration Date of Call Option Contract (Month/Day/Year) Number of Call Option Contracts in Which You Had an Open Interest (including any short holdings) Confirm Proof of Purchase Enclosed Action

14. PURCHASES/ACQUISITIONS OF AEGEAN CALL OPTION CONTRACTS – Separately list each and every purchase/acquisition (including free receipts) of Aegean Call Option contracts from after the opening of trading on February 27, 2014, through and including the expiration date of any Aegean Call Option contracts that you held long as of the close of trading on February 4, 2019. (Must be documented.)



Must click Add Purchase to submit your transactions.


Date of Purchase/ Acquisition (List Chronologically) (Month/Day/Year) Strike Price of Call Option Contract Expiration Date of Call Option Contract (Month/Day/ Year) Number of Call Option Contracts Purchased/ Acquired Purchase/ Acquisition Price Per Call Option Contract Total Purchase/ Acquisition Price (excluding taxes, commissions, and fees) Insert an “E” if Exercised Insert an “A” if Assigned Insert an “X” if Expired Exercise Date (Month/ Day/ Year) Confirm Proof of Purchase Enclosed Action




15. SALES OF AEGEAN CALL OPTION CONTRACTS – Separately list each and every sale/disposition (including free deliveries) of Aegean Call Option contracts from after the opening of trading on February 27, 2014, through and including the expiration date of any Aegean Call Option contracts that you held long as of the close of trading on February 4, 2019. (Must be documented.)



Must click Add Sale to submit your transactions.


Date of Sale (List Chronologically) (Month/Day/Year) Strike Price of Call Option Contract Expiration Date of Call Option Contract (Month/Day/Year) Number of Call Option Contracts Sold Sale Price Per Call Option Contract “E” if Exercised “X” if Expired Total Sale Price (excluding taxes, commissions, and fees) Confirm Proof of Purchase Enclosed Action




16. ENDING HOLDINGS OF AEGEAN CALL OPTION CONTRACTS – Separately list each Aegean Call Option held as of the close of trading on February 4, 2019. (Must be documented.)


Must click Add to submit your transactions.


Strike Price of Call Option Contract Expiration Date of Call Option Contract (Month/Day/Year) Number of Call Option Contracts in Which You Had an Open Interest (including any short holdings) Confirm Proof Enclosed Action



SCHEDULE OF TRANSACTIONS IN AEGEAN PUT OPTIONS


17. HOLDINGS OF PUT OPTION CONTRACTS ON AEGEAN COMMON STOCK – Separately list each Aegean Put Option held as of the close of trading on February 26, 2014. (Must be documented.)


Must click Add to submit your transactions.


Strike Price of Put Option Contract Expiration Date of Put Option Contract (Month/Day/Year) Number of Put Option Contracts in Which You Had an Open Interest (including any short holdings) Confirm Proof Enclosed Action

B. SALES (WRITING) OF AEGEAN PUT OPTIONS – Separately list each and every sale (writing) (including free deliveries) of Aegean Put Option contracts from after opening of trading on February 27, 2014, through and including the expiration date of Aegean Put Option contracts that you held a short position in as of the close of trading on February 4, 2019. (Must be documented.)



Must click Add Sale to submit your transactions.


Date of Sale(Writing) (List Chronologically) (Month/Day/Year) Strike Price of Put Option Contract Expiration Date of Put Option Contract (Month/Day/Year) Number of Put Option Contracts Sold(Written) Sale Price Per Put Option Contract Total Sale Price (excluding taxes, commissions, and fees) Insert an “A” if Assigned Insert an “X” if Expired Exercise Date (Month/ Day/ Year) Confirm Proof of Purchase Enclosed Action




C. PURCHASES/ACQUISITIONS OF AEGEAN PUT OPTIONS – Separately list each and every purchase/acquisition (including free receipts) of Aegean Put Option contracts from after opening of trading on February 27, 2014, through and including the expiration date of any Aegean Put Option contracts that you held a short position in as of the close of trading on February 4, 2019. (Must be documented.)



Must click Add Purchase to submit your transactions.


