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P7451 v.04 08.15.2016 101-CA8587
UNITED STATES DISTRICT COURTCENTRAL DISTRICT OF CALIFORNIA
WESTERN DIVISION
IN RE AMGEN INC. SECURITIES LITIGATION
Case No. CV 07-2536 PSG (PLAx)Honorable Philip S. Gutierrez
PROOF OF CLAIM AND RELEASE FORM
I. GENERAL INSTRUCTIONS
1. Capitalized terms not defined in this Proof of Claim and Release form (“Claim Form”) have the samemeaningsassetforthintheNoticeofProposedClassActionSettlementandMotionforAttorneys’FeesandExpenses(“SettlementNotice”)thataccompaniesthisClaimFormandtheStipulationandAgreementofSettlement,datedasofJuly20,2016(the“Stipulation”).
2. To be eligible to recover from the Net Settlement Fund in the action entitled In re Amgen Inc. Securities Litigation,CaseNo.CV07-2536PSG (PLAx) (C.D.Cal.) (the “Action”), youmust complete and, on page9,signthisClaimForm.IfyoufailtosubmitaproperlycompletedandaddressedClaimForm,yourclaimmayberejectedandyoumaybeprecludedfromanyrecoveryfromtheNetSettlementFundcreatedinconnectionwiththeSettlementoftheAction.
3. SubmissionofthisClaimForm,however,doesnotassurethatyouwillshareintheNetSettlementFund.
4. YOU MUST MAIL OR SUBMIT YOUR COMPLETED AND SIGNED CLAIM FORM SO THAT IT IS POSTMARKED OR RECEIVED ON OR BEFORE DECEMBER 23, 2016, ADDRESSED AS FOLLOWS:
AMGEN INC. SECURITIES LITIGATIONc/o Epiq
P.O. Box 4178Portland, OR 97208-4178
Tobeconsideredtimely,yourClaimFormmustbepostmarkedorreceivedbythedeadlineabove.Inallothercases,aClaimFormshallbedeemedtohavebeensubmittedwhenactuallyreceivedbytheClaimsAdministrator.
5. IfyouareNOTaClassMember(asdefinedintheSettlementNotice),DONOTsubmitaClaimForm.
6. IfyouareaClassMemberandhavenottimelyandvalidlyrequestedexclusion,youwillbeboundbythetermsoftheSettlementandanyjudgmententeredinthisAction,WHETHERORNOTYOUSUBMITACLAIMFORM.
7. NOTICE REGARDING ELECTRONIC FILES: Certain claimants with large numbers of transactionsmay request, or may be requested, to submit information regarding their transactions in electronic files. Toobtain the mandatory electronic filing requirements and file layout, you may visit the settlement website at www.AmgenSecuritiesLitigation.comor youmay email theClaimsAdministrator’s electronic filing departmentat [email protected]. Any file not in accordance with the required electronic filing formatwill be subject to rejection. No electronic files will be considered to have been properly submitted unless theClaimsAdministratorissuesanemailafterprocessingyourfilewithyourclaimnumbersandrespectiveaccountinformation.Donotassumethatyourfilehasbeenreceivedorprocesseduntilyoureceive thisemail. Ifyoudonotreceivesuchanemailwithin10daysofyoursubmission,youshouldcontacttheelectronicfilingdepartmentat info@AmgenSecuritiesLitigation.comtoinquireaboutyourfileandconfirmitwasreceivedandacceptable.
8. YoushouldbeawarethatitwilltakeasignificantamountoftimetoprocessalloftheClaimFormsandtoadministertheSettlement.Thisworkwillbecompletedaspromptlyastimepermits,giventheneedtoreviewandtabulateeachClaimForm.PleasenotifytheClaimsAdministratorofanychangesofaddress.
P7452 v.04 08.15.2016 202-CA8587
MUSTBE POSTMARKEDORRECEIVEDONORBEFORE
DECEMBER23,2016
In re Amgen Inc. Securities Litigation
PROOF OF CLAIM AND RELEASEUseBlueorBlackInkOnly.
