Election/Rollover Form

Election/Rollover Form Login

In order to receive your share of the Settlement by direct rollover to a qualified individual retirement account, Class Members must complete and submit this form on or before July 16, 2025. Please review the instructions below carefully. If you have questions regarding this form, you may contact the Settlement Administrator at (866) 675-3082.

This Rollover Form is ONLY for Class Members who would like to elect to receive their settlement payment through a rollover to a qualified retirement account through direct deposit or by paper check. To do so, Class Members must complete and sign this form and received on or before July 16, 2025.Please review the instructions below carefully. Former Participants who do not complete and timely return this form will receive their settlement payment by a check payable to themselves (subject to applicable tax withholding). If you have questions regarding this form, you may contact the Settlement Administrator at (866) 675-3082 or info@RVNBESOPSettlement.com.

Instructions for Completing Former Participant Rollover Form.

  1. If you would like to receive your settlement payment through a rollover to a qualified retirement account, complete this rollover form. It is your responsibility to ensure the Settlement Administrator has timely received your Rollover Form by July 16, 2025.

  2. You must provide all required information (including date of birth and social security number) and sign your form where indicated.

  3. If you omit to provide all necessary information or fail to sign your form, payment will be made to you by check.

  4. If you change your address after sending in your Rollover Form, you must provide your new address to the Settlement Administrator as soon as possible.

  5. To start your online Rollover Form, please provide the Unique ID and PIN located on your Notice.

Questions? If you have any questions about this Rollover Form or need assistance finding your Unique and PIN, please call the Settlement Administrator at (866) 675-3082. The Settlement Administrator will provide advice only regarding completing this form and will not provide financial, tax or other advice concerning the Settlement. You therefore may want to consult with your financial or tax advisor.

Note: The timing of the distribution of the Settlement payments is conditioned on several matters, including the Court’s final approval of the Settlement and any approval becoming final and no longer subject to any appeals in any court. If the Settlement is approved by the Court, and there are no appeals, the first Settlement distribution likely will occur within sixty days of the Court's Final Approval Order.