I,, of age, holder of Passport Number/ National Identification, with residence in the city of, of nationality (hereinafter THE PARTY AFFECTED ).

Transcription

1 ACCEPTANCE DOCUMENT AND POWER OF ATTORNEY Colombia, March 2014 I,, of age, holder of Passport Number/ National Identification Document, with residence in the city of, of nationality (hereinafter THE PARTY AFFECTED ). Having read and fully accepted Annex 1 to this Acceptance Document which contains the six clauses detailing the specific conditions of the power of attorney I am granting, in which I agree to be represented by the persons referred to herein, and who may, in the event of obtaining an economic compensation in my favor, retain, by way of fees, a percentage of such indemnity. And conditioned to the fulfillment of the obligations set in Annex 2 of this document, Annex that I declare have read and understood. Hereby state my decision to be advised and represented by attorney at law Natalie LOZANO, an attorney at law in Colombia, who represents Lozano Blanco & Asociados in each and every one of the scenarios, and processes in and out of court which are held in relation to the subject of the PIP implants and, if there is a possibility to include new affected parties in such process, and the attorney consider it is worth and convenient to include them, in particular: All the civil processes in which the company PIP and/or TÜV RHEINLAND LGA, or any of its partners, subsidiaries or parent establishments are involved. Any procedure before the SARVI of France (Service of Assistance for Payment to Victims of!infringements) or before any other guarantee fund, which is applicable in the area of PIP implants. Any criminal procedure related to the PIP implants case.! Any negotiation or process of conciliation in the processes referred to herein.! PARAGRAPH. I hereby expressly place on record that the Attorney has all the powers inherent and necessary, in particular those of granting power of attorney to attorney at law Laurent GAUDON, an attorney at law registered with the Bar of the City of Marseille, France, or any other lawyer in France in capacity to fulfill this mandate in the name of THE PARTY AFFECTED, for them to exercise representation, in or out of court, in the actions to be brought against THE DEFENDANTS, to receive, conciliate, claim, accept, settle, substitute, desist, renounce, reassume, draft, pay and, in general, all those necessary for the satisfactory fulfillment of their representation.! SIGNATURE AS A SIGN OF ACCEPTANCE OF THAT WHICH IS EXPRESSED HEREIN AND OF THE CONTENT OF ANNEX 1. SPECIFIC CONDITIONS OF THE POWER OF ATTORNEY GRANTED TO LOZANO BLANCO & ASOCIADOS S.A.S., AND ANNEX 2. CONDITIONS THAT THE PARTY AFFECTED MUST COMPLY WITH. Signature Name Passport No./ National Identification Document Date Address City Country Phone number I attach: Copy of Passport, Copy of PIP implants card, Copy of Public utility Bill.

