Zanca v. Epic Games, Inc.

Class Action Settlement

CLAIM FORM

TO RECEIVE A CASH PAYMENT OR V-BUCKS/CREDITS FROM THIS SETTLEMENT, YOU MUST

COMPLETE THIS CLAIM FORM AND RETURN IT ON OR BEFORE APRIL 26, 2021.
This Settlement is open only to certain eligible United States residents who spent real money for items in Fortnite or
Rocket League. Please review this form to determine if you are eligible to participate in this Settlement. If you are
a Settlement Class Member who acquired a Fortnite loot box or a Rocket League loot box where the contents were
not known until after you opened it, you do not need to complete a Claim Form in order to receive 1,000 V-Bucks or
1,000 Credits in the Fortnite or Rocket League account in which you acquired that item. You only need to submit this
Claim Form if you believe you are entitled to, and would like to receive, the additional benefits made available by
the Settlement. For more information, visit www.EpicLootBoxSettlement.com, or call the Settlement Administrator
at 1-800-466-0862.

IMPORTANT NOTE: You must submit this Claim Form to the Settlement Administrator by April 26, 2021. To
complete this Claim Form, read the instructions below in Part 1, truthfully provide the requested information in Parts
2 and 3 (or Part 4 if seeking minor disaffirmance), sign the certification in Part 5, and submit the Claim Form using
one of the methods stated in Part 6. This Claim Form must be completed by a legal adult. Parents or guardians may
submit claims on behalf of minors.
Each Settlement Class Member is entitled to submit only one Claim Form relating to Fortnite play and one Claim
Form relating to Rocket League play, regardless of the number of accounts opened.

PART 1: GENERAL INSTRUCTIONS

If at any time between July 1, 2015, and February 25, 2021, you had a Fortnite or Rocket League account that you
used to play either game on any device and in any mode, and you made a real-money purchase of virtual currency or
other in-game benefit for use within Fortnite or Rocket League, you may be eligible to receive one of the following
benefits under the Settlement Agreement (the “Settlement”):
• Refunds for Real Money Purchases: If you bought virtual currency or other in-game benefits with real
money, and contend that any aspect of these real-money purchases, or of your use of in-game virtual currency
for in-game benefits, gives rise to a claim of consumer fraud, breach of contract, or other legal claim for
damages, you may file a claim. A neutral settlement administrator will review your claim and determine if
you should receive a refund through the settlement.
• Minor Disaffirmation: If (i) you were a legal minor at the time you used real money to buy virtual currency
or other in-game benefits in connection with your play of Fortnite or Rocket League, and (ii) made these real
money purchases with your own money and without permission from a parent or guardian, then (iii) you (if
you are now an adult) or your parent or guardian (if you are still a minor) may file a claim. If you disaffirm
purchases, you must disclose all of your Epic Games accounts, and Epic Games will close them. You cannot
continue to play in any accounts you opened as a minor after disaffirming your purchases.
This document must be filled out by a legal adult. It is important that all of the information you provide in
this Claim Form is true, accurate, and complete. You may be required to provide documentation to the Settlement
Administrator supporting the answers you provide. Persons who submit false or fraudulent claims will not be eligible
for benefits.

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 PART 2: ACCOUNT OWNER’S INFORMATION

Please provide the following information regarding your CURRENT contact information:
(Parents and guardians filing claims on behalf of minors will also provide their information in Part 4.)
This claim concerns: Fortnite OR Rocket League
To submit a claim for both games, you must submit separate Claim Forms—one Claim Form for Fortnite and one for
Rocket League. You cannot submit one Claim Form for both.

Account Owner’s First Name MI Last Name

Address 1 (street name and number)

Address 2 (apartment, unit, or box number)

City State ZIP Code

Contact Phone Number

– –
Contact Email Address

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 Please provide your Epic Games account information below.

