Zimmer Biomet Holdings, Inc. (ZBH)

First Name*

Last Name*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

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Phone Number*

Area CodePhone Number

Email*

name@domain.com

ZBH Shares purchased*

Estimated total losses*

Shares purchased during the Relevant Period

Range of losses*

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Date Contacted HB

Date

Type of Initial contact

HB Initial Contact

R&R Sent

R&R Returned

Cert Sent

Cert Returned

Attorney Notes:

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Please list the date, quantity and share price of your purchases/sales during the Relevant Period so that we can calculate your losses. *

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