2 ANNEX 1. SPECIFIC CONDITIONS OF THE POWER OF ATTORNEY GRANTED TO LOZANO BLANCO & ASOCIADOS S.A.S. This document contains the specific conditions of the power of attorney granted by the undersigned of the ACCEPTANCE DOCUMENT AND POWER OF ATTORNEY and forms an integral part of such document (hereinafter The ACCEPTANCE DOCUMENT AND POWER OF ATTORNEY ) and it has been read and accepted in its entirety by the person who signed it, who has the capacity to sign it, holder of the passport or national identification shown beneath her signature of the Acceptance Document and Power of Attorney, and who acts in full use of her legal powers (hereinafter, the PARTY AFFECTED ). This Annex obliges the PARTY AFFECTED and Lozano Blanco & Asociados S.A.S., a commercial company duly incorporated in accordance with the laws of the Republic of Colombia, identified by NIT (Tax Identification Number) , represented for these purposes by Natalie Lozano Blanco, holder of citizenship identity card number and Professional Card No issued by the Superior Judiciary Council (C.S. de la J.) (hereinafter THE ATTORNEY), referred to jointly as THE PARTIES, whereas: THE PARTY AFFECTED has stated that she underwent a surgical operation in which Poly Implant Prothese brand mammary prostheses (hereinafter PIP and/or prostheses) were implanted in her body and that she holds the documents evidencing this operation. THE ATTORNEY offers a representation of THE PARTY AFFECTED to pursue an economic compensation for the damages caused by the PIP Implants which may include the representation of THE PARTY AFFECTED as a victim in any judicial process (hereinafter the Judicial Process) against the following Companies: Poly Implant Prothese, TUV Rheinland France SAS and TUV Rheinland Product Safety GmBY, and any of its partners, subsidiaries or parent establishments (hereinafter THE DEFENDANTS). The foregoing is for the purpose of claiming an economic compensation to cover any present and future damages, moral and material, which may arise or have arisen as a result of THE PARTY AFFECTED having or having had PIP implants. THE ATTORNEY would also undertake the necessary acts for THE PARTY AFFECTED to be represented in any other scenario or process, in or out of court, held outside Colombian territory in relation to the subject of PIP implants and, in particular, in any of the actions referred to in the Acceptance Document and Power of Attorney. THE PARTY AFFECTED hereby grants such power of attorney in the following terms in order for it to be legally binding: FIRST. PURPOSE. THE PARTY AFFECTED wishes THE ATTORNEY to advise her and to act in her judicial representation in the judicial claim which the PARTY AFFECTED has brought against THE DEFENDANTS, because of their participation in the certification, and marketing of PIP prostheses. THE PARTY AFFECTED knows and agrees that this representation shall be exercised in France by the members of the team of the firm of Dr. Laurent Gaudon, including himself (hereinafter the TEAM OF ATTORNEYS IN FRANCE) and/or the attorneys that replace him, for which purpose, by granting this power of attorney, she authorizes THE ATTORNEY to act and/or to grant power of attorney in her name and/or in favor of THE TEAM OF ATTORNEYS IN FRANCE, in compliance with the requirements for such purposes imposed by French legislation. THE PARTY AFFECTED recognizes that, within the framework of this power of attorney, THE

3 ATTORNEY will endure that THE TEAM OF ATTORNEYS IN FRANCE act with the greatest diligence in exercising the power of attorney consisting of obtaining compensation in the name of THE PARTY AFFECTED. However, THE PARTY AFFECTED recognizes that the nature of the power of attorney consists of an obligation regarding means rather than an end. FIRST PARAGRAPH. In exercising this power of attorney, THE ATTORNEY, has all the powers inherent in and necessary for it to be exercised, in particular those of granting power of attorney in the name of THE PARTY AFFECTED to exercise such representation in or out of court in the actions brought against THE DEFENDANTS, to receive, conciliate, claim, accept, settle, substitute, desist, renounce, reassume, draft, pay and, in general, all those necessary for the due fulfillment of the representation. For this purpose, THE PARTY AFFECTED hereby recognizes and accepts that, because what is involved is a collective action, THE ATTORNEY and THE TEAM OF ATTORNEYS IN FRANCE will seek the best alternatives for all the women represented taken as a global group, and, to this end, the negotiations and possible agreements with THE DEFENDANTS shall seek a reasonable solution for all the PARTIES AFFECTED, and the characteristics of one case in particular shall not delay the obtaining of a solution for the global group of women affected. According to this, the party affected hereby recognizes that the attorney might not seek an economic compensation adjusted to every single case, but according to a broad category of damages in which every PARTY AFFECTED is included. SECOND PARAGRAPH. THE TEAM OF ATTORNEYS IN FRANCE is formed by legal practitioners from the most important law firms in France, and is supported by a wide range of professionals in Colombia. SECOND. FEES. THE ATTORNEY shall have the right to receive fees for his professional work, under the terms and in the amounts referred to in this clause, only if, by reason of the claim brought against THE DEFENDANTS, an economic compensation is obtained, by whatever means, and regardless of its amount. If no compensation is rewarded, neither THE PARTY AFFECTED nor THE ATTORNEY shall be obliged to deliver to the other party any amount whatsoever by way of fees, compensations, reparation of damages or expenses of the process, etc. THE PARTIES agree that, in the event that an compensation and/or provision is obtained by any means whatsoever in the process against THE DEFENDANTS, including but not limited to that obtained by an order enacted by a competent judicial or administrative authority, or through a direct agreement with any of THE DEFENDANTS, their attorneys or delegates, THE ATTORNEY will retain, by way of fees, an amount corresponding to nineteen per cent (19%) of the total gross amount of any compensation and/or provision and THE PARTY AFFECTED shall receive eightyone per cent (81%) of the total gross amount of such compensation and/or provision. THE PARTIES agree that the fees agreed upon fully remunerate all the expenses which have been and will be incurred by THE ATTORNEY and THE TEAM OF ATTORNEYS IN FRANCE in respect of aspects such as: hours of work, contracting of advisers, expert opinions, travel expenses, investment in means of communication,, publicity and negotiations with THE TEAM OF ATTORNEYS IN FRANCE. The total fees will be retained in their entirety by THE ATTORNEY once payment of the indemnity has been made, or gradually until the amount is complete if a payment in installments has been ordered, accepted or agreed upon with THE DEFENDANTS.