PART I: CLAIMANT IDENTIFICATIONTheClaimsAdministratorwillusethisinformationforallcommunicationsrelevanttothisClaim(includingthecheck,ifeligibleforpayment).Ifthisinformationchanges,youMUSTnotifytheClaimsAdministratorinwritingattheaddressabove.Pleasetypeorprint.BeneficialOwner’sFirstName MI BeneficialOwner’sLastName
Co-BeneficialOwner’sFirstName MI Co-BeneficialOwner’sLastName
EntityName(ifBeneficialOwnerisnotanindividual)
RepresentativeorCustodianName(ifdifferentfromBeneficialOwner(s)listedabove)
Address1(streetnameandnumber)
Address2(apartment,unitorboxnumber)
City State ZIPCode
ForeignCountry(onlyifnotUSA)
LastfourdigitsofSocialSecurityNumberorTaxpayerIdentificationNumber
TelephoneNumber(home) TelephoneNumber(work)– – – –
Email address (Email address is not required, but if you provide it you authorize theClaimsAdministrator to use it in providing youwith information relevant to thisclaim.):
AccountNumber(account(s)throughwhichthesecuritiesweretraded):
Specifyoneofthefollowing:
Individual(s) IRA Estate
Corporation Partnership Trust
UGMACustodian Other
IfyouwereemployedbyAmgen,Inc.atanytimebetweenApril22,2004andMay10,2007,inclusive,pleaseprovidethetitle(s)youheldandthedate(s)duringwhichyouheldanysuchtitle(s).Position StartDate(MMYYYY) EndDate(MMYYYY)
– –
– –
P7453 v.04 08.15.2016 303-CA8587
PART II: TRANSACTIONS IN AMGEN PUBLICLY TRADED COMMON STOCK
1. BEGINNING HOLDINGS – StatethetotalnumberofsharesofAmgenpubliclytradedcommonstockheldasoftheopeningoftradingonApril22,2004.Ifnone,write“0”or“Zero.”(Mustbedocumented.)
•2. PURCHASES DURING THE CLASS PERIOD –Separately list each and everypurchaseofAmgenpublicly tradedcommonstockfromaftertheopeningoftradingonApril22,2004throughandincludingthecloseoftradingonMay10,2007.(Mustbedocumented.)
Purchase Date(List Chronologically)
(MMDDYY)Number of Shares
Purchased Price Per Share
Total Purchase Price (excluding taxes,
commissions, and fees)
● ●
● ●
● ●
● ●
3. PURCHASES DURING 90-DAY LOOKBACK PERIOD – StatethetotalnumberofsharesofAmgenpubliclytradedcommonstockpurchasedfromaftertheopeningoftradingonMay11,2007andincludingthecloseoftradingonAugust8,2007.(Mustbedocumented.Forclaimbalancingpurposesonly.)
•4. SALES DURING THE CLASS PERIOD AND DURING THE 90-DAY LOOKBACK PERIOD– Separatelylisteachandeverysale/dispositionofAmgenpubliclytradedcommonstockfromaftertheopeningoftradingonApril22,2004throughandincludingthecloseoftradingonAugust8,2007.(Mustbedocumented.)
IF NONE, CHECK HERE.
Sale Date(List
Chronologically)(MMDDYY)
Number of Shares Sold
Price Per Share
Total Sale Price (excluding taxes,
commissions, and fees)
● ●
● ●
● ●
● ●
5. ENDING HOLDINGS – StatethetotalnumberofsharesofAmgenpubliclytradedcommonstockheldasofthecloseoftradingonAugust8,2007.Ifnone,write“0”or“Zero.”(Mustbedocumented.)
•IF YOU NEED ADDITIONAL SPACE TO LIST YOUR TRANSACTIONS, YOU MUST
PHOTOCOPY THIS PAGE AND CHECK THIS BOX.