Note: If you are claiming minor disaffirmation, you must disclose all of your Epic Games accounts so that they may
be closed. Please use a separate sheet if necessary, providing the email address, account number, and display name
associated with each of your Epic Games accounts.
Email Address Epic Games Account Number (requires 32 characters) Epic Games Account
Associated with Epic Display Name or Platform
Games Account Display Name
________________________________

________________________________

________________________________

PART 3: REFUNDS FOR REAL MONEY PURCHASES OF IN-GAME ITEMS

If you are a minor, this Claim Form must be completed by your parent or guardian.
A. Describe below the real money purchase(s) for which you are seeking a refund. If you purchased virtual
currency and are claiming any issue or problem with your use of that purchased virtual currency or with
any in-game item that you obtained with that purchased virtual currency, the information you provide below
should relate to the actual purchase of the virtual currency:

Where you
made
purchase(s): Date of the
What item(s) purchase Purchase
Epic Games Account # that you used for the purchase you purchased Price for
OR Third (requires 32 characters) with real MM/DD/ the item
party (e.g., money YYYY
Apple Store,
PlayStation
Store, etc.)

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

If you made the real-money purchase(s) from a source other than Epic Games, you must provide a receipt
showing the purchase details. This can be a screen shot, picture, or document that clearly shows the product(s)
or item(s) purchased, the total amount paid, the purchase date, and the invoice/order/confirmation identifier.
You also must provide a receipt in the case of a purchase from Epic Games if you cannot provide the date of
purchase. If you need additional space, please use the space at the end of this Claim Form, or attach additional sheets
if necessary.

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 B. Provide a short description or explanation of how you believe you have been damaged or harmed from your
real-money purchases identified above (or, if you are seeking a refund of a virtual currency purchase, the
damage or harm that resulted from or related to your use or attempted use of that virtual currency in the
game) and why that damage or harm entitles you to a benefit. You may submit documentation as part of your
claim. If you need additional space, please use the space at the end of this Claim Form, or attach additional
sheets if necessary.

The Settlement Administrator will review your claim and determine your eligibility to receive a payment from
the Settlement and the amount of your payment. You may elect to receive your benefit either (i) in cash or
(ii) as a deposit of V-Bucks into your Fortnite account or Credits into your Rocket League account. If you request
a cash payment and your claim does not exceed $25.00, you may be awarded the entire amount of the
claim in cash. If you request a cash payment and your claim exceeds $25.00, your award will be capped at
$25.00 plus 50% of the amount by which the claim exceeds $25.00, up to a maximum total of $50.00. Your
payment may be reduced based on the amount of funds available to satisfy all claims (see the Long Form Notice at
www.EpicLootBoxSettlement.com for more details).

If you request a V-Bucks or Credit benefit and your claim does not exceed the amount for which Epic Games sells
13,500 V-Bucks or 13,000 Credits, you may receive a V-Bucks or Credit benefit in proportion to the full amount
claimed. For example, if you select a V-Bucks benefit and the Settlement Administrator approves your claim in the
amount of $80.00, you will receive 13,500 V-Bucks deposited into your Fortnite account.
Elect whether to receive a cash benefit or a credit of V-Bucks or Credits to the Game Account Number
provided above in the Account Owner’s Information section:

Check

Digital Payment

V-Bucks/Credits

Note: You agree that in choosing the Check or Digital Payment benefit, if your claim exceeds $25.00, your award will be capped
at $25.00 plus 50% of the amount by which the claim exceeds $25.00, up to a maximum total of $50.00.

If you choose the Digital Payment option, an email will be sent to you at the provided email address after Final Approval of the
Settlement to provide Digital Payment options.

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 PART 4: MINOR CONTRACTUAL DISAFFIRMATION
If you are a minor, this Claim Form must be completed by your parent or guardian. If you (i) were a minor at
the time you used real money to purchase V-Bucks or Credits from Epic Games or a third party, or made other real
money purchases from Epic Games in connection with your play of Fortnite or Rocket League; (ii) made these real
money purchases with your own money; (iii) did so without permission from a parent or guardian; and (iv) wish to
obtain refunds for those purchases, you may receive a refund for one-third (1/3) of your total purchase amounts at
issue or $50.00, whichever is less. Contractual disaffirmation, as a matter of law, must be total. For this reason,
by making a claim under this section, you agree to the closure of all of your Epic Games accounts that you
opened while you were a minor. If you are still a minor, your parent/guardian will be able to open a new
account and allow you to play on it, but you cannot open a new account for yourself until you are an adult. If
you are now an adult, you may open a new account yourself.

Describe below, in as much detail as possible, your real-money purchase(s) of virtual currency or other in-game
benefits that you wish to disaffirm:

Where you
made What
purchase(s): item(s) you Date of the Purchase
Epic Games Account # that you used for the purchase purchase
OR Third purchased Price for
(requires 32 characters)
party (e.g., with real MM/DD/YYYY the item
Apple Store, money
PlayStation
Store, etc.)

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

________________________________ _ _ /_ _ /_ _ _ _ $_ _ _ _._ _

If you did not make the purchase(s) from Epic Games, you must provide a receipt showing the purchase
details. This can be a screen shot, picture, or document that clearly shows the product(s) or item(s) purchased,
the total amount paid, the purchase date, and the invoice/order/confirmation identifier. You also must provide
a receipt in the case of a purchase from Epic Games if you cannot provide the date of purchase. If you need
additional space, please use the space at the end of this Claim Form, or attach additional sheets if necessary.

The Settlement Administrator will determine the amount of the real-money purchase(s) for which you may be eligible
for reimbursement based on the information you provide above and the available Settlement funds. Your Minor
Disaffirmation benefit may be reduced based on the amount of funds available to satisfy all claims (see the Long
Form Notice at www.EpicLootBoxSettlement.com for more details).

Elect whether to receive your benefit as a check or digital payment:

Check

Digital Payment

If you choose the Digital Payment option, an email will be sent to you at the provided email address after Final Approval of the
Settlement to provide Digital Payment options.

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 Attestation: If the Settlement Class Member seeking disaffirmation is still a minor, this Claim Form must be
completed by the Settlement Class Member’s parent or guardian, and that parent or guardian must complete the
below attestation:

I am the Parent/Guardian of the Claimant, and I attest that the Claimant (i) was a minor when he or she
purchased virtual currency or other in-game benefits from Epic Games or a third party in connection with
his or her play of Fortnite or Rocket League, (ii) made these purchases with his or her own money, and
(iii) did so without permission from a parent or guardian.

True

False

Parent/Guardian Contact Information:

First Name MI Last Name

Address 1 (street name and number)

Address 2 (apartment, unit, or box number)

City State ZIP Code

Telephone Number
– –
Email Address

PART 5: CERTIFICATION AND SIGNATURE

I certify that I am an adult of 18 years or older and a member of the Settlement Class or am the Parent/Guardian
of a member of the Settlement Class. I further certify that the information I have provided in this Claim Form
is true and correct to the best of my knowledge and belief. I understand that the Settlement Administrator has
the right to verify my claim and may ask Epic Games to provide certain information related to my Epic Games
Membership Account to verify my claim.

– –
Date:
MM DD YYYY
Signature of Claimant (or Parent/Guardian if minor)

Print your name here

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 PART 6: METHODS OF SUBMISSION
Please complete the Claim Form above and return it by one of the following methods (the electronic submission
of your Claim Form via the settlement website is recommended for the most efficient processing of your claim):

1. Visit www.EpicLootBoxSettlement.com and submit an online Claim Form no later than midnight, U.S.
Eastern Standard Time, on April 26, 2021; OR

2. Mail your completed and signed Claim Form to the Settlement Administrator via U.S. Mail, postmarked no
later than April 26, 2021, and addressed to:

Epic Games Settlement

Settlement Administrator
P.O. Box 2973
Portland, OR 97208-2973

3. Email your completed claim form to: claims@EpicLootBoxSettlement.com no later than April 26, 2021.

If you have any questions or need any assistance, please visit

www.EpicLootBoxSettlement.com, or call the Settlement Administrator at 1-800-466-0862.

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