FIRST CHOICE ZYLON VEST CLAIM FORM

FIRST CHOICE ZYLON VEST CLAIM FORM [EFFECTIVE ONLY FOR CLAIMS FILED ON OR AFTER AUGUST 17, 2007] TO RECEIVE SETTLEMENT BENEFITS INCLUDING A CASH REFUND OR REPLACEMENT VEST(S), YOU MUST COMPLETE THIS FORM OR COMPLETE A CLAIM FROM ONLINE. PLEASE READ THIS FORM CAREFULLY. IT AFFECTS YOUR LEGAL RIGHTS. IT ALSO PROVIDES DEADLINES THAT YOU MUST MEET. If you purchased (in part or in whole), used or use a First Choice Armor & Equipment vest containing Zylon®, including any of the models listed in section IV below, you are a Class member and entitled to receive settlement benefits. Class members who, subsequent to August 24, 2005 but prior to March 30, 2007, received a vest(s) from First Choice to replace their First Choice Zylon® vest(s), please complete the information below in Section I or Section 2 (Section I if individual, Section 2 if agency) then go directly to Section V. All other Class members, if you want to PARTICIPATE in the Settlement and receive a cash refund or free replacement vest(s), you must complete a Claim Form. You may complete and submit a Claim Form ONLINE at www.firstchoiceclassaction.com by December 13, 2007 OR complete this paper Claim Form and MAIL or FAX it to the Claims Administrator by December 13, 2007 addressed or faxed to: First Choice Zylon Vest Class Action Claims Administrator P.O. Box 4230 Portland, OR 97208-4230 Telephone: 1(800) 469-1248 / Facsimile: (503) 820-3002 SECTION I. Individual Purchasers - Complete Sections I and III and sign and date the top of page 5. Please also complete Section IV if you elect the replacement option instead of cash. If you are a department, agency, etc. that purchased multiple vests, skip this section and go to the next page. Name: First Position or Title: Address1: Address2: City: State: Zip: Last Agency Name: NO PO BOXES - Requires a FedEx shipping address. Work Phone: _______- ________-_____________ Extension: ___________ Best time to call: G Morning G Afternoon G Evening G Prefer email G Tuesday G Wednesday G Thursday G Friday G Saturday Home or Cell Phone: ________-________-__________ Best Days to Call (Check all that apply): E-mail Address: G Monday Please provide the name and contact information (or as much of the contact information as you know) for the Distributor or Representative from whom you purchased your vest(s). If you purchased your vest directly from First Choice, please indicate "Direct from First Choice" in the “Name” field below: Name City: Form H8051 v.0.13 Phone # State: Claim Form 1 of 6 Zip: SECTION II. Departments, Agencies, Organizations, Etc. (For example: state, city, county, municipal police departments, security company, etc.) Please complete this Section, Section III and date and sign one copy of page 5. Please also complete Section IV if you elect the replacement option instead of the cash option. Please make additional copies of Section IV as needed. Copies are also available for download at www.firstchoiceclassaction.com. Agency Name: Address1: Address2: City: State: Zip: Contact Person: First Name Last Name Position or Title: Phone: _______- ________-_____________ Extension: ___________ Best time to call: G Morning G Afternoon G Evening G Prefer email Best Days to Call (Check all that apply): G Monday G Tuesday G Wednesday G Thursday G Friday G Saturday E-mail Address: Number of Vests Purchased: Your check or replacement vest(s), depending on which option you select on the next page, will be delivered to the address listed above. If your check or replacement vest(s) should not be delivered to the agency address above, please provide the address where your check or replacement vest(s) should be delivered - NO PO BOXES, requires a physical street address: Address: City: State: Zip: Please provide the name and contact information (or as much of the contact information as you know) for the Distributor or Representative from whom you purchased your vest(s). If you purchased your vest directly from First Choice, please indicate “Direct from First Choice”: Name: Phone # Address: City: State: Zip: Form H8052 v.0.13 Claim Form 2 of 6 SECTION III. To Participate in the Settlement and Receive Benefits - You Must Complete This Section PLEASE SELECT ONE OF THE FOLLOWING THREE OPTIONS (If you