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PAR
T II
I: T
RA
NSA
CT
ION
S IN
AM
GE
N E
XC
HA
NG
E-T
RA
DE
D C
AL
L O
PTIO
NS
1. B
EGIN
NIN
G H
OL
DIN
GS
– Statethetotalnum
berofA
mgencalloptioncontractsh
eldasoftheopeningoftradingonApril22,2004.If
none,w
rite“0”or“Zero.”(M
ustbedocumented.)
IF N
ON
E, C
HEC
K
HE
RE
.
Stri
ke P
rice
of C
all
Opt
ion
Con
trac
t
Expi
ratio
n D
ate o
f C
all O
ptio
n C
ontr
act
(MM
DDY
Y)
Num
ber
of C
all O
ptio
n C
ontr
acts
in W
hich
You
H
ad a
n O
pen
Inte
rest
● ● ● ●
2. P
UR
CH
ASE
S D
UR
ING
TH
E C
LA
SS P
ER
IOD
– SeparatelylisteachandeverypurchaseofA
mgencalloptioncontractsfrom
aftertheopeningoftradingon
April22,2004throughandincludingthecloseoftradingonM
ay10,2007.(M
ustbedocumented.)
Dat
e of
Pur
chas
e (L
ist
Chr
onol
ogic
ally
) (M
MD
DY
Y)
Stri
ke
Pric
e of
C
all O
ptio
n C
ontr
act
Exp
irat
ion
Dat
e of
Cal
l Opt
ion
Con
trac
t (M
MD
DY
Y)
Num
ber
of C
all
Opt
ion
Con
trac
ts
Purc
hase
d
Purc
hase
Pr
ice
Per
Cal
l O
ptio
n C
ontr
act
Tota
l Pur
chas
e Pri
ce
(exc
ludi
ng ta
xes,
com
miss
ions
, and
fees
)
Inse
rt
an “
E” if
Ex
erci
sed
Inse
rt a
n “X
” if
Expi
red
Exer
cise
Dat
e (M
MD
DYY
)
●●
●
●●
●
●●
●
●●
●
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3. S
AL
ES
DU
RIN
G T
HE
CL
ASS
PE
RIO
D A
ND
DU
RIN
G T
HE
90-
DA
Y L
OO
KBA
CK
PE
RIO
D –
Separatelylist
eachandeverysaleofA
mgencalloptioncontractslistedin#2abovefrom
aftertheopeningoftradingonApril22,2004
throughandincludingthecloseoftradingonM
ay10,2007.(M
ustbedocumented.)
IF N
ON
E, C
HEC
K H
ER
E.
Dat
e of
Sal
e (L
ist
Chr
onol
ogic
ally
) (M
MD
DY
Y)
Stri
ke
Pric
e of
C
all O
ptio
n C
ontr
act
Exp
irat
ion
Dat
e of
Cal
l Opt
ion
Con
trac
t (M
MD
DY
Y)
Num
ber
of
Cal
l Opt
ion
Con
trac
ts S
old
Sale
Pri
ce P
er
Cal
l Opt
ion
Con
trac
t
Tota
l Sal
e Pri
ce
(exc
ludi
ng ta
xes,
com
miss
ions
, and
fees
)
●●
●
●●
●
●●
●
●●
●
4. E
ND
ING
HO
LD
ING
S –SeparatelylistallpositionsinAmgencalloptioncontractsinwhichyouhadanopeninterest
asofthecloseoftradingonMay10,2007.(Mustbedocumented.)
IF N
ON
E, C
HEC
K H
ER
E.
Stri
ke P
rice
of C
all
Opt
ion
Con
trac
t
Expi
ratio
n D
ate o
f C
all O
ptio
n C
ontr
act
(MM
DDY
Y)
Num
ber
of C
all O
ptio
n C
ontr
acts
in W
hich
You
H
ad a
n O
pen
Inte
rest
● ● ● ●IF
YO
U N
EE
D A
DD
ITIO
NA
L S
PAC
E T
O L
IST
YO
UR
TR
AN
SAC
TIO
NS/
HO
LD
ING
S Y
OU
MU
STPH
OT
OC
OPY
TH
IS P
AG
E A
ND
CH
EC
K T
HIS
BO
X.
