.

In re Anthem, Inc. Data Breach Litigation

c/o KCC Class Action Services
P.O. Box 404001
+
Louisville, KY 40233-4001
AAB-C

Claim #: AAB-C-«ClaimID» «MailRec»

«Payee»
«co»
«Addr1»
«Addr2»
«City», «ST» «Zip»
«Country»

Re: In re Anthem, Inc. Data Breach Litigation Settlement Alternative Compensation Distribution Payment «MailDate»

Dear «Payee»:

Enclosed is a check in the amount of «IssueAmount» representing your Alternative Compensation Settlement Award in the In re Anthem, Inc. Data Breach Litigation
Settlement. The total amount of your settlement award has been calculated pursuant to the terms of the Settlement that was approved by the Court.

The enclosed check must be cashed by «StaleDate»; after that date the check will be void and will not be reissued.

You should consult your tax advisor or accountant as to the tax treatment of the settlement award you are receiving under this Settlement because the Settlement
Administrator and the attorneys representing the parties in the case cannot provide you with tax advice.

Very truly yours,

In re Anthem, Inc. Data Breach Litigation Settlement Administrator

Holder Account Number

3ROS A A B _ D S B +
001CD70003 02XS6A

WARNING: MULTIPLE SAFETY FEATURES. THE FACE OF THIS CHECK HAS A BLUE BACKGROUND AND FLUORESCENT INK (HOLD UNDER BLACKLIGHT TO VIEW). REFER TO SECURITY ENDORSEMENT BACKER FOR TRUE WATERMARK AND ADDITIONAL FEATURES.

Computershare/KCC
In re Anthem, Inc. Data Breach Litigation Bank of America 64-1278
P.O. Box 404012 Atlanta, DeKalb County, Georgia 611 GA
Louisville, KY 40233-9821

VOID AFTER <<STALE DATE>>

Check Number <<check #>>

The sum of ***ONE HUNDRED TWENTY-THREE DOLLARS AND FORTY-FIVE CENTS***
<<Issue Date>>
Pay to «Payee»

$ ***123.45***
Computershare Inc.
Authorized Paying Agent.

Claim #: AAB-C-«ClaimID» «MailRec»

Security Features Details on Back. Authorized Signature(s)

6078 00000
 THIS PAPER CONTAINS GENUINE WATERMARK - DO NOT ACCEPT WITHOUT
NOTING CHAIN LINK WATERMARK - HOLD TO LIGHT TO VERIFY WATERMARK
ORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENT
PAYEE SIGNATURE
DO NOT WRITE OR SIGN BELOW THIS LINE
ORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENTORIGINALDOCUMENT
RESERVED FOR FINANCIAL INSTITUTION USE *

DOCUMENT
ORIGINAL
xxxxxxxx
Listed below are the security features provided on this document
which meet and/or exceed industry guidelines.
Security Features: Results of check alteration:
• Chemical Protection Paper • When chemically altered, the area treated will appear with a
colored stain.
• Watermark • The paper contains a genuine chain link watermark - Hold
to light to verify watermark.
• Fluorescent Fibers • Visible only under ultraviolet light. Cannot be photocopied
or scanned.
• MicroPrint Line • Small type in line appears as dotted line when photocopied.
MicroPrint Line must read “ORIGINAL DOCUMENT”
Other security features may be included on this document and yet not listed above. The feature
should be apparent upon visible inspection of the document.
®
Padlock design is a certification mark of Check Payment Systems Association
.
*FEDERAL RESERVE BOARD OF GOVERNORS REG. CC