have multiple Zylon® vests and would like to receive cash for some of the vests and replacement vests for others, you may check more than one box. Next to the selected boxes please write the number of vests you have that you would like applied to each option): OPTION 1: G CASH OPTION 2: OPTION 3: G REPLACEMENT VEST TO BE DELIVERED AS SOON AS POSSIBLE G REPLACEMENT VEST TO BE DELIVERED IN THE FUTURE (until February 28, 2010). PLEASE COMPLETE THE INFORMATION BELOW CORRESPONDING TO THE OPTION(S) YOU SELECT. PLEASE SPECIFY HOW MANY OF YOUR ORIGINAL ZYLON VESTS YOU HAVE TO RETURN UPON RECEIPT OF YOUR BENEFITS AND A PREPAID BOX FROM FIRST CHOICE. _______________ [ENTER NUMBER HERE] OPTION 1 - This cash option provides a 100%, 80% or 60% refund depending on the date of purchase. Class members making this election please note the certification on the top of page five regarding the use of your cash refund. CLASS MEMBERS ELECTING THIS OPTION MUST HAVE THEIR ORIGINAL ZYLON VEST TO RETURN UPON RECEIVING THEIR MONEY AND A PREPAID BOX FOR ITS RETURN. IF YOU DO NOT HAVE YOUR ZYLON VEST TO RETURN YOU MAY ONLY SELECT OPTION 2 OR OPTION 3 BELOW. Please check one of the following two boxes. G The receipt, cancelled check, credit card receipt, sale or purchase invoice or other document showing the purchase price paid for the your vest(s) is enclosed; OR G I/our department or organization does not have a receipt, cancelled check, credit card receipt, sale or purchase invoice. Note: The Claims Administrator has sales records for many First Choice Zylon® vests and may be able to confirm the price paid for your vest(s) from the serial number(s) on your vest(s) and your contact information above. If you do not have proof of purchase you may call to see if the Claims Administrator has a record of your vest sale. Please have the serial number on your ballistic panel available when you call. If you purchased multiple vests and do not have proof of purchase, please write in the serial numbers for each of the vests purchased in the space below or attach a listing of serial numbers with this form. If neither you nor the Claims Administrator has a sales record, you may still select OPTION 2 or OPTION 3 below. Serial Number of vest(s) and date of purchase (Month/Year) - [IF YOU NEED MORE SPACE THAN BELOW, YOU MAY ATTACH A SEPARATE PAGE, SPREADSHEET, INVOICE, ETC. WITH ALL SERIAL NUMBERS] OPTION 2 - Please check one of the following four boxes and complete Section IV on the next page: G I have a First Choice level IIA or level II vest containing Zylon® and select a Synergy level II replacement Note: All Class members who purchased a level IIA Zylon® vest will be upgraded to level II vests at no cost. No IIA vest will be provided under this Settlement. G I have a First Choice level IIIA vest containing Zylon® and select a Synergy level IIIA replacement. G If you or your agency purchases from the Colorado Body Armor Qualified Products List please check this selection if you would like to receive a First Choice ICC 526C level IIIA replacement rather than the Synergy level IIIA replacement. G My organization or department has special requirements such that the Synergy vest is not an authorized or proper replacement vest. If this is applicable to you, please write the name of the First Choice replacement vest you would like to receive and the Claims Administrator will contact you. OPTION 3 Please complete this section and the information in Section IV on the next page: If you have already replaced your First Choice Zylon® vest with a vest from another manufacturer and thus, do not have a need for a vest right now, you may elect to have a First Choice Replacement Vest delivered in the future for up to thirty six months after final approval of this Settlement or February 28, 2010, whichever is later. The Final Approval Hearing is scheduled for August 13, 2007. If you elect to receive a replacement vest delivered in the future, please write the requested date of future delivery here: , 20 . G I have a First Choice level IIA or level II vest containing Zylon® and select a Synergy level II replacement Note: All Class members who purchased a level IIA Zylon® vest will be upgraded to level II vests at no cost. No IIA vest will be provided under this