4 Each party shall be responsible for covering the taxes and/or rates and/or contributions and/or expenses related to money transfer from France or Colombia to the city of residence of the PARTY AFFECTED incurred by virtue of the amount of their percentage received. That is, THE PARTY AFFECTED shall pay the taxes or expenses payable on her 81% of the compensation and THE ATTORNEY shall pay the taxes or expenses arising from the 19% corresponding to here by way of fees. THE PARTY AFFECTED will only be responsible for paying the following costs associated with the judicial process: (i) expenses for sending her documentation to THE ATTORNEY s, (ii) payment for the translation of her documents if this becomes necessary in later stages of the process, (iii) payment of taxes charged by French Courts, as detailed in the Fourth Clause of these Specific Conditions (iv) expenses related to the apostille of documents in case this becomes necessary. THIRD. OBLIGATIONS OF THE ATTORNEY. THE ATTORNEY hereby undertakes, in addition to exercising the greatest diligence in the implementation of the power of attorney agreed upon hereunder: (i) to keep THE PARTY AFFECTED permanently informed of developments under the power of attorney; (ii) if the need arises, to grant power of attorney to THE TEAM OF ATTORNEYS IN FRANCE and on behalf of THE PARTY AFFECTED, whose powers are sufficient in accordance with French legislation, for THE TEAM OF ATTORNEYS IN FRANCE to be able to exercise such representation; and (iii) to include THE PARTY AFFECTED in the legal actions related to this power of attorney, THE PARTY AFFECTED must fulfill all her obligations, specially those stated in clause 4 of this document. If for any reason, THE PARTY AFFECTED that has fulfilled all her obligations is not included by THE ATTORNEY, he will grant that THE PARTY AFFECTED receive the same economic treatment as an effective included PARTY AFFECTED, in terms of the amount and terms that they will receive their economic compensation. This situation will not compromise the ATTORNEY S disciplinary liability in any case; (iv) all other obligations inherent in this power of attorney. FOURTH. OBLIGATIONS OF THE PARTY AFFECTED. For her part, THE PARTY AFFECTED is obliged to: (i) deliver to THE ATTORNEY, all the true and relevant information pertaining to her case, with which the purpose of this power of attorney may be duly exercised. Any inaccurate or false statements regarding the status of the risk and/or the situation of THE PARTY AFFECTED shall be of the exclusive responsibility of THE PARTY AFFECTED, and, if verified as such, will allow THE ATTORNEY to terminate this agreement unilaterally; (ii) to deliver any additional information and/or documentation required by THE ATTORNEY within the three (3) days following a request made through any medium; (iii) to sign and send to THE ATTORNEY the document entitled Acceptance Document and Power of Attorney before the date established by the attorney by any mean; (iv) to deposit the amount of the taxes required by the Tribunal for the judicial process in the bank account or any other medium determined by THE ATTORNEY before the date determined by the attorney. This money shall be for the exclusive use of the Tribunal and under no circumstances shall it be part of THE ATTORNEY s fees. THE PARTY AFFECTED recognizes and accepts that, in the event of her failing to fulfill this obligation, THE ATTORNEY will not include her in the Judicial Process; (v) In the event that the judicial process leads to a second instance or that the Tribunal establishes any payments for experts collaborating in the Trial, THE PARTY AFFECTED shall pay the fiscal costs required by the competent judicial body on the date indicated by THE ATTORNEY or will withdraw from the judicial process without being obliged to compensate THE ATTORNEY. In the event that THE PARTY AFFECTED decides to withdraw from the judicial process, she shall so notify THE ATTORNEY in writing fifteen (15) days in advance of the date fixed for the decision of the appeal. Withdrawal of THE PARTY AFFECTED shall imply that neither THE ATTORNEY nor THE

