In re Dentsply Sirona, Inc. Securities Litigation

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF NEW YORK
In re Dentsply Sirona, Inc. Securities Litigation
Case No. 1:18-cv-07253-NG-PK
PROOF OF CLAIM AND RELEASE
Must Be Postmarked or Submitted Online No Later Than:
October 7, 2025, or within 30 days after final approval is granted to the Settlement, whichever is later

PART I: CLAIMANT INFORMATION

The Claims Administrator will use this information for all communications regarding this Proof of Claim and Release Form. If this information changes, you MUST notify the Claims Administrator in writing at the address above. Complete names of all persons and entities must be provided.

NAME SECTION

Beneficial Owner’s Name:

Joint Beneficial Owner’s Name (If Applicable)

If this claim is submitted for an IRA, and if you would like any check that you MAY be eligible to receive made payable to the IRA, please include “IRA” in the “Last Name” box above (e.g., Jones IRA).

Entity Name (if Beneficial Owner is not an individual):

Name of Representative, if applicable (executor, administrator, trustee, c/o, etc if different from Beneficial Owner

ADDRESS SECTION

Address 1 (street name and number): *

Address 2 (apartment, unit, or box number):

Country: *

City: *

State: *

Zip Code: *

CONTACT SECTION

Telephone Number (Day): *

Telephone Number (Evening):

Email Address:(email address is not required, but if you provide it you authorize the Claims Administrator to use it in providing you with information relevant to this claim)

Claimant Account Type: *

PART II – SCHEDULE OF TRANSACTIONS IN COMMON STOCK

1. HOLDINGS AS OF DECEMBER 8, 2015. – State the total number of shares of Dentsply Intl. common stock held as of the opening of trading on December 8, 2015. If none, enter “0". (Must be documented.) *

2. PURCHASES OR OTHER ACQUISITIONS FROM DECEMBER 8, 2015 THROUGH AUGUST 6, 2018. – Separately list each and every purchase or other acquisition of Dentsply Intl. or Dentsply Sirona common stock from December 8, 2015 through the close of trading on August 6, 2018. (Must be documented.)

Date of Purchase or Other Acquisition (List Chronologically) (Month/Day/Year):

Number of Shares Purchased or Otherwise Acquired:

Purchase or Other Acquisition Price Per Share:

Total Purchase or Other Acquisition Price (excluding taxes, commissions, and fees):

Must click Add Purchase to submit your transactions.

Date of Purchase or Other Acquisition (List Chronologically) (Month/Day/Year):

Number of Shares Purchased or Otherwise Acquired

Purchase or Other Acquisition Price Per Share

Total Purchase or Other Acquisition Price (excluding taxes, commissions, and fees)

Action

3. NUMBER OF SHARES PURCHASED OR OTHERWISE ACQUIRED FROM AUGUST 7, 2018 THROUGH NOVEMBER 2, 2018. – State the total number of shares of Dentsply Sirona common stock purchased or otherwise acquired from on August 7, 2018 through November 2, 2018. If none, enter “0" (Must be documented.)¹

¹The number of shares purchased or otherwise acquired of Dentsply Sirona common stock during the “90-day look-back period” from August 7, 2018 through November 2, 2018 are needed in order to balance your claim. NOTE that those shares are not eligible for a recovery in this Settlement.

4. SALES FROM DECEMBER 8, 2015 THROUGH NOVEMBER 2, 2018. – Separately list each and every sale of Dentsply Intl. or Dentsply Sirona common stock from on December 8, 2015 through the close of trading on November 2, 2018. (Must be documented.):

Date of Sale (List Chronologically) (Month/Day/Year):

Number of Shares Sold:

Sales Price Per Share:

Total Sale Price (excluding taxes, commissions and fees):

Must click Add Sale to submit your transactions.

Date of Sale (List Chronologically) (Month/Day/Year)

Number of Shares Sold

Sale Price Per Share

Total Sale Price

Action

5. HOLDINGS AS OF NOVEMBER 2, 2018. – State the total number of shares of Dentsply Sirona common stock held as of the close of trading on November 2, 2018. If none, enter “0". (Must be documented.): *

UPLOAD SUPPORTING DOCUMENTS

All supporting documentation for your positions and transactions should be uploaded to this page prior to moving on to the next step in your online claim submission.

Please use the browse option, by clicking on “Select Files” in the box below, to upload your supporting documentation being submitted to verify all of your positions and transactions.

