Exhibit,Appendix: Daniel Martinez, Rafael Rodriguez, Terrence Bullard, Sunghai Anderson, Ryan Hamilton, Steven Haynes, Andy Rolle v. Excell Communications, Inc., Abel Barbosa

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                                INDEX     NO.   618753/2023
NYSCEF   DOC.      NO.   9                                                                       RECEIVED   NYSCEF       01/19/2024




                SUPREME COURT OF THE STATE OF NEW YORK
                COUNTY OF NASSAU
                pene anne n enna nnn enna nnn nnn   nnn nnn nnn nnn
                DANIEL MARTINEZ, RAFAEL RODRIGUEZ,
                TERRENCE BULLARD, SUNGHAI ANDERSON,
                RYAN HAMILTON, STEVEN HAYNES, and
                ANDY     ROLLE, on behalf of themselves and all
                other persons similarly situated,                                        Index No.: 618753/2023

                                                     Plaintiffs,

                                  -against-

                EXCELL COMMUNICATIONS,                    INC. and ABEL
                BARBOSA,

                                                     Defendant
                pene nnn nn nan nn nn -nen nanan nena.                nnan-a-n------
                                                                                  ===

                                                      CLAIM FORM AND RELEASE

                                                                   INSTRUCTIONS

                       In order to receive any portion of the settlement funds described in the Notice of Class
                Action Lawsuit and Fairness Hearing (“Notice”), you must sign, date, and return this Claim
                Form and Release to the Settlement Claims Administrator by mail postmarked, or by email
                or fax, by [DATE], 2024:

                                                             Arden Claims Service
                                                      Re: Excell Communications Matter
                                                                     [ADDRESS]
                                                     Email Address: [EMAIL ADDRESS]
                                                          Fax No.: [FAX NUMBER]

                                                          CHANGES        OF ADDRESS

                        It is your responsibility to keep a current address and contact information on file with the
                Settlement Claims Administrator. Please make sure to notify the Settlement Claims Administrator
                of any change of address or other contact information by the following means:

                                                             Arden Claims Service
                                                      Re: Excell Communications Matter
                                                                     [ADDRESS]
                                                    Tel.: [ENTER TELEPHONE NUMBER]
                                                       Email Address: [EMAIL ADDRESS]
                                                            Fax No.: [FAX NUMBER]
INDEX      NO.   618753/2023
NYSCEF   DOC.     NO.    9                                                                    RECEIVED    NYSCEF:      01/19/2024




                                                    CLAIM AND RELEASE

                   THIS FORM       MUST BE MAILED, EMAILED OR SENT BY FAX BY [DATE], 2024.

                         I affirm that I was employed by Defendants at some point between July 18, 2016 through
                September 5, 2022.

                         I affirm that I wish to receive my allotted portion of the proceeds from the settlement in
                this matter.

                         I designate the law firm of Romero Law Group PLLC to represent me in this action.

                 YOU MUST ENCLOSE A COMPLETED AND SIGNED IRS FORM W-9 WITH THIS
                            CL.   FORM OR YOU WILLNOT GET A CHECK

                         I declare under penalty of perjury that the above information is correct and agree to its
                terms.



                         Name (Print)                             Signature                              Date


                         Mailing Address


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