3. ELIGIBLE PAYMENTS

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1 Please carefully read the Notice of Class Action and Proposed Missouri Settlement ( Full Notice ), which is available at MissouriDogTreatSettlement.com, before filling out this Form. YOUR SIGNED CLAIM MUST BE POSTMARKED, FAXED OR ED IN PDF FORMAT TO THE CLAIMS ADMINISTRATOR BY NO LATER THAN June 5, WHAT THIS CLAIM FORM CONCERNS This Claim Form concerns the Settlement for Missouri residents only of a state class action lawsuit filed in the State of Missouri in which the plaintiff alleges that Waggin Train and Canyon Creek Ranch brand pet treat products imported from China or containing any ingredients imported from China ( Dog Treat Products ) were worth less than the purchase price because they were contaminated or defective. If you are a member of the Missouri Settlement Class because you are a Missouri resident and purchased the Dog Treat Products, and you do not timely request exclusion from the Missouri Settlement, you are entitled to submit a claim for reimbursement for your purchase(s) of the Dog Treat Products, as described below. The Court will determine whether to approve the Missouri Settlement and Missouri Settlement Fund after conducting a Final Approval Hearing, scheduled for June 2, 2015 (date subject to change). Within the last year, you may have received notice of a related nationwide class action settlement concerning Waggin Train or Canyon Creek Ranch brand Dog Treat Products that is pending federal court in the Northern District of Illinois ( Adkins Class Action Settlement ). If you submitted a Claim Form seeking reimbursement for Dog Treat Product purchases in the Adkins Class Action Settlement, you do not need to resubmit this Claim Form to be eligible to receive reimbursement for those claimed purchases under this Missouri Settlement. Your entitlement to reimbursement from the Missouri Settlement Fund in this Action shall be determined at the sole discretion of the Claims Administrator and subject to the terms and limitations of this Missouri Settlement. For further information, visit the settlement website at MissouriDogTreatSettlement.com or call the toll-free number at REVIEW OF YOUR CLAIM An independent third party called a Claims Administrator has been appointed by the Court to review your claim. The Missouri Settlement between the parties provides compensation to persons submitting valid and reasonable claims as determined by the Claims Administrator. The Claims Administrator will review your Claim Form in its entirety and the documents you submit, if any, to evaluate the eligibility of your claim for payment from the Missouri Settlement Fund. The Claims Administrator will determine whether a claim is reasonable, valid, and payable from the Missouri Settlement Fund before paying a claim. The information that you supply below may be checked by the Claims Administrator. By filling out this Claim Form and signing the verification statement at the end, you are specifically authorizing a representative from the Claims Administrator to contact you to confirm the information provided and to seek additional information about your claim. The Claims Administrator has complete and final authority to determine whether a claim is valid and the amount to be paid on each claim, and its decision shall be final, binding, and cannot be appealed. 3. ELIGIBLE PAYMENTS If you are an eligible Missouri Settlement Class Member, you may be able to recover compensation for your purchase(s) of Dog Treat Products, subject to certain limitations described in this Claim Form. Reimbursement is limited to the costs or amounts for which you have not already been reimbursed, including through the Defendants Historic Payment Programs, reimbursement in the Adkins Class Action Settlement, or through previous return or exchange of the product to the retail locations from which you purchased the Dog Treat Products. You are eligible to recover reimbursement for purchases you made in Missouri for which you provide supporting documentation or proof of purchase. In addition, the Claims Administrator has authority and discretion to pay you up to $300 from the Missouri Settlement Fund for purchases for which you lack supporting documentation. If you do not supply supporting documentation for your claims, then reimbursement from the Missouri Settlement Fund is limited to a maximum of $300. You must provide a Missouri address where you resided at the time of the purchase to be eligible for reimbursement on any claim. To the extent that you do not provide documentation to support some or all of your purchases, you should provide a written description of your claimed purchases and an explanation why you do not have documentation to support them. This will help the Claims Administrator in evaluating your claim. You can write your explanation in Section IV or on separate sheets of paper, if necessary. 01-CA8552 N4961 v

