(Sample from The Altman Group Ballot Archives)

Transcription

1 EXHIBIT C-6 SINGLE BALLOT FOR GIT CLASS 4-A (APG ASBESTOS TRUST CLAIMS) IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA : In Re: : In Proceedings for a : Reorganization under Chapter 11 GLOBAL INDUSTRIAL : TECHNOLOGIES, INC., et al., : Jointly Administered under : Case No JKF Debtors. : : SINGLE BALLOT FOR ACCEPTING OR REJECTING THIRD AMENDED PLAN OF REORGANIZATION FOR GLOBAL INDUSTRIAL TECHNOLOGIES, INC. ( GIT ) CLASS 4-A (APG ASBESTOS TRUST CLAIMS) On December 28, 2005, Global Industrial Technologies, Inc., et al., ( GIT or the Debtors ), filed their Third Amended Plan of Reorganization (as it may be amended, supplemented or otherwise modified, the Plan ), a Disclosure Statement with Respect to the Plan and exhibits thereto, (as it may be amended, supplemented or otherwise modified, the Disclosure Statement ), pursuant to section 1125 of the Bankruptcy Code. On January 30, 2006, the Bankruptcy Court approved the Disclosure Statement with respect to the Plan. Please use this Ballot to record votes solicited for PI Trust Claims in GIT Class 4-A regarding the acceptance or rejection of the Plan. The Plan provides different treatment for different classes of Claims or Interests. PI Trust Claims are included in GIT Class 4-A (APG Asbestos Trust Claims) under the Plan. This treatment is also described in the Disclosure Statement. If you have any questions on how to complete this Ballot properly, please refer to the attached instructions. IF YOU ARE AN INDIVIDUAL AND INTEND FOR YOUR COUNSEL TO VOTE YOUR CLAIM ON A MASTER BALLOT, THEN PLEASE ARRANGE WITH YOUR COUNSEL TO VOTE ON THE PLAN ON YOUR BEHALF WELL IN ADVANCE OF THE VOTING DEADLINE (AS DEFINED BELOW) SO THAT YOUR VOTE MAY BE INCLUDED ON THE MASTER BALLOT. IF YOU ARE AN INDIVIDUAL AND INTEND TO VOTE DIRECTLY OR IF YOUR CLAIM IS NOT INCLUDED ON YOUR COUNSEL S MASTER BALLOT, THEN IN ORDER FOR YOUR VOTE TO BE COUNTED, THIS BALLOT MUST BE PROPERLY COMPLETED, SIGNED AND RETURNED SO THAT IT IS RECEIVED BY THE VOTING AGENT, BEFORE 5:00 P.M. EST ON MARCH 31, 2006 (THE VOTING DEADLINE ), AT THE FOLLOWING ADDRESS: Logan and Company, Inc. 546 Valley Road Upper Montclair, NJ IF YOU DO NOT KNOW WHETHER YOUR COUNSEL IS INCLUDING YOUR CLAIM ON A MASTER BALLOT, PLEASE CONTACT YOUR COUNSEL. 1

2 PLEASE COMPLETE THE FOLLOWING: ITEM 1. Tabulation of Votes Regarding the Plan. Each holder of a PI Trust Claim must vote his or her entire Claim either to accept or to reject the Plan. A holder of a PI Trust Claim may not split his or her vote within a Class and, accordingly, any holder of a PI Trust Claim who attempts partially to reject and partially to accept the Plan shall not be counted. If the Ballot is signed, but does not designate either acceptance or rejection of the Plan, then the Ballot will not be counted as either a vote to accept or reject the Plan. For Claimants holding a Claim in GIT Class 4-A (APG Asbestos Trust Claim), please mark one of the boxes below: The undersigned GIT Class 4-A (APG Asbestos Trust Claim) Claimant ACCEPTS the Plan The undersigned GIT Class 4-A (APG Asbestos Trust Claim) Claimant REJECTS the Plan ITEM 2. Disease Category and Amount of Claim. For purposes of voting to accept or reject the Plans, the undersigned holds a GIT Class 4-A claim based on one of the following types of disease. Please check the appropriate basis for your claim. Check one box only. If the basis for the claim is OTHER ASBESTOS DISEASE (LEVEL I), it requires: (1) diagnosis of a Bilateral Asbestos-Related Nonmalignant Disease. GIT Class 4-A claim amount for voting purposes only: $2,750. If the basis for the claim is ASBESTOSIS/PLEURAL DISEASE (LEVEL II), it requires: (1) (a) Diagnosis of a Bilateral Asbestos-Related Nonmalignant Disease, and (b) TLC less than 80%, or FVC less than 80% plus FEV1/FVC ratio greater than or equal to 65%. GIT Class 4-A claim amount for voting purposes only: $8,300. If the basis for the claim is SEVERE ASBESTOSIS (LEVEL III), it requires: (1) diagnosis of asbestosis with ILO of 2/1 or greater, or asbestosis determined by pathological evidence of asbestos, plus (a) TLC less than 65%, or (b) FVC less than 65% plus FEV1/FVC ration greater than 65%. If the basis for the claim is OTHER CANCER (LEVEL IV), it requires: (1) diagnosis of a primary colo-rectal, laryngeal, esophageal, pharyngeal, or stomach cancer, plus evidence of an underlying Bilateral Asbestos-Related Nonmalignant Disease. If the basis for the claim is LUNG CANCER 2 (LEVEL V), it requires: (1) diagnosis of a primary lung cancer. GIT Class 4-A claim amount for voting purposes only: $15,000. If the basis for the claim is LUNG CANCER 1 (LEVEL VI), it requires: (1) diagnosis of a primary lung cancer plus evidence of an underlying Bilateral Asbestos-Related Nonmalignant Disease. GIT Class 4-A claim amount for voting purposes only: $47,000. 2

