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.
2If 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.
PART III – SCHEDULE OF TRANSACTIONS IN MULLEN COMMON STOCK
Complete this Part III if and only if you purchased/acquired Mullen Common Stock during the period from June 15, 2020 through April 17, 2022, inclusive. 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 Mullen Common Stock.5
1. BEGINNING HOLDINGS – State the total number of shares of Mullen Common Stock held as of the opening of trading on June 15, 2020. (Must be documented.) If none, write “zero” or “0.” *
2. PURCHASES/ACQUISITIONS DURING THE SETTLEMENT CLASS PERIOD
– Separately list each and every purchase/acquisition (including free receipts) of Mullen Common Stock from after the opening of trading on June 15, 2020, through and including the close of trading on April 17, 2022. (Must be documented.)
Trade Date
|
Ticker Symbol
(NETE or MULN)
|
Quantity
|
Price
|
Net Amount
|
Issue Type
|
Proof of Purchase Enclosed
|
Action |
3. PURCHASES/ACQUISITIONS DURING THE 90-DAY LOOKBACK PERIOD – State the total number of shares of Mullen Common Stock purchased/acquired (including free receipts) from after the opening of trading on April 18, 2022, through and including the close of trading on July 13, 2022. If none, write “zero” or “0.”
If none, enter "0."6
4. SALES DURING THE SETTLEMENT CLASS PERIOD AND DURING THE 90-DAY LOOKBACK PERIOD
– Separately list each and every sale/disposition (including free deliveries) of Mullen Common Stock from after the opening of trading on June 15, 2020, through and including the close of trading on July 13, 2022. (Must be documented.)
Trade Date
|
Ticker Symbol
|
Quantity
|
Price
|
Net Amount
|
Confirm Proof
of Sale Enclosed
|
Action |
5. ENDING HOLDINGS
– State the total number of shares of Mullen Common Stock held as of the close of trading on July 13, 2022. (Must be documented.) If none, write “zero” or “0.” *
5Herein, “Mullen Common Stock” refers to: (i) the common stock of Net Element Inc., listed on the NASDAQ under the symbol “NETE” through November 4, 2021;
and (ii) the common stock of Mullen Automotive Inc., that commenced trading on the NASDAQ on November 5, 2021, under the ticker symbol “MULN” following the merger of
Mullen Tech and Net Element.
6Please note: Information requested with respect to your purchases/acquisitions of Mullen Common Stock from after the opening of trading on April
18, 2022, through and including the close of trading on July 13, 2022, 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.
PART IV– SCHEDULE OF TRANSACTIONS IN MULLEN CALL OPTIONS
Complete this Part IV if and only if you purchased/acquired Mullen Call Options during the period from June 15, 2020 through April 17, 2022, inclusive. 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 Mullen Call Options.7
1. BEGINNING HOLDINGS – Separately list all positions in Mullen Call Option contracts in which you had an open interest as of the opening of trading on June 15, 2020. (Must be documented.)
Strike Price
|
Expiration Date
|
Quantity
|
Confirm Proof of Purchase Enclosed
|
Action |
2. PURCHASES/ACQUISITIONS DURING THE SETTLEMENT CLASS PERIOD THROUGH APRIL 18, 2022
– Separately list each and every purchase/acquisition (including free receipts) of Mullen Call Option contracts from after the opening of trading on June 15, 2020 through and including the close of trading on April 18, 2022. (Must be documented.)
Trade Date
|
Expiration Date
|
Strike Price
|
Trade Status
|
Status Date
|
Quantity
|
Price
|
Net Amount
|
Proof of Purchase Enclosed
|
Action |
3. SALES DURING THE SETTLEMENT CLASS PERIOD THROUGH APRIL 18, 2022
– Separately list each and every sale/disposition (including free deliveries) of Mullen Call Options from after the opening of trading on June 15, 2020, through and including the close of trading on April 18, 2022. (Must be documented.)