5 TEAM OF ATTORNEYS IN FRANCE may neither represent in court nor claim any economic compensation in representation of THE PARTY AFFECTED. Such money shall be for the exclusive use of the competent judicial body and in no event shall it form part of the fees of THE ATTORNEY. THE PARTY AFFECTED recognizes and accepts that, in the event of her failing to comply with payment of the tax, THE ATTORNEY will not include her in either the first or the second instance of the Judicial Process; (vi) to notify THE ATTORNEY about any changes in her contact information; (vii) All other obligations inherent in this Power of Attorney. FIFTH. TERMINATION. THE PARTY AFFECTED agrees that THE ATTORNEY may terminate this representation unilaterally with just cause without any type of notification in advance or compensation being necessary and/or a requirement. The following shall be just causes for termination: (i) failure to fulfill any of the obligations of THE PARTY AFFECTED, (ii) impossibility of contacting THE PARTY AFFECTED within a term exceeding one (1) week, (ii) failure on the part of THE PARTY AFFECTED to deliver to THE ATTORNEY any verbal or written information necessary for her to undertake the pre-judicial or judicial process, including THE PARTY AFFECTED passport and the PIP implants ID Card. The incomplete delivery of that information, or its delivery with a substandard quality according to the ATTORNEY S criteria, makes it impossible to process and will be a termination with just case. (iv) non-fulfillment of the obligation of THE PARTY AFFECTED to pay the amount of the taxes required by the Tribunal prior to the date established by the attorney and/or the taxes required by the competent judicial body in a second instance within the term fixed by THE ATTORNEY, (v) termination on any grounds of the Agreement between THE ATTORNEY and THE TEAM OF ATTORNEYS IN FRANCE and/or (vi) impossibility for THE ATTORNEY, THE PARTY AFFECTED or third parties to finance unforeseen costs of the process. SIXTH. EXCLUSIVENESS. THE PARTY AFFECTED will not grant another Power of Attorney, in order to be represented by a different attorney in the same legal actions in which THE PARTY AFFECTED is already represented by the ATTORNEY. The failure to comply with this clause will be a just cause for the termination of this agreement, and will allow THE ATTORNEY to claim from THE PARTY AFFECTED the payment off all his representation expenses. For that purpose this document will represent an enforceable right.

6 ANNEX. Specific obligations of the Party Affected for her inclusion in the legal actions. In regard to the power of attorney that THE PARTY AFFECTED granted to the ATTORNEY, and as an essential condition to make that document legally binding, THE PARTY AFFECTED is obliged to: 1. Ensure that all the documents delivered are legible and have the quality required by THE ATTORNEY to be processed. In case that the ATTORNEY requires THE PARTY AFFECTED to send a document in a better quality, THE PARTY AFFECTED is obliged to do so before the date established by THE ATTORNEY. 2. Pay the tax required by the Tribunal in order to be included in the legal action. THE PARTY AFFECTED must deposit or transfer the amount of money in the time and place established by THE ATTORNEY. Failure to comply with these obligations will make the power of attorney unenforceable and will allow THE ATTORNEY to deny the inclusion of THE PARTY AFFECTED in the legal actions related, without any kind of responsibility.!