3 If the basis for the claim is MESOTHELIOMA (LEVEL VII), it requires: (1) diagnosis of mesothelioma. GIT Class 4-A claim amount for voting purposes only: $130,000. For purposes of voting, please note that failure to assign a disease category to a particular PI Trust Claim will result in treatment of such vote as a Level I Claim. This ballot is for holders of Asbestos Personal Injury Claims only. If you hold or assert an Indirect Asbestos Claim you must use ballot C-10. ITEM 3. Required Certifications Regarding Asbestos PI Trust Claims: No vote for or against the Plan by or on behalf of a holder of an Asbestos PI Trust Claim shall be counted by the Voting Agent unless the Ballot reflecting such vote is submitted to the Voting Agent with written certifications, under penalty of perjury in accordance with 28 U.S.C. 1746, that: (1) The undersigned certifies that he or she is a holder of a PI Trust Claim in GIT Class 4-A of the Plan or is an attorney that has been authorized to submit this ballot on behalf of the holder of a PI Trust Claim. (2) The holder of such PI Trust Claim has been exposed to an asbestos or silicacontaining product so that such claimant holds a PI Trust Claim, as defined in the Plan and described in the Disclosure Statement that. (3) The holder of such PI Trust Claim has the disease level asserted on such holder s Ballot or Master Ballot, which meets the criteria as described in the Voting Instructions for Completing the Ballot based on medical records or similar documentation in the holder s files. Sign and date below. For your vote to be counted, you must sign this ballot and provide your social security number. Dated: Signature Printed Name Social Security Number (Required) Address: 3

4 VOTING INSTRUCTIONS FOR COMPLETING BALLOT FOR GIT CLASS 4-A (APG ASBESTOS TRUST CLAIMS) 1. This Ballot is submitted to you in connection with the solicitation of votes of holders of PI Trust Claims to accept or reject the Plan. Unless otherwise defined, all capitalized terms used herein shall have the meaning ascribed to such terms in the Plan. PLEASE READ THE PLAN AND DISCLOSURE STATEMENT CAREFULLY BEFORE COMPLETING THIS BALLOT. A COPY OF THE PLAN AND DISCLOSURE STATEMENT ARE ENCLOSED IN THIS PACKET. 2. If your Claim is not included in a GIT Class 4-A Master Ballot submitted by your counsel, this Ballot must be returned directly to the Voting Agent. Alternatively, if your Claim is included in a GIT Class 4-A Master Ballot submitted by your counsel, you need not return this Ballot. If you do not know if your Claim will be included in your counsel s GIT Class 4-A Master Ballot, please contact your counsel. 3. The Ballot must be completed, signed and returned so that it is received not later than 5:00 p.m. EST, on March 31, 2006 (the Voting Deadline ), unless such time is extended by order of the Bankruptcy Court. If you return the Ballot to your counsel, please allow sufficient time for your counsel to prepare and submit a Master Ballot by the Voting Deadline. If your Ballot is sent to the Voting Agent, please return it as follows: Logan and Company, Inc. 546 Valley Road Upper Montclair, NJ plan. 4. The Ballot may not be used for any purpose other than to transmit a vote to accept or reject the 5. Each holder of a PI Trust Claim must vote his or her entire claim either to accept or to reject the Plan. A holder of a PI Trust Claim may not split his or her vote within a Class and, accordingly, any holder of a PI Trust Claim who purports partially to reject and partially to accept the Plan shall not be counted. Furthermore, for purposes of computing the Ballot vote, each voting individual holder of a PI Trust Claim shall be deemed to have voted the full amount of his or her Claim according to the disease category specified for such PI Trust Claim. This Ballot is for holders of Asbestos Personal Injury Claims only. If you hold or assert an Indirect Asbestos Claim you must use the Ballot for C This Ballot requires that you register your vote as well as your disease category. Any vote on behalf of a Claimant submitted without inclusion of the name and the valid social security number of such Claimant will not be counted. Any vote on behalf of a Claimant submitted in GIT Class 4-A without inclusion of the disease category applicable to such Claimant will be counted as a vote on behalf of a Claimant with Other Asbestos Disease (Level I). ITEM 1 7. Item 1 of the Ballot allows you to indicate whether you accept the Plan or reject the Plan. Please check the appropriate box. If you submit a signed Ballot but fail to indicate whether you accept or reject the Plan, your vote will not be counted either as an acceptance or rejection of the Plan. ITEM 2 8. Item 2 of the Ballot requires that you indicate the disease category applicable to your GIT Class 4- A Claim. The relevant disease categories, explanation of requirements for such categories and Claim Amount for voting purposes only are as follows: (a) If the basis for the claim is OTHER ASBESTOS DISEASE (LEVEL I), it requires: (1) diagnosis of a Bilateral Asbestos-Related Nonmalignant Disease. GIT Class 4-A claim amount for voting purposes only: $2,750. 4

