Supreme Court of Victoria - Origin Energy Opt Out

ORIGIN ENERGY CLASS ACTION

NOTICE OF OPTING OUT BY GROUP MEMBER
ONLY COMPLETE THIS FORM IF YOU WANT TO OPT OUT OF THE ORIGIN ENERGY CLASS ACTION

IF YOU OPT OUT, YOU WILL NO LONGER BE A GROUP MEMBER.
INTERNAL - Class Action Name
INTERNAL - Class Action Inbox
INTERNAL - Email Recipients
Your name

First NameLast Name
I am a
Name of Company you are Director of:
Insert company name
Name of Estate you are Executor or Administrator for:
Insert first and last name of group member
Name of group member you are Power of Attorney for:
Insert first and last name of group member
Name of group member you act for:
Insert first and last name of group member
in the above group proceeding, and give notice under section 33J(2) of the Supreme Court Act 1986 (Vic) that I am opting out of this proceeding (if a group member) or on behalf of the group member whom I represent (if I am a representative of that group member).

Signature of group member, director of group member, Executor, power of attorney or solicitor for group member.
Should be Empty:

ORIGIN ENERGY CLASS ACTION