IF
YO
U D
O N
OT
CH
EC
K T
HIS
BO
X T
HE
SE A
DD
ITIO
NA
L P
AG
ES
WIL
L N
OT
BE
RE
VIE
WE
D.
P74
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PAR
T I
V –
TR
AN
SAC
TIO
NS
IN A
MG
EN
EX
CH
AN
GE
-TR
AD
ED
PU
T O
PTIO
NS
1. B
EGIN
NIN
G H
OL
DIN
GS
–Statethetotalnum
berofA
mgenputoptioncontractsheldasoftheopeningoftradingonApril22,2004.
(Mustbedocumented.)
IF N
ON
E,
CH
ECK
H
ER
E.
Stri
ke P
rice
of P
ut
Opt
ion
Con
trac
t
Expi
ratio
n D
ate o
f Pu
t Opt
ion
Con
trac
t (M
MD
DYY
)
Num
ber
of P
ut O
ptio
n C
ontr
acts
in W
hich
You
H
ad a
n O
pen
Inte
rest
● ● ● ●
2. S
AL
ES
(WR
ITIN
G O
F PU
T O
PTIO
NS)
DU
RIN
G T
HE
CL
ASS
PE
RIO
D– Separatelylisteachandeverysale(w
riting)ofA
mgenputoptioncontracts
from
aftertheopeningoftradingonApril22,2004throughandincludingthecloseoftradingonM
ay10,2007.(M
ustbedocumented.)
Dat
e of
Sal
e (W
ritin
g) (L
ist
Chr
onol
ogic
ally
)(M
MD
DY
Y)
Stri
ke P
rice
of
Put
Opt
ion
Con
trac
t
Exp
irat
ion
Dat
e of
Put
Opt
ion
Con
trac
t (M
MD
DY
Y)
Num
ber
of P
ut
Opt
ion
Con
trac
ts
Sold
(Wri
tten
)
Sale
Pri
ce P
er
Put O
ptio
n C
ontr
act
Tota
l Sal
e Pri
ce (e
xclu
ding
ta
xes,
com
miss
ions
, and
fe
es)
Inse
rt
an “
E” if
Ex
erci
sed
Inse
rt a
n “X
” if
Expi
red
Exer
cise
Dat
e (M
MD
DYY
)
●●
●
●●
●
●●
●
●●
●
P74
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3.
RE
-PU
RC
HA
SES
DU
RIN
G T
HE
CL
ASS
PE
RIO
D A
ND
DU
RIN
G T
HE
90-
DA
Y L
OO
KBA
CK
PE
RIO
D –
Separatelylisteachandeveryre-purchaseofAmgenputoptioncontractslistedin#2abovefrom
aftertheopeningof
tradingonApril22,2004throughandincludingthecloseoftradingonM
ay10,2007.(M
ustbedocumented.)
IF N
ON
E, C
HEC
K H
ER
E.
Dat
e of
Pu
rcha
se (L
ist
Chr
onol
ogic
ally
)(M
MD
DY
Y)
Stri
ke P
rice
of
Put
Opt
ion
Con
trac
t
Exp
irat
ion
Dat
e of
Put
Opt
ion
Con
trac
t (M
MD
DY
Y)
Num
ber
of P
ut
Opt
ion
Con
trac
ts
Purc
hase
d
Purc
hase
Pri
ce
Per
Put O
ptio
n C
ontr
act
Tota
l Pur
chas
e Pri
ce
(exc
ludi
ng ta
xes,
com
miss
ions
, and
fees
)
●●
●
●●
●
●●
●
●●
●
4. E
ND
ING
HO
LD
ING
S –SeparatelylistallpositionsinAmgenputoptioncontractsinwhichyouhadanopeninterest
asofthecloseoftradingonMay10,2007.(Mustbedocumented.)
IF N
ON
E, C
HEC
K H
ER
E.
