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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 (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.

Name
Email*
Mailing Address
State
Zip
Phone
Purchase Information
- 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 (Company) stock were as follows:
Date Shares Purchased
Date Format: YYYY dash MM dash DD
Number of Shares Purchased
Price Per Share
Date Shares Purchased (2)
Date Format: YYYY dash MM dash DD
Number of Shares Purchased (2)
Price Per Share (2)
Date Shares Purchased (3)
Date Format: YYYY dash MM dash DD
Number of Shares Purchased (3)
Price Per Share (3)
Date Shares Purchased (4)
Date Format: YYYY dash MM dash DD
Number of Shares Purchased (4)
Price Per Share (4)
Date Shares Purchased (5)
Date Format: YYYY dash MM dash DD
Number of Shares Purchased (5)
Price Per Share (5)
- Plaintiff’s Sales of (Company) stock were as follows:
Date Shares Sold
Date Format: YYYY dash MM dash DD
Number of Shares Sold
Price Per Share
Date Shares Sold (2)
Date Format: YYYY dash MM dash DD
Number of Shares Sold (2)
Price Per Share (2)
Date Shares Sold (3)
Date Format: YYYY dash MM dash DD
Number of Shares Sold (3)
Price Per Share (3)
Date Shares Sold (4)
Date Format: YYYY dash MM dash DD
Number of Shares Sold (4)
Price Per Share (4)
Date Shares Sold (5)
Date Format: YYYY dash MM dash DD
Number of Shares Sold (5)
Price Per Share (5)
- 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:
Comments
Declaration*
- I declare under penalty of perjury, under the laws of the United States, that the information in this Certification is accurate.
Signature*
- By checking this box and the "Submit Certification" button below, I intend to sign and execute this Certification.
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