Select files

Files To Be Uploaded	Size	Action

PART III – ACKNOWLEDGMENTS AND RELEASE

A. SUBMISSION TO JURISDICTION OF COURT AND ACKNOWLEDGMENTS

I (We) submit this Proof of Claim and Release Form under the terms of the Stipulation and Agreement of Settlement, dated March 12, 2025, described in the Notice. I (We) also submit to the jurisdiction of the United States District Court for the Eastern District of New York with respect to my (our) claim as a Class Member and for purposes of enforcing the release set forth herein. I (We) further acknowledge that I am (we are) bound by and subject to the terms of any judgment that may be entered in the Action. I (We) agree to furnish additional information to the Claims Administrator to support this claim if requested to do so. I (We) have not submitted any other claim in the Action covering the same purchases/acquisitions or sales of Dentsply Intl. or Dentsply Sirona common stock and know of no other person having done so on my (our) behalf.

B. RELEASE AND WARRANTIES

1. I (We), on behalf of myself (ourselves) and my (our) heirs, executors, administrators, predecessors, successors, and assigns, in their capacities as such, hereby acknowledge full and complete satisfaction of, and do hereby fully, finally, and forever compromise, settle, release, resolve, relinquish, waive, and discharge each and every Released Plaintiffs’ Claim (as defined in paragraph 39 of the Notice) against each and every one of the Defendants and the other Defendants’ Releasees (as defined in paragraph 40 of the Notice), and shall forever be barred and enjoined from commencing, instituting, prosecuting, or maintaining any or all of the Released Plaintiffs’ Claims, including any Unknown Claims (as defined in paragraph 41 of the Notice), against any of the Defendants’ Releasees.

2. I (We) hereby acknowledge that I (we) will not be entitled to receive recovery in any other action against any of the Defendants’ Releasees based on or arising out of the Released Plaintiffs’ Claims.

3. I (We) hereby warrant and represent that I am (we are) a Class Member as defined in the Notice, and that I (we) believe I am (we are) eligible to receive a distribution from the Net Settlement Fund under the terms and conditions of the Plan of Allocation, as set forth in the Notice.

4. I (We) hereby warrant and represent that I (we) have included information (including supporting documentation) about all of my (our) transactions in Dentsply Intl. or Dentsply Sirona common stock which occurred during the Class Period between December 8, 2015 and August 6, 2018, inclusive, and any sales of Dentsply Intl. or Dentsply Sirona common stock purchased or otherwise acquired during the Class Period and sold on or prior to the close of trading on November 2, 2018, as well as the number of shares of Dentsply Intl. or Dentsply Sirona common stock held by me (us) at the opening of trading on December 8, 2015 and the close of trading on November 2, 2018.

5. I (WE) UNDERSTAND AND INTEND THAT THE SIGNATURE BELOW REGARDING CERTAIN INFORMATION FOR THE INTERNAL REVENUE SERVICE CONCERNING BACKUP WITHHOLDING ALSO SERVES AS THE SIGNATURE VERIFYING THE INFORMATION AND REPRESENTATIONS IN THIS PROOF OF CLAIM.

6. This release shall be of no force or effect unless and until the Court approves the Settlement and it becomes effective on the Effective Date.

7. I (We) hereby warrant and represent that I (we) have not assigned or transferred or purported to assign or transfer, voluntarily or involuntarily, any matter released pursuant to this release or any other part or portion thereof.

8. I (We) certify that I am (we are) not subject to backup withholding under the provisions of Section 3406(a)(1)(C) of the Internal Revenue Code. (Note: If you have been notified by the Internal Revenue Service that you are subject to backup withholding, please strike out the prior sentence.)

I declare under penalty of perjury under the laws of the United States of America that all of the foregoing information supplied on this Proof of Claim and Release Form by the undersigned is true and correct.

Signature of Claimant: *

Signature of joint Claimant, if any:

(Capacity of person(s) signing, e.g., Beneficial Purchaser, Executor or Administrator)

REMINDER CHECKLIST

1. Please sign the above release and acknowledgement.

2. If this claim is being made on behalf of Joint Claimants, then both must sign.

3. Remember to attach copies of supporting documentation, if available.

4. Do not send originals of supporting documentation. DO NOT SEND ORIGINAL STOCK CERTIFICATES.

5. Keep a copy of your Proof of Claim and Release Form and all supporting documentation for your records.

The Claims Administrator will acknowledge receipt of your Proof of Claim and Release Form within 60 days. Your claim is not deemed submitted until you receive an acknowledgment e-mail or postcard. If you do not receive an acknowledgment e-mail or postcard within 60 days of mailing your Proof of Claim and Release Form, please call the Claims Administrator toll free at (866) 217-4456

7. If you move, please send your new address to:
Dentsply Sirona Inc. Securities Litigation
c/o A.B. Data, Ltd.
P.O. Box 173027
Milwaukee, WI 53217
info@DentsplySironaSecuritiesLitigation.com
(866) 217-4456