Settlement. G I have a First Choice level IIIA vest containing Zylon® and select a Synergy level IIIA replacement. G If you or your agency purchases from the Colorado Body Armor Qualified Products List please check this selection if you would like to receive a First Choice ICC 526C level IIIA replacement rather than the Synergy level IIIA replacement. G My organization or department has special requirements such that the Synergy vest is not an authorized or proper replacement vest. If this is applicable to you, please write the name of the First Choice replacement vest you would like to receive and the Claims Administrator will contact you. Form H8053 v.0.13 Claim Form 3 of 6 SECTION IV. PLEASE COMPLETE THIS SECTION ONLY IF YOU ARE REQUESTING A REPLACEMENT VEST(S) UNDER OPTION 2 OR OPTION 3. YOU MUST COMPLETE THIS INFORMATION FOR EACH REPLACEMENT VEST REQUESTED OR YOU MAY CONTACT THE CLAIMS ADMINISTRATOR AT THE TOLL FREE NUMBER BELOW FOR ASSISTANCE WITH PROCESSING MULTIPLE CLAIMS. PLEASE MAKE ADDITIONAL COPIES OF THIS PAGE AS NEEDED. EXTRA COPIES MAY ALSO BE DOWNLOADED AT www.firstchoiceclassaction.com. First Name of Vest User: G Male G Female G Tactical G Corrections G Executive Last Name of Vest User: G Concealable G Other Model of your Zylon® vest: (Please select the vest you purchased) Level IIA G MSF1-IIA G MSF1REV2A G Other G MF46 G MF123 G MF123C G MF465 G MF472 G MF713 Level II G MSF1-II G MF1113 G MF2000 G MP201 G MP201C G MFF143C G MSFFII G MFF374 G MFREVII G MFREV1433 G MFF143-II G Other Level IIIA G MSF1-IIIA G MSF1REV3A G MF261 G MF733 G MF1234 G Other Date of purchase of you Zylon®-containing vest: Month / Year SERIAL NUMBER FRONT PANEL SIZE BACK PANEL: G If you would like a replacement vest(s) in a different size than the vest(s) you originally purchased, please check the box here and someone will contact you about sizing information. Yes G No G Were your Zylon® ballistic panels modified or repaired at the factory after your purchase? If yes, and if you are satisfied with the modification or repair to the fit of your vest, please trace an outline of the panel(s) and include the tracing with this Claim Form. Please also write the serial number of your original vest on the tracing you send. Please indicate your preference for the carrier color for your Replacement Vest(s): (Please choose one of the following): G Navy G White G Black G Tan Form H8054 v.0.13 Claim Form 4 of 6 SIGNATURE & CERTIFICATION [TO RECEIVE A CASH REFUND OR REPLACEMENT VEST THIS SIGNATURE AND CERTIFICATION MUST BE COMPLETED BY THE CLASS MEMBER OR HIS, HER OR ITS AUTHORIZED REPRESENTATIVE] ALL CLASS MEMBERS MUST PRINT AND SIGN YOUR NAME AND ENTER THE DATE. BY SIGNING THIS CLAIM FORM CLASS MEMBERS ELECTING THE CASH OPTION CERTIFY UNDER PENALTY OF PERJURY THAT THEY STILL HAVE THEIR FIRST CHOICE ZYLON VEST AND WILL RETURN IT PROMPTLY UPON RECEIVING THEIR MONEY AND A PREPAID BOX FOR ITS RETURN. CLASS MEMBERS ELECTING THE CASH OPTION FURTHER CERTIFY THAT THE MONEY YOU WILL RECEIVE WILL BE USED FOR THE PURCHASE OF PROTECTIVE EQUIPMENT OR FOR THE REIMBURSEMENT OF THE PRIOR PURCHASE OF PROTECTIVE EQUIPMENT, OR THAT YOU ARE NO LONGER EMPLOYED IN LAW ENFORCEMENT, SECURITY OR THE POSITION YOU PREVIOUSLY HELD. Print Name Signature Date SECTION V - Class Members Who Have Already Received A Replacement Vest G Class members who, subsequent to August 24, 2005 but prior to March 30, 2007, received a vest(s) from First Choice to replace their First Choice Zylon® vest(s), will be deemed to have already received the benefits set forth in Options 1 through 3 above so long as the replacement vest(s) received is of at least the same or higher threat level as the Class member's original vest and so long as any charges for the replacement vest(s) and associated carriers have been fully refunded. If you paid First Choice any money to replace your First Choice Zylon® vest or for an associated carrier and have not received a full refund of the money you paid, please check the box at the beginning of this paragraph and make certain you have also completed Section I or Section II of this Claim Form (Section I for individuals, Section II for agencies). You do not need to complete the remainder of the Claim Form. The Claims Administrator will process your claim for