Claim Form

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  1 *NJPA1FIRST* To receive a payment, you must accurately complete this Claim Form and submit it by December 17, 2013 . Failure to do sowill result in a reduction or the denial of your Claim. Claim Forms (and proof of purchase, if you submit a claim with proof of purchase) may be submitted online at www.NakedJuiceClass.com or by mail to: Gilardi & Co. LLC, P.O. Box 808061Petaluma, CA 94975-8061: A. CLASS MEMBER INFORMATION: First Name M.I. Last Name Address 1 Address 2City State Zip CodeEmail Address (optional) B. CLAIM INFORMATION - CLAIMS WITH PROOF OF PURCHASE If you choose to submit a claim with proof of purchase, you must follow both of the following two (2) steps and fullycomplete and sign this Claim Form: 1. First  , state the amount of your purchases of the Eligible Products (see page 2for list of Eligible Products) from September 27, 2007 to August 19, 2013: 2. Second  , along with this Claim Form, please submit your proof of purchase, such as receipts or other documentation,for the amount stated above. Must Be ElectronicallySubmitted or MailedNo Later ThanDecember 17, 2013 NJPA1 Case No. LA CV 11-08276-JAK (PLAx), Lead Case (Consolidated with LA CV 11-08007;SA CV 11-01701; LA CV 11-09412; LA CV 11-09677) NAKED JUICE SETTLEMENT CLAIM FORM NATALIE PAPPAS v. NAKED JUICE CO.OF GLENDORA, INC., a California corporation UNITED STATES DISTRICT COURTCENTRAL DISTRICT OF CALIFORNIA FOR CLAIMSPROCESSINGONLY  REV OZ LC DOC $ .  2 *NJPA1SECOND* C. CLAIM INFORMATION - CLAIMS WITHOUT PROOF OF PURCHASE Claims submitted without proof of purchase are entitled to a payment that depends upon the amount of your stated purchases of the Eligible Products from September 27, 2007 to August 19, 2013.If you choose to submit a claim without a proof of purchase, please respond to the following question and fully completeand sign this Claim Form.What is the total amount of your purchases of Eligible Products from September 27, 2007to August 19, 2013 (see page 2 for the list of Eligible Products)? D. SIGN AND DATE YOUR CLAIM FORM  my knowledge and that I purchased the amount of the Eligible Product(s) claimed above from September 27, 2007 toAugust 19, 2013.   provisions of the Stipulation of Settlement, including granting to Naked Juice and other Released Parties a release of all  entered pursuant to the Settlement. Signature Date Signed ELIGIBLE PRODUCTS: AÇAÍ MACHINE / PURPLE MACHINE / RAINFOREST ACAIAPPLEAPPLE CRANBERRYBERRY BLAST / BERRY BLAST WELL BEINGBERRY PROBIOTICBERRY VEGGIE / BERRY VEGGIE MACHINEBLACK AND BLUEBERRY / BLACK AND BLUEBERRY RUSHBLUE MACHINECARROTCHAI SPICED CIDER CHERRY POMEGRANATE / CHERRY POMEGRANATE POWER CITRUS LEMONGRASS (REDUCED CALORIE) / CITRUSLEMONGRASSGOLD MACHINEGREEN MACHINELYCHEE (REDUCED CALORIE)MANGO VEGGIEMIGHTY MANGO / MIGHTY MANGO WELL BEINGO-JORANGE CARROTORANGE MANGO / ORANGE MANGO MOTIONORGANIC CARROTPEACH GUAVA (REDUCED CALORIE)PEACH MANGOSTEEN / PEACH MANGOSTEEN BLISSPOMEGRANATE / PLENTIFUL POMEGRANATEPOMEGRANATE AÇAÍPOMEGRANATE BLUEBERRYPOWER-C MACHINE / POWER-CPROBIOTIC TROPICAL MANGOPROTEIN ZONEPROTEIN ZONE BANANA CHOCOLATEPROTEIN ZONE DOUBLE BERRYPROTEIN ZONE MANGORAZALICIOUSRED MACHINESTRAWBERRY BANANA / STRAWBERRY BANANA C /STRAWBERRY BANANA WELL BEINGSTRAWBERRY KIWI / STRAWBERRY KIWI KICK TANGERINE SCREAMTROPICAL (REDUCED CALORIE) / TROPICAL C / TROPICALWATERMELON CHILL Claim Forms must be electronically submitted no later than December 17, 2013 orpostmarked no later than December 17, 2013.Questions? Visit www.NakedJuiceClass.com or call, toll-free, (888) 283-2947 $ .
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