Electronic Filing
To file your claim electronically, click the other tabs below for the proper format. Please follow the instructions belo instructions as noted in ¶8 on Instruction Page 2 of the Proof of Claim and Release. Instructions: 1. 2. 3. 4. Click on the Excel Efile Template tab below. Save the file on your computer. Open the file with Microsoft Excel and fill it in. Additionally, please follow the instructions in the Notice Packet.
Important Notes:
This format is used for Institutions, Brokers and Nominees only. This is not used for Individual potentia
PDF files are not accepted for electronic filing. Only a completed Excel Efile Template worksheet will b
Please fill out the Proof of Claim entirely and attach a list of account names you are filing on behalf. W you either mail the electronic data (CD) with the Proof of Claim to the address provided (no emails) or uplo FTP site. Please submit documents showing you have authority to file on behalf of your clients.
If you would like to mail the claim via courier, please use the address below. If you would like to upload your claim site, please contact us at (877) 567-4298 or by email to info@ChicagoBridgeSecuritiesSettlement.com and we will information to you. Chicago Bridge & Iron Co. Securities Litigation Settlement c/o Complete Claim Solutions, LLC, Claims Administrator 5210 Hood Road Palm Beach Gardens, FL 33418
Please follow the instructions below and the Efile se.
is not used for Individual potential claimants.
el Efile Template worksheet will be accepted.
ames you are filing on behalf. We do request that ess provided (no emails) or upload it to our secured behalf of your clients.
u would like to upload your claim to a secured FTP uritiesSettlement.com and we will provide that
Motorola Electronic Claim Format
Column Heading 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Last Name Beneficial Owner (Individual, Joint, or IRA accounts ONLY) First Name Beneficial Owner Last Name of Co-Owner, if applicable First Name of Co-Owner, if applicable Entity Name Representative Name Addr1 Addr2 City State Zip5 Zip4 Account # Tax Id # CUSIP Description Last name of Beneficial Owner - Individual or Joint Accounts only. If IRA and you want the check made out to IRA, use the following format: JONES IRA First name of Beneficial Owner Last Name of Co-Owner (if applicable) First name of Co-Owner Name of Company, Trust, Estate, etc. THIS COLUMN SHOULD NEVER BE POPULATED IF COLUMN 1 (Last Name Beneficial Owner - for Individual, Joint, or IRA accounts Only) IS POPULATED Representative Name, if applicable (e.g. executor, custodian, trustee, administrator, nominee,etc) Addr1 Addr2 City State Zip5 Zip4 Account Number Acct holders Tax Id or SSN Security Cusips - N19808109 and 167250109; ISIN: USN198081093 B = Beginning Balance as of 3/8/2005 (one record per acct per security code) P = Open Market Purchase from 3/9/2005 to 2/3/2006 PR = Free Receipt Transfer into this account from 3/9/2005 to 2/3/2006 P2 = Sum of all purchases from 2/4/2006 to 5/4/2006(one record per acct per security code) S = Open Market Sales from 3/9/2005 to 5/4/2006 SD = Free Delivery Transfer to another account from 3/9/2005 to 5/4/2006 U = Unsold Shares - Balance as of 5/4/2006 (one record per acct per security code). Common Stock = "CBI" Transaction Date Qty of shares for Common Stock Price per share for Common Stock Total Amount Paid for Purchases; Total Amount Received for Sales; leave blank for all others
16 Type
17 Security Code 18 Trade Date 19 Shares 20 Price/Share 21 Net Amount
> > > > > > >
Instructions: Columns 1 thru 4 are for Individual, Joint, or IRA accounts only Column 5 is for Entities (Corporations, Estates, Trusts, etc.) only EITHER Column 1-4 OR Column 5 should be populated - NEVER all 5 Columns Columns 7 through 19 are required for every transaction. Only ONE Beginning Balance and ONE Unsold Shares transaction per Acct # Please use mm/dd/yyyy format for all date fields For fields 16 and 17 please use provided abbreviations
Beneficial Owner Last Name (Individual, Joint, or IRA accounts only)
Beneficial Owner First Name
Co-Owner Last Name
Co-Owner First Name
Entity Name (Corporation, Estate, Trust, etc.)
Rep name (e.g. Custodian, Trustee, Executor, etc.)
Addr1
Addr2
City
State
Zip5
Zip4
Account #
Tax Id # CUSIP Type Security Code Trade Date # of Shares Price/Share
Amt Pd or Rec'd.
Beneficial Owner Last Name (Individual, Joint, or IRA accounts only) Smith Smith Smith Smith Smith
Beneficial Owner First Name John John John John John
Co-Owner Last Name
Co-Owner First Name
Entity Name (Corporation, Estate, Trust, etc.)
Rep name (e.g. Custodian, Trustee, Executor, etc.)
XYZ Corporations XYZ Corporations XYZ Corporations Simmons Simmons Jones IRA Jones IRA Bob Bob Robert Robert Simmons Simmons Betty Betty
Attn: John Doe, President Attn: John Doe, President Attn: John Doe, President
ABC Bank, Custodian ABC Bank, Custodian
Addr1 123 Anywhere Street 123 Anywhere Street 124 Anywhere Street 123 Anywhere Street 123 Anywhere Street 456 Overthere Road 456 Overthere Road 456 Overthere Road 15678 Nowhere Boulevard 15678 Nowhere Boulevard 538 Everywhere 539 Everywhere
Addr2 America Plaza America Plaza America Plaza America Plaza America Plaza Bldg 100 Bldg 100 Bldg 100
City Hometown Hometown Hometown Hometown Hometown Big City Big City Big City
State AL AL AL AL AL NY NY NY
Zip5 12345 12345 12345 12345 12345 98765 98765 98765 65432 65432 000045678 000045678
Zip4 Account # 6789 12345 6789 12345 6789 12345 6789 12345 6789 12345 4321 4321 4321 44444 44444 44444 78945 78945 4561 4561 45678 45678
Downtown TN Downtown TN Uptown Uptown FL FL
Tax Id # 123456789 123456789 123456789 123456789 123456789 987654321 987654321 987654321 012345678 012345678
CUSIP 167250109 167250109 167250109 167250109 167250109
Type B P P2 S U
Security Code CBI CBI CBI CBI CBI CBI CBI CBI CBI CBI CBI CBI
Trade Date 3/8/2005 3/15/2005 3/23/2005 4/25/2006 5/4/2006 3/8/2005 3/15/2005 5/4/2006 3/15/2005 5/4/2006 3/15/2005 4/25/2006
167250109 B 167250109 P 167250109 U N19808109 P N19808109 U
789456123 USN198081093 P 789456123 USN198081093 S
# of Shares 1000 1500 600 500 2600 1 1 2 10 10 100 100
Price/Share 50 50
Amt Pd or Rec'd. 75312.5 24856.22
90
950
92.5
93187.25
50 25
5156 2345