Submit your information to Shepherd, Finkelman, Miller & Shah, LLP

The individual or institution listed below authorizes and retains Shepherd, Finkelman, Miller & Shah, LLP (SFMS) to file an action under the federal securities laws against ZELTIQ Aesthetics, Inc. (Company). SFMS will litigate this action on a contingency fee basis and will pay the costs and expenses incurred in prosecuting this action. The undersigned will not be responsible for any out-of-pocket expenses. Upon SFMS's review of this Certification, SFMS will send the undersigned a retention agreement.

Please fill out the information in the Certification below and check the appropriate boxes to submit the Certification.

First Name*

Last Name*

Mailing address

City

State

Zip

Country

Telephone number

E-mail address*

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The individual or institution (“Plaintiff”) certifies that:

• Plaintiff has reviewed the complaint and authorize SFMS to act on his or her behalf.

• Plaintiff did not purchase the security that is the subject of this action at the direction of Plaintiff’s counsel or in order to participate in this action.

• Plaintiff is willing to serve as a representative party on behalf of the class, including providing testimony at deposition and trial, if necessary.

• Plaintiff will not accept any payment for serving as a representative party on behalf of the class beyond Plaintiff’s pro rata share of any recovery, except such reasonable costs and expenses (including lost wages) directly relating to the representation of the class as ordered or approved by the Court.

• Plaintiff’s Purchases of ZELTIQ Aesthetics, Inc. (Company) stock were as follows:
  

Plaintiff’s Sales of ZELTIQ Aesthetics, Inc. (Company) stock were as follows:

• I certify that as of the date of submission of this Certification, I have not sought to serve as a representative for a class action filed under the federal securities laws, within the past 3 years, except as follows:

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