Stri
ke P
rice
of P
ut
Opt
ion
Con
trac
t
Expi
ratio
n D
ate o
f Pu
t Opt
ion
Con
trac
t (M
MD
DYY
)
Num
ber
of P
ut O
ptio
n C
ontr
acts
in W
hich
You
H
ad a
n O
pen
Inte
rest
● ● ● ●IF
YO
U N
EE
D A
DD
ITIO
NA
L S
PAC
E T
O L
IST
YO
UR
TR
AN
SAC
TIO
NS/
HO
LD
ING
S Y
OU
MU
STPH
OT
OC
OPY
TH
IS P
AG
E A
ND
CH
EC
K T
HIS
BO
X.
IF Y
OU
DO
NO
T C
HE
CK
TH
IS B
OX
TH
ESE
AD
DIT
ION
AL
PA
GE
S W
ILL
NO
T B
E R
EV
IEW
ED
.
P7458 v.04 08.15.2016 808-CA8587
PART V – TRANSACTIONS IN AMGEN PUBLICLY TRADED BONDS
CodeA=0.125%ConvertibleSeniorNotesDueFebruary1,2011(CUSIP:031162AN0)CodeB=0.375%ConvertibleSeniorNotesDueFebruary1,2013(CUSIP:031162AQ3)
1. BEGINNING AND ENDING HOLDINGS – StatethefacevalueofeachtypeofAmgenBondheldattheopeningoftradingonApril22,2004andatthecloseoftradingonMay10,2007.Ifnone,write“0”or“Zero.”(Mustbedocumented.)
Bond Code (see above)
Face Value of This Bond Held as of the Opening of Trading on April 22, 2004
Face Value of This Bond Held as of the Close of Trading on May 10, 2007
2. PURCHASES – ForeachparticularAmgenBond, state (inchronologicalorder)allpurchases fromafter theopeningoftradingonApril22,2004throughandincludingthecloseoftradingonMay10,2007.Ifnone,write“0”or“Zero.”(Mustbedocumented.)
Bond Code (see above)
Trade Date of Purchase (Month/Day/Year)
Face Value of This Bond Purchased Purchase Price
Aggregate Cost (excluding taxes,
commissions, and fees)
3. SALES – Separatelylist(inchronologicalorder)eachandeverysaleofAmgenBondsfromaftertheopeningoftradingonApril22,2004throughandincludingthecloseoftradingonMay10,2007.(Mustbedocumented.)
IF NONE, CHECK HERE.
Bond Code (see above)
Trade Date of Sale (Month/Day/Year)
Face Value of This Bond Sold Sale Price
Aggregate Received (excluding taxes,
commissions, and fees)
IF YOU NEED ADDITIONAL SPACE TO LIST YOUR TRANSACTIONS, YOU MUSTPHOTOCOPY THIS PAGE AND CHECK THIS BOX.
P7459 v.04 08.15.2016 909-CA8587
II. SUBMISSION TO JURISDICTION OF COURT AND ACKNOWLEDGMENTS1. BysigningandsubmittingthisClaimForm,theclaimant(s)ortheperson(s)actingonbehalfoftheclaimant(s)
certify(ies)that:I(We)submitthisClaimFormunderthetermsofthePlanofAllocationofNetSettlementFunddescribedintheaccompanyingSettlementNotice.I(We)alsosubmittothejurisdictionoftheUnitedStatesDistrictCourtfortheCentralDistrictofCalifornia(the“Court”)withrespecttomy(our)claimasaClassMember(s)andforpurposesofenforcingthereleasessetforthherein.I(We)furtheracknowledgethatI(we)willbeboundbythetermsofanyjudgmententeredinconnectionwiththeSettlementintheAction,includingthereleasessetforththerein.I(We)agreetofurnishadditionalinformationtotheClaimsAdministratortosupportthisclaim,suchasadditionaldocumentationfortransactionsineligibleAmgensecurities,ifrequiredtodoso.I(We)havenotsubmittedanyotherclaimcoveringthesametransactionsinpubliclytradedAmgensecuritiesduringtheallegedClassPeriodandknowofnootherpersonhavingdonesoonmy(our)behalf.III. RELEASES, WARRANTIES, AND CERTIFICATION
1. I(We)herebywarrantandrepresentthatIam(weare)aClassMemberasdefinedintheSettlementNotice,thatIam(weare)notexcludedfromtheClass,thatIam(weare)notoneofthe“ReleasedDefendantParties”asdefinedintheaccompanyingSettlementNotice,andthatI(we)believeIam(weare)eligibletoreceiveadistributionfromtheNetSettlementFundunderthetermsandconditionsofthePlanofAllocation,assetforthintheSettlementNotice.
