CLAIM FORM. I. General Instructions. A. Type or print all information clearly and legibly. B. You must answer all questions to obtain a benefit.

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1 CLAIM FORM TimberTech Limited Attn: Warranty Program 894 Prairie Avenue Wilmington, OH Use this form if you wish to make a claim in the settlement of Gornstein, et al. v. TimberTech, Ltd., et al., Civil No. 1:14-cv MBB (D. Mass.). For information about what benefits the settlement provides, please visit the website listed above. Claimant Name(s) Claim Number (to be completed by TimberTech) I. General Instructions A. Type or print all information clearly and legibly. B. You must answer all questions to obtain a benefit. C. Be sure to enclose all requisite evidence as indicated. If you do not, your claim will be denied and a Deficiency Letter will be sent to you by US Mail. D. Make a copy of all submissions, as no documents or photos will be returned. E. Sign and date the form on the last page. F. Your claim must be postmarked or received no later than March 16, If your claim is not timely, it will be denied. You may send your claim form together with all requisite proof by , U.S. mail, or overnight delivery to the addresses listed above. G. You will not receive an acknowledgement of receipt. If you wish to have proof of delivery, use a delivery method that will provide proof such as a return receipt.

2 II. Claimant Information A. Name of Claimant(s) Last First M.I. Last First M.I. B. Claimant s Address Street Address City State Zip Address of Deck Location (if different from your address) Street Address City State Zip C. Claimant s Phone Numbers Home Work Mobile Home Work Mobile D. Ownership Claimant is the current owner of a deck covered by the settlement and has not assigned his or her claim hereunder. YOU MUST ATTACH A DEED, MORTGAGE STATEMENT, UTILITY BILL, OR OTHER DOCUMENTARY PROOF OF OWNERSHIP OF THE PROPERTY ON WHICH THE DECK COVERED BY THE SETTLEMENT IS LOCATED. Claimant is the former owner of a deck covered by the settlement, has received an assignment of the claim from the current owner, and has not made any further assignment of the claim. YOU MUST ATTACH A COPY OF THE ASSIGNMENT. III. Deck Information A. The deck for which claimant is making a claim is made of: TimberTech Mountain Cedar decking material purchased on or before August 31, TimberTech Desert Bronze decking material purchased on or before November 1, 2011.

3 The square footage of the deck is square feet. YOU MUST ATTACH A RECEIPT OR OTHER DOCUMENTATION SHOWING THE TYPE OF DECKING, THE DATE OF PURCHASE, AND THE SQUARE FOOTAGE OF THE DECK. B. The deck for which claimant is making a claim has: Scorching Whitening Manifestation of a surface film (blistering) YOU MUST ATTACH STILL PHOTOGRAPHS TO SHOW ANY SCORCHING OR FADING. THE PHOTOGRAPHS MUST SHOW (1) THE ENTIRE DECK, (2) THE AREA(S) OF SCORCHING, WHITENING, OR MANIFESTATION OF A SURFACE FILM (BLISTERING), AND (3) THE SCORCHING, WHITENING, OR MANIFESTATION OF A SURFACE FILM (BLISTERING) IN CLOSE UP. THE PHOTOGRAPHS SHOULD INDICATE THE DATE ON WHICH THEY WERE TAKEN WITH A DATE STAMP. YOU DO NOT NEED TO SUBMIT THIS PROOF IF YOUR ONLY REQUEST BELOW IS FOR AN INCREASED LABOR REIMBURSEMENT, NOT A REPLACEMENT DECK. C. Claimant or, if applicable, Claimant s assignor: Has previously received a warranty benefit from TimberTech, such as a replacement deck and/or a payment. IF SO, CLAIMANT S WARRANTY CLAIM NUMBER IS. Has not previously received any warranty benefit from TimberTech. D. Claimant or, if applicable, claimant s assignor: Has not previously received any compensation from any party other than TimberTech with respect to scorching of, whitening of, or manifestation of a surface film (blistering) on the deck. Has received such compensation from a contractor, lumberyard, or other third party. LIST THE AMOUNT AND WHO MADE THE PAYMENT. Amount $ Payor

4 IV. Relief Requested A. Claimant requests (check only one): Replacement decking and labor reimbursement. An increase of a labor reimbursement previously paid by TimberTech to make up any difference between the prior reimbursement and your actual labor cost up to a maximum not to exceed $4.50/sq. ft. YOU MUST ATTACH RECEIPTS OR OTHER EVIDENCE OF THE AMOUNT THAT YOU PAID A CONTRACTOR TO INSTALL A REPLACEMENT DECK AND ANY LESSER AMOUNT PREVIOUSLY PAID BY TIMBERTECH. A cash payment of $400. You are not eligible for this option if you previously received a replacement deck from TimberTech. In making this election, you commit to advising any purchaser of the property that you declined the preceding options. B. If you are requesting a replacement deck, indicate whether the purchase of the deck to be replaced: Included the purchase of TimberTech fasteners. YOU MUST ATTACH RECEIPTS OR OTHER DOCUMENTARY PROOF OF THE PURCHASE OF TIMBERTECH FASTENERS IF YOU WISH TO RECEIVE FASTENERS WITH A REPLACEMENT DECK AT NO COST. OTHERWISE YOU MUST PURCHASE FASTENERS FROM TIMBERTECH OR PROVIDE YOUR OWN. Did not include the purchase of TimberTech fasteners, or claimant lacks knowledge and/or proof. C. If you are requesting a replacement deck or an increase in a labor reimbursement for previous installation of a replacement deck: The removal of the original deck did not cause any damage to the claimant s other property for which claimant seeks relief. The removal of the original deck caused damage to claimant s other property and claimant is seeking reimbursement for the damage in an amount not to exceed $100. YOU MUST ATTACH STILL PHOTOGRAPHIC PROOF OF THE DAMAGE TO OTHER PROPERTY, PROOF THAT ANY SUCH DAMAGE WAS NECESSARILY AND DIRECTLY CAUSED BY THE REMOVAL OF THE ORIGINAL DECK, AND DOCUMENTARY PROOF OF THE AMOUNT OF THE LOSS.

5 V. Replacement Options TimberTech Mountain Cedar and Desert Bronze are no longer in production. If you are requesting a replacement deck, you must specify a substitute color. The substitutes listed below may be viewed at and A. If the deck to be replaced is made of Mountain Cedar, choose one of the following: Azek Harvest Collection Brownstone Azek Harvest Collection Slate Gray Azek Harvest Collection Autumn Chestnut TimberTech Terrain Collection Brown Oak TimberTech Terrain Collection Rustic Elm TimberTech Tropical Collection Antique Palm TimberTech Tropical Collection Caribbean Redwood B. If the deck to be replaced is made of Desert Bronze, choose one of the following: Azek Harvest Collection Brownstone Azek Harvest Collection Slate Gray Azek Harvest Collection Autumn Chestnut Azek Arbor Collection Silver Oak Azek Arbor Collection New Morado TimberTech Terrain Collection Brown Oak TimberTech Tropical Collection Antigua Gold TimberTech Tropical Collection Antique Palm TimberTech Tropical Collection Caribbean Redwood VI. Certification The undersigned hereby certifies under penalty of perjury that all of the information herein and attached hereto is true, accurate, and complete. The undersigned authorizes TimberTech to enter the property to inspect the deck at issue, and promises to cooperate reasonably with TimberTech in any investigation of this claim. Signature(s) of Claimant(s) Date Print Name(s)