2 Reimbursement of valid and reasonable claims may be reduced on a pro rata basis if the total amount of money due to eligible class members exceeds the total amounts available under the Missouri Settlement. This is described in greater detail in the Full Notice available at MissouriDogTreatSettlement.com or by calling HOW YOU CAN QUALIFY FOR AND RECEIVE A PAYMENT. In order to be eligible for any compensation from the Missouri Settlement, you must: fill out this Claim Form in its entirety; sign the verification statement in section VI. By signing the verification statement, you swear under penalty of perjury that the information you have supplied is accurate; and return this Claim Form together with copies of your supporting documentation, if any. All information submitted will be kept confidential and will be used only for the purpose of reviewing and administering the claim submitted. I. YOUR INFORMATION Name of Person Submitting Claim: First Name: MI: Last Name: Missouri Address: Telephone Number: Address: If you no longer reside in Missouri, but did so at the time you purchased Dog Treat Products, please provide your former Missouri address(es): Address: Address: II. PET INFORMATION Pet Type: Pet s Name: Breed, if known (optional): Pet s Date of Birth (best approximation): Gender of Pet (check one): Male Female Proceed to the next page. 02-CA8552 N4962 v

3 III. DOG TREAT PRODUCT PURCHASE INFORMATION You may be entitled to reimbursement for the purchase of Dog Treat Products for which you have not already been reimbursed, including by previous return or exchange of product. Total cost of unreimbursed Dog Treat Products: $, To recover the maximum amount you can from the Missouri Settlement Fund for unreimbursed Dog Treat Products, attach documentation showing your purchase of Dog Treat Products. Acceptable proof includes receipts, cancelled checks, credit card statements, copies of the product labels, other records from place of purchase, or other records that could show you bought the food and how much you paid. To the extent that you do not submit documentation of these items, you should provide information regarding those expenses below in Section IV, and your recovery may be limited by the Claims Administrator. DATE OF PURCHASE (Month/Date/Year) PLACE OF PURCHASE (Store/City/State) PRODUCT PURCHASED (Brand/Variety or Product Name) NUMBER OF BAGS PURCHASED (Type/Size) TOTAL COST (Add additional pages, if necessary) 03-CA8552 N4963 v

4 IV. EXPLANATION OF UNDOCUMENTED PURCHASES If you did not provide documentation to support some or all of your claimed purchases, you should try to provide as much information in this section as possible about the basis of those claims that are not documented and why you did not provide documentation. Providing this explanation will help the Claims Administrator evaluate your claim. Attach additional pages if necessary. V. PRIOR REIMBURSEMENT You or someone else in your household (or organization) may already have been reimbursed, or have submitted a claim for reimbursement that is still pending, for your purchase of Dog Treat Products. Please indicate whether you or another person in your household (or organization) have previously submitted claims for reimbursement or compensation to Nestle Purina PetCare Company/Waggin Train LLC, a retailer, an insurance company, or as part of the Adkins Class Action Settlement. Yes or No If you answered no, then you can proceed to Section VI, sign the Claim Form, and mail, fax or (by.pdf) it to the address on the front of the Form. If you answered yes, then please provide the following information: Name of Person Submitting Claim for Reimbursement: First Name: MI: Last Name: Name of the Pet: Check the Entity that Received Claim: 04-CA8552 Nestle Purina PetCare Company/Waggin Train LLC As part of the Adkins Class Action Settlement Retailer or Insurer If you checked this box, provide the name of the entity: N4964 v

5 Address: The date on which claim(s) for reimbursement was or were made: Was Reimbursement Provided? Yes or No Amount of Reimbursement: $, IMPORTANT INFORMATION REGARDING REIMBURSEMENT: If you have been previously reimbursed by Nestle Purina PetCare Company/Waggin Train LLC, a retailer, or an insurance company for expenses associated with the Dog Treat Products, including through the Adkins Class Action Settlement, then the reimbursed amount will be deducted from the total amount owed to you as part of this settlement. If the total amount of your previous reimbursement is greater than the total amount that you are entitled to as part of this claims program, then you will not receive any further reimbursement as part of this settlement. VI. VERIFICATION I declare under the penalty of perjury that the above information is true and correct. I understand that the above information will be reviewed and verified by a representative from the Claims Administrator. I hereby authorize a representative from the Claims Administrator to contact me for more information to properly evaluate my claim. Signature Date Please keep a copy of your completed Claim Form and copies of any attached documentation for your records. Please mail, fax or (by.pdf) your completed Claim Form, with all required documentation, by no later than June 5, 2015 to: Missouri Dog Treat Settlement Claims Administrator PO Box 4655 Portland, OR If you would like confirmation that your Claim Form has been received, then you may send it by certified mail, return receipt requested. You may also call the Claims Administrator at the above number. It will take some time for the Claim Administrator to review and process your claim. Please check MissouriDogTreatSettlement.com periodically for updates on the Missouri Settlement and the claims process. Additional copies of the Full Notice and this Claim Form are available at MissouriDogTreatSettlement.com. If you have any questions about the Full Notice or Claim Form, please contact the Claims Administrator at or visit MissouriDogTreatSettlement.com. 05-CA8552 N4965 v