5 (b) If the basis for the claim is ASBESTOSIS/PLEURAL DISEASE (LEVEL II), it requires: (1) (a) Diagnosis of a Bilateral Asbestos-Related Nonmalignant Disease, and (b) TLC less than 80%, or FVC less than 80% plus FEV1/FVC ratio greater than or equal to 65%. GIT Class 4-A claim amount for voting purposes only: $8,300. (c) If the basis for the claim is SEVERE ASBESTOSIS (LEVEL III), it requires: (1) diagnosis of asbestosis with ILO of 2/1 or greater, or asbestosis determined by pathological evidence of asbestos, plus (a) TLC less than 65%, or (b) FVC less than 65% plus FEV1/FVC ration greater than 65%. (d) If the basis for the claim is OTHER CANCER (LEVEL IV), it requires: (1) diagnosis of a primary colo-rectal, laryngeal, esophageal, pharyngeal, or stomach cancer, plus evidence of an underlying Bilateral Asbestos-Related Nonmalignant Disease. (e) If the basis for the claim is LUNG CANCER 2 (LEVEL V), it requires: (1) diagnosis of a primary lung cancer. GIT Class 4-A claim amount for voting purposes only: $15,000. (f) If the basis for the claim is LUNG CANCER 1 (LEVEL VI), it requires: (1) diagnosis of a primary lung cancer plus evidence of an underlying Bilateral Asbestos-Related Nonmalignant Disease. GIT Class 4-A claim amount for voting purposes only: $47,000. (g) If the basis for the claim is MESOTHELIOMA (LEVEL VII), it requires: (1) diagnosis of mesothelioma. GIT Class 4-A claim amount for voting purposes only: $130, Please further note that failure to assign a disease category to a particular GIT Class 4-A claim will result in treatment of such vote as Other Asbestos Disease (Level I) category. ITEM Item 3 of the Ballot requires you to certify your vote, the disease category and product exposure applicable to your Claim. Please note that your certification is provided under penalty of perjury, pursuant to 28 U.S.C PRODUCT EXPOSURE CERTIFICATION: By signing and returning a Ballot, the Claimant certifies that the Claimant has been exposed to an asbestos-containing product so that such claimant holds a PI Trust Claim, as defined in the Plan and described in the Disclosure Statement. TO BE COUNTED, IT IS IMPERATIVE THAT YOU SIGN AND DATE YOUR BALLOT AND THAT YOU PROVIDE YOUR SOCIAL SECURITY NUMBER. A BALLOT THAT DOES NOT CONTAIN THIS REQUIRED INFORMATION WILL NOT BE COUNTED. THE COMPLETED AND SIGNED BALLOT MUST BE RETURNED TO THE VOTING AGENT NO LATER THAN THE VOTING DEADLINE, MARCH 31, IF YOU AUTHORIZE YOUR COUNSEL TO VOTE ON YOUR BEHALF AND YOUR CLAIM IS INCLUDED ON YOUR COUNSEL S MASTER BALLOT, YOU DO NOT NEED TO RETURN THIS BALLOT TO THE VOTING AGENT. IF YOU HAVE ANY QUESTIONS REGARDING THIS BALLOT, OR IF YOU DID NOT RECEIVE A RETURN ENVELOPE WITH YOUR BALLOT, OR IF YOU DID NOT RECEIVE A COPY OF THE PLAN OR DISCLOSURE STATEMENT, OR IF YOU BELIEVE YOU HAVE RECEIVED THE WRONG BALLOT, OR IF YOU NEED ADDITIONAL COPIES OF THIS BALLOT OR OTHER ENCLOSED MATERIALS, PLEASE CONTACT THE VOTING AGENT AT (973) or at 5