Trade Date
|
Expiration Date
|
Strike Price
|
Quantity
|
Price
|
Net Amount
|
Proof of Purchase Enclosed
|
Action |
4. ENDING HOLDINGS – Separately list all positions in Mullen Call Option contracts in which you had an open interest as of the close of trading on April 18, 2022. (Must be documented.)
Strike Price
|
Expiration Date
|
Quantity
|
Confirm Proof Enclosed
|
Action |
7Herein, “Mullen Call Options” refers to: (i) exchange traded call options with Net Element common stock (ticker symbol “NETE”) as the underlying security through November 4, 2021; and (ii) exchange traded call options with Mullen Auto common stock (ticker symbol “MULN”) as the underlying security commencing November 5, 2021. On November 5, 2021, the option symbol for Mullen Call Options changed from “NETE” to “MULN.”
PART V – SCHEDULE OF TRANSACTIONS IN MULLEN PUT OPTIONS
Complete this Part V if and only if you sold (wrote) Mullen Put Options during the period from June 15, 2020 through April 17, 2022, inclusive. 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 Mullen Put Options.8
1. BEGINNING HOLDINGS – Separately list all positions in Mullen Put Option contracts in which you had an open interest as of the opening of trading on June 15, 2020. (Must be documented.)
Strike Price
|
Expiration Date
|
Quantity
|
Confirm Proof Enclosed
|
Action |
2. SALES (WRITING) DURING THE SETTLEMENT CLASS PERIOD THROUGH APRIL 18, 2022
– Separately list each and every sale (writing) (including free deliveries) of Mullen Put Option contracts from after the opening of trading on June 15, 2020, through and including the close of trading on April 18, 2022. (Must be documented.)
Trade Date
|
Strike Price
|
Expiration Date
|
Trade Status
|
Status Date
|
Quantity
|
Price
|
Net Amount
|
Proof of Purchase Enclosed
|
Action |
3. PURCHASES/ACQUISITIONS DURING THE SETTLEMENT CLASS PERIOD THROUGH APRIL 18, 2022
– Separately list each and every purchase/acquisition (including free receipts) of Mullen Put Option contracts from after the opening of trading on June 15, 2020, through and including the close of trading on April 18, 2022. (Must be documented.)
Trade Date
|
Strike Price
|
Expiration Date
|
Quantity
|
Price
|
Net Amount
|
Confirm Proof Enclosed
|
Action |
4. ENDING HOLDINGS – Separately list all positions in Mullen Put Option contracts in which you had an open interest as of the close of trading on April 18, 2022. (Must be documented.)
Strike Price
|
Expiration Date
|
Quantity
|
Confirm Proof Enclosed
|
Action |
8Herein, “Mullen Put Options” refers to: (i) exchange traded put options with Net Element common stock (ticker symbol “NETE”) as the underlying security through November 4, 2021; and (ii) exchange traded put options with Mullen Auto common stock (ticker symbol “MULN”) as the underlying security commencing November 5, 2021. On November 5, 2021, the option symbol for Mullen Put Options changed from “NETE” to “MULN.”
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
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Size
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Action
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PART VI – RELEASE OF CLAIMS AND SIGNATURE
YOU MUST ALSO READ THE RELEASE AND CERTIFICATION BELOW AND SIGN ON PAGE 10 OF 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 on behalf of any other Person legally entitled to bring Released Plaintiff’s 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, and discharged each and every Released Plaintiff’s Claim against the Defendants and the other Released
Defendants’ Parties (as defined in the Stipulation and in the Settlement Notice), and shall forever be barred and enjoined
from prosecuting, directly or indirectly, representatively, or in any other capacity, any or all of the Released Plaintiff’s
Claims against any of the Released Defendants’ Parties.
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 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 Settlement 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 Mullen Common Stock and Mullen Call Options and had an interest in the Mullen Put Options identified in the
Claim Form and have not assigned the claim against the Released Defendants’ 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) 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;
5. 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;
6. 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;
7. 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
8. 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/they is (are) 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/they is (are) no longer subject to backup withholding. If the IRS has notified the Claimant(s)
that he, she, it, or they is (are) 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.
If the claimant is other than an individual, or is not the person completing this form, the
following also must be provided: