Variable Electric Settlement

Claim Form

PART A - PERSONAL INFORMATION

Please read the following instructions carefully before filling out your Claim Form.

If you were a customer of Starion Energy’s variable rate electricity supply services in connection with a property located within Connecticut the District of Columbia, Delaware, Illinois, Maryland, Massachusetts, New Jersey, New York, Ohio or Pennsylvania (the “Service Territories”) at any time through and including May 24, 2017 (the “Class Period”), you could be entitled to a cash payment from the class action settlement.

Please complete all information below.

Claim Forms must be postmarked or electronically submitted by October 30, 2017

PART B - ACCOUNT ELIGIBILITY

Please provide your electric utility account number for the account for which you enrolled in Starion Energy’s variable rate electricity supply services in connection with a property located within the Service Territories during the Class Period. This account number will be used to assist in determining your membership in the Class and the eligible amount of variable rate electricity you used during the Class Period.

PART C - CERTIFICATION

Required