In completing and submitting this form, I understand that I am providing my personal information to Class Counsel. I understand that I will be informed by Charles Veilleux & Associates (hereafter, "CVA") as to my eligibility as a potential claimant, and if eligible, I understand and consent to receiving their assistance to submit any claim I might have, or that my claim may be submitted on my behalf by CVA. I understand that I am hereby requesting that CVA act as my legal representative to submit my claim to the Administrator on my behalf, and that I can contact CVA or the Administrator at any time to inquire about the status of my claim. I also understand that the official Claims Form is available on the Administrator's website and that nothing precludes me completing this official Claims Form on the Administrator's website, or from from contacting the Administrator for any inquiries or claims I might have.