Date of Purchase/ Acquisition (List Chronologically) (Month/Day/Year) Strike Price of Put Option Contract Expiration Date of Put Option Contract (Month/Day/ Year) Number of Put Option Contracts Purchased/ Acquired Purchase/ Acquisition Price Per Put Option Contract Insert an “A” if Assigned Insert an “X” if Expired Total Purchase/ Acquisition Price (excluding taxes, commissions, and fees) Confirm Proof Enclosed Action



D. ENDING HOLDINGS – Separately list all positions Aegean Put Option contracts that you had a short position in as of the close of trading on February 4, 2019, in which you had an open interest as of the expiration date. (Must be documented.)


Must click Add Closing Holdings Info to submit your transactions.


Strike Price of Put Option Contract Expiration Date of Put Option Contract (Month/Day/Year) Number of Put Option Contracts in Which You Had an Open Interest (including any short holdings) Confirm Proof Enclosed Action



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

PART VI – 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 PwC Greece Partial Settlement, pursuant to the terms set forth in the PwC Greece Stipulation, I (we), on behalf of myself (ourselves) and my (our) heirs, executors, administrators, predecessors, successors, affiliates and assigns, in their capacities as such, shall be deemed to have, and by operation of law and of the Order and Final Judgment with Prejudice Regarding PwC Greece shall have, fully, finally and forever released, relinquished and discharged all PwC Released Claims (as defined in the PwC Greece Stipulation and in the Notice) against PwC Greece, PricewaterhouseCoopers International Limited, PricewaterhouseCoopers LLP and the other PwC Released Parties (as defined in the PwC Greece Stipulation and in the Notice), whether served or unserved with any complaint in the Action, and shall have covenanted not to sue the PwC Released Parties with respect to any such PwC Released Claims, and shall be permanently barred and enjoined from asserting, commencing, prosecuting, instituting, assisting, instigating or in any way participating in the commencement or prosecution of any action or other proceeding, in any forum, asserting any PwC Released Claims, either directly, representatively, derivatively or in any other capacity, against any of the PwC Released Parties.

I (we) hereby acknowledge that, as of the Effective Date of the Deloitte Greece Partial Settlement, pursuant to the terms set forth in the Deloitte Greece Stipulation, I (we), on behalf of myself (ourselves) and my (our) heirs, executors, administrators, predecessors, successors, affiliates and assigns, in their capacities as such, shall be deemed to have, and by operation of law and of the Order and Final Judgment with Prejudice Regarding Deloitte Greece shall have, fully, finally and forever released, relinquished and discharged all Deloitte Released Claims (as defined in the Deloitte Greece Stipulation and in the Notice) against Deloitte Greece, Deloitte Touche Tohmatsu Limited, Deloitte & Touche LLP and the other Deloitte Released Parties (as defined in the Deloitte Greece Stipulation and in the Notice), whether served or unserved with any complaint in the Action, and shall have covenanted not to sue the Deloitte Released Parties with respect to any such Deloitte Released Claims, and shall be permanently barred and enjoined from asserting, commencing, prosecuting, instituting, assisting, instigating or in any way participating in the commencement or prosecution of any action or other proceeding, in any forum, asserting any Deloitte Released Claims, either directly, representatively, derivatively or in any other capacity, against any of the Deloitte Released Parties.


CERTIFICATION

By signing and submitting this Claim Form, the Claimant(s) or the person(s) who represent(s) the Claimant(s) certifies (certify), as follows:

1. that I (we) have read and understand the contents of the Notice and this Claim Form, including the releases provided for in the Settlement and the terms of the PwC Greece Plan of Allocation and the Deloitte Greece Plan of Allocation;

2. that the Claimant(s) is a (are) Settlement Class Member(s), as defined in the Notice and in paragraph 2 on page 3 of this Claim Form, and is (are) not excluded from the Settlement Class by definition or pursuant to request as set forth in the Notice and in paragraph 3 on page 3 of this Claim Form;

3. that I (we) own(ed) Aegean Securities and have not assigned the claim against either of the Settling Defendants, PricewaterhouseCoopers International Limited, PricewaterhouseCoopers LLP, Deloitte Touche Tohmatsu Limited, Deloitte & Touche LLP, or the other PwC Released Parties or the Deloitte Released Parties 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 Aegean Securities 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 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.