2. AsaClassMember,I(we)herebyacknowledgefullandcompletesatisfactionof,anddoherebyfully,finally,and forever settle, release, anddischargewithprejudice theReleasedClaims as to each and all of theReleasedDefendantParties(asthesetermsaredefinedintheaccompanyingSettlementNotice).
3. AsaClassMember,I(we)herebyacknowledgethatI(we)willnotbeentitledtoreceivearecoveryinanyotheractionagainstanyoftheReleasedDefendantPartiesbasedonorarisingoutoftheReleasedClaims(asthesetermsaredefinedintheaccompanyingSettlementNotice).
4. ThisreleaseshallbeofnoforceoreffectunlessanduntiltheCourtapprovestheSettlementanditbecomeseffectiveontheEffectiveDate.
5. I(We)herebywarrantandrepresentthatI(we)havenotassignedortransferredorpurportedtoassignortransfer,voluntarilyorinvoluntarily,anymatterreleasedpursuanttothisreleaseoranyotherpartorportionthereof.
6. I(We)herebywarrantandrepresentthatI(we)haveincludedinformationaboutallofmy(our)purchasesandsalesandothertransactionsinpubliclytradedAmgensecuritiesthatoccurredduringtheClassPeriodandthenumberofsecuritiesheldbyme(us),totheextentrequested.
7. I(We)certifythatIam(weare)NOTsubjecttobackuptaxwithholding.(IfyouhavebeennotifiedbytheInternalRevenueServicethatyouaresubjecttobackupwithholding,pleasestrikeoutthepriorsentence.)
I(We)declarethatalloftheforegoinginformationsuppliedbytheundersignedistrueandcorrect.
Executedthis dayof ,2016
SignatureofClaimant Date – –MM DD YY
TypeorprintnameofClaimant
SignatureofJointClaimant,ifany
Date – –MM DD YY
TypeorprintnameofJointClaimant,ifany.
If the Claimant is other than an individual, or is not the person completing this form, the following also must be provided:
Signatureofpersonsigningonbehalfof
ClaimantDate – –
MM DD YY
Typeorprintnameofpersonsigning,onbehalfofClaimant.
CapacityofpersonsigningonbehalfofClaimant,ifotherthananindividual,e.g.,Administrator,Executor,Trustee,President,Custodian,PowerofAttorney,etc.
P74510 v.04 08.15.2016 10010-CA8587
REMINDER CHECKLIST:
1. PleasesignthisClaimForm.
2. Remembertoattachsupportingdocumentation,ifavailable.DONOTHIGHLIGHTTHECLAIMFORMORYOURSUPPORTINGDOCUMENTATION.
3. DoNOTsendoriginalstockcertificatesororiginalbrokeragestatements.
4. KeepacopyofyourClaimFormforyourrecords.
5. TheClaimsAdministratorwillacknowledgereceiptofyourClaimFormbymail,within60days.Yourclaimisnotdeemedsubmitteduntilyoureceiveanacknowledgmentpostcard.Ifyoudonotreceiveanacknowledgmentpostcardwithin60days,pleasecalltheClaimsAdministratortoll-freeat800-462-2317.
6. IfyoumoveaftersubmittingthisClaimForm,pleasenotifytheClaimsAdministratorof thechangeinyouraddress.
THIS CLAIM FORM MUST BE POSTMARKED OR RECEIVED NO LATER THAN DECEMBER 23, 2016.
Amgen Inc. Securities Litigationc/oEpiq
P.O.Box4178Portland,OR97208-4178
