PROOF OF CLAIM AND RELEASE Deadline fr Submissin: July 11, 2015 IF YOU PURCHASED THE COMMON STOCK OF, INC., ( ) DURING THE PERIOD FROM NOVEMBER 14, 2013 THROUGH APRIL 9, 2014, INCLUSIVE (THE CLASS PERIOD ), YOU ARE A CLASS MEMBER AND YOU MAY BE ENTITLED TO SHARE IN THE SETTLEMENT PROCEEDS. IF YOU ARE A CLASS MEMBER, YOU MUST COMPLETE AND SUBMIT THIS FORM IN ORDER TO BE ELIGIBLE FOR ANY SETTLEMENT BENEFITS. YOU MUST COMPLETE AND SIGN THIS PROOF OF CLAIM AND RELEASE ( PROOF OF CLAIM ) AND MAIL IT BY FIRST CLASS MAIL, POSTMARKED NO LATER THAN JULY 11, 2015 TO STRATEGIC CLAIM SERVICES, THE CLAIMS ADMINISTRATOR, AT THE FOLLOWING ADDRESS: Grwlife, Inc. Litigatin c/ Strategic Claims Services P.O. Bx 230 600 N. Jacksn St., Ste. 3 Media, PA 19063 Tel.: 866 274 4004 Fax: 610 565 7985 inf@strategicclaims.net YOUR FAILURE TO SUBMIT YOUR CLAIM BY JULY 11, 2015 WILL SUBJECT YOUR CLAIM TO REJECTION AND PRECLUDE YOUR RECEIVING ANY MONEY IN CONNECTION WITH THE SETTLEMENT OF THIS ACTION. DO NOT MAIL OR DELIVER YOUR CLAIM TO THE COURT OR TO ANY OF THE PARTIES OR THEIR COUNSEL AS ANY SUCH CLAIM WILL BE DEEMED NOT TO HAVE BEEN SUBMITTED. SUBMIT YOUR CLAIM ONLY TO THE CLAIMS ADMINISTRATOR. CLAIMANT S STATEMENT 1. I (we) purchased cmmn stck in Grwlife, Inc. and was (were) damaged thereby. (D nt submit this Prf f Claim if yu did nt purchase Grwlife cmmn stck during the designated Class Perid). 2. By submitting this Prf f Claim, I (we) state that I (we) believe in gd faith that I am (we are) a Class Member as defined abve and in the Ntice f Pendency and Settlement f Class Actin (the Ntice ), r am (are) acting fr such persn(s); that I am (we are) nt a Defendant in the Actins r anyne excluded frm the Class; that I (we) have read and understand the Ntice; that I (we) believe that I am (we are) entitled t receive a share f the Net Settlement Fund, as defined in the Ntice; that I (we) elect t participate in the prpsed Settlement described in the Ntice; and that I (we) have nt filed a request fr exclusin. (If yu are acting in a representative capacity n behalf f a Class Member [e.g., as an executr, administratr, trustee, r ther representative], yu must submit evidence f yur current authrity t act n behalf f that Class Member. Such evidence wuld include, fr example, letters testamentary, letters f administratin, r a cpy f the trust dcuments.) 3. I (we) cnsent t the jurisdictin f the Curt with respect t all questins cncerning the validity f this Prf f Claim. I (we) understand and agree that my (ur) claim may be subject t investigatin and discvery under the Federal Rules f Civil Prcedure, prvided that such investigatin and discvery shall be limited t my (ur) status as a Class Member(s) and the validity and amunt f my (ur) claim. N discvery 11
shall be allwed n the merits f the Litigatin r Settlement in cnnectin with prcessing f the Prf f Claim. 4. I (we) have set frth where requested belw all relevant infrmatin with respect t each purchase f Grwlife cmmn stck during the Class Perid, and each sale, if any, f such securities. I (we) agree t furnish additinal infrmatin t the Claims Administratr t supprt this claim if requested t d s. 5. I (we) have enclsed phtcpies f the stckbrker s cnfirmatin slips, stckbrker s statements, r ther dcuments evidencing each purchase, sale r retentin f Grwlife cmmn stck listed belw in supprt f my (ur) claim. (IF ANY SUCH DOCUMENTS ARE NOT IN YOUR POSSESSION, PLEASE OBTAIN A COPY OR EQUIVALENT DOCUMENTS FROM YOUR BROKER BECAUSE THESE DOCUMENTS ARE NECESSARY TO PROVE AND PROCESS YOUR CLAIM.) 6. I (we) understand that the infrmatin cntained in this Prf f Claim is subject t such verificatin as the Claims Administratr may request r as the Curt may direct, and I (we) agree t cperate in any such verificatin. (The infrmatin requested herein is designed t prvide the minimum amunt f infrmatin necessary t prcess mst simple claims. The Claims Administratr may request additinal infrmatin as required t efficiently and reliably calculate yur recgnized claim. In sme cases, the Claims Administratr may cnditin acceptance f the claim based upn the prductin f additinal infrmatin, including, where applicable, infrmatin cncerning transactins in any derivatives securities such as ptins.) 7. Upn the ccurrence f the Curt s apprval f the Settlement, as detailed in the Ntice, I (we) agree and acknwledge that my (ur) signature(s) heret shall effect and cnstitute a full and cmplete release, remise and discharge by me (us) and my (ur) heirs, jint tenants, tenants in cmmn, beneficiaries, executrs, administratrs, predecessrs, successrs, attrneys, insurers and assigns (r, if I am (we are) submitting this Prf f Claim n behalf f a crpratin, a partnership, estate r ne r mre ther persns, by it, him, her r them, and by its, his, her r their heirs, executrs, administratrs, predecessrs, successrs, and assigns) f each f the Released Parties f all Release f Claims, as defined in the Ntice. 8. NOTICE REGARDING ELECTRONIC FILES: Certain claimants with large numbers f transactins may request, r may be requested, t submit infrmatin regarding their transactins in electrnic files. All Claimants MUST submit a manually signed paper Prf f Claim frm listing all their transactins whether r nt they als submit electrnic cpies. If yu wish t file yur claim electrnically, yu must cntact the Claims Administratr at 1 866 274 4004 r visit their website at www.strategicclaims.net t btain the required file layut. N electrnic files will be cnsidered t have been prperly submitted unless the Claims Administratr issues t the Claimant a written acknwledgment f receipt and acceptance f electrnically submitted data. 12