reimbursement. If you have already received a replacement vest from First Choice and have already received a refund of any money you paid to receive the replacement vest and associated carrier, you do not need to complete a Claim Form but may object or exclude yourself from the Settlement. To object to the Settlement, see Section VI below. To be excluded from the Settlement, see Section VII below. SECTION VI - To Object to the Supplemental Relief Program or the Settlement If you wish to OBJECT to the Settlement, to the application by Plaintiffs' Counsel for an award of attorneys' fees and expenses or to the application for named plaintiff stipends, then you must state your objection in writing, follow the detailed instructions in Section 7 of the attached notice and mail the objection, postmarked on or before August 1, 2007 to: Office of Clerk of Court United States District Court 1 Courthouse Way, Suite 2300 Boston, Massachusetts 02210 AND PROVIDE A COPY TO David M. Cohen, Esq. Carr & Palmer, LLP 10 North Parkway Square 4200 Northside Parkway, NW Atlanta, Georgia 30327 SECTION VII - To Exclude Yourself From the Settlement If you purchased, used or use a Zylon®-containing vest manufactured by First Choice and you wish to EXCLUDE yourself from the Settlement, you must complete the Request for Exclusion on the next page and mail it by August 1, 2007 to: First Choice Zylon Vest Class Action Claims Administrator P.O. box 4230 Portland, Oregon 97208-4230 AND PROVIDE A COPY TO David M. Cohen, Esq. Carr & Palmer, LLP 10 North Parkway Square 4200 Northside Parkway, NW Atlanta, Georgia 30327 Fax: (404) 442-9700 For Additional Information For additional information or questions you may contact the Claims Administrator toll-free by calling 1 (800) 469-1248, or visit www.firstchoiceclassaction.com If you have any problems participating in the Settlement, or receiving your benefits, you may also contact one of the Plaintiffs' Counsel David M. Cohen, Esq. at the address above or by telephone at (404) 442-9000 x 116. Form H8055 v.0.13 Claim Form 5 of 6 REQUEST FOR EXCLUSION DO NOT SIGN THIS PAGE IF YOU WANT TO RECEIVE A CASH REFUND OR REPLACEMENT VEST(S) FROM THE SETTLEMENT If you purchased, used or use of a Zylon®-containing vest manufactured by First Choice Armor & Equipment, Inc. and do NOT want to participate in this Settlement and do not want to receive a cash refund or a replacement vest, complete this portion of this Claim Form. G G I/our agency does NOT want to participate in the Settlement. I/our agency have never purchased or used a First Choice Armor & Equipment vest(s) that contains Zylon®. I/my agency understand(s) that I/it may be a member of a Class of persons who purchased, used or use First Choice Armor & Equipment, Inc. vests containing Zylon®. I understand that certain legal claims have been asserted on behalf of the Class and that I/my agency may choose to be excluded from the Class. I have read this First Choice Armor & Equipment, Inc. Notice of Class Action, Proposed Settlement and Hearing and Claim Form. I am sufficiently advised of my rights to remain a Class member and to be bound by any judgment rendered therein. I do NOT wish to be a Class member. By opting out, I am excluding myself/my agency from the binding effect of judgment and from all benefits available to members of the Class, including cash refunds or new vests. I also realize that if I exclude myself/my agency from the Class by opting-out and subsequently choosing to bring an independent action, I will be responsible for choosing and compensating my own attorney(s) and that the statute of limitations for bringing claims set forth in this litigation will continue to run again from the date of my request for exclusion. I understand that this REQUEST FOR EXCLUSION must be completed and returned by first class mail, postmarked on or before AUGUST 1, 2007. IF YOU WANT TO RECEIVE A CASH REFUND OR A REPLACEMENT VEST(S) FROM THE SETTLEMENT DO NOT COMPLETE THIS SECTION YOU MUST PRINT AND SIGN YOUR NAME, ENTER THE DATE, YOUR TELEPHONE NUMBER AND THE NUMBER OF VESTS PURCHASED, OR INDICATE NONE. Print Name Signature Date Telephone No. Number of First Choice Armor & Equipment, Inc. Zylon® containing vests purchased. Form H8056 v.0.13 Claim Form 6 of 6