I. CLAIMANT INFORMATION Name Address City State ZIP Freign Prvince Day Phne Freign Cuntry Evening Phne Email Scial Security Number (fr individuals) OR Taxpayer Identificatin Number (fr estates, trusts, crpratins, etc.) II. SCHEDULE OF TRANSACTIONS IN COMMON STOCK Beginning Hldings: A. State the ttal number f shares f Grwlife cmmn stck wned at the clse f trading n Nvember 13, 2013, lng r shrt (must be dcumented). Purchases: B. Separately list each and every pen market purchase f Grwlife cmmn stck during the perid frm Nvember 14, 2013 thrugh July 23, 2014, inclusive, and prvide the fllwing infrmatin (must be dcumented): Trade Date (List Chrnlgically) (Mnth/Day/Year) Number f Shares Purchased Price per Share Ttal Cst (Excluding Cmmissins, Taxes, and Fees) 13
Sales: C. Separately list each and every sale f Grwlife cmmn stck during the perid Nvember 14, 2013 thrugh July 23, 2014, inclusive, and prvide the fllwing infrmatin (must be dcumented): Trade Date Amunt Received (List Chrnlgically) (Excluding Cmmissins, (Mnth/Day/Year) Number f Shares Sld Price per Share Taxes, and Fees) Ending Hldings: D. State the ttal number f shares f Grwlife cmmn stck wned at the clse f trading n July 23, 2014, lng r shrt (must be dcumented). If additinal space is needed, attach separate, numbered sheets, giving all required infrmatin, substantially in the same frmat, and print yur name and Scial Security r Taxpayer Identificatin Number at the tp f each sheet. III. SUBSTITUTE FORM W 9 Request fr Taxpayer Identificatin Number: Enter taxpayer identificatin number belw fr the Beneficial Owner(s). Fr mst individuals, this is yur Scial Security Number. The Internal Revenue Service ( I.R.S. ) requires such taxpayer identificatin number. If yu fail t prvide this infrmatin, yur claim may be rejected. Scial Security Number (fr individuals) r Taxpayer Identificatin Number (fr estates, trusts, crpratins, etc.) IV. CERTIFICATION I (We) certify that I am (we are) NOT subject t backup withhlding under the prvisins f Sectin 3406 (a)(1)(c) f the Internal Revenue Cde because: (a) I am (We are) exempt frm backup withhlding, r (b) I (We) have nt been ntified by the I.R.S. that I am (we are) subject t backup withhlding as a result f a failure t reprt all interest r dividends, r (c) the I.R.S. has ntified me (us) that I am (we are) n lnger subject t backup withhlding. NOTE: If yu have been ntified by the I.R.S. that yu are subject t backup withhlding, please strike ut the language that yu are nt subject t backup withhlding in the certificatin abve. 14
UNDER THE PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES, I (WE) CERTIFY THAT ALL OF THE INFORMATION I (WE) PROVIDED ON THIS PROOF OF CLAIM AND RELEASE FORM IS TRUE, CORRECT AND COMPLETE. Signature f Claimant (If this claim is being made n behalf f Jint Claimants, then each must sign): (Signature) (Signature) Date: (Capacity f persn(s) signing, e.g. beneficial purchaser(s), executr, administratr, trustee, etc.) Check here if prf f authrity t file is enclsed. (See Item 2 under Claimant s Statement) THIS PROOF OF CLAIM MUST BE SUBMITTED NO LATER THAN JULY 11, 2015 AND MUST BE MAILED TO: Grwlife, Inc. Litigatin c/ Strategic Claims Services P.O. Bx 230 600 N. Jacksn St., Ste. 3 Media, PA 19063 Tel.: 866 274 4004 Fax: 610 565 7985 inf@strategicclaims.net A Prf f Claim received by the Claims Administratr shall be deemed t have been submitted when psted, if mailed by July 11, 2015 and if a pstmark is indicated n the envelpe and it is mailed first class and addressed in accrdance with the abve instructins. In all ther cases, a Prf f Claim shall be deemed t have been submitted when actually received by the Claims Administratr. Yu shuld be aware that it will take a significant amunt f time t prcess fully all f the Prfs f Claim and t administer the Settlement. This wrk will be cmpleted as prmptly as time permits, given the need t investigate and tabulate each Prf f Claim. Please ntify the Claims Administratr f any change f address. 15
REMINDER CHECKLIST Please be sure t sign this Prf f Claim n page 15. If this Prf f Claim is submitted n behalf f jint claimants, then bth claimants must sign. Please remember t attach supprting dcuments. D NOT send any stck certificates. Keep cpies f everything yu submit. D NOT use highlighter n the Prf f Claim r any supprting dcuments. If yu mve after submitting this Prf f Claim, please ntify the Claims Administratr f the change in yur address.