AR5

Air Cargo Settlement 5

Must be Postmarked c/o Garden City Group, LLC
P.O. Box 10083
No Later Than
September 9, 2016
Dublin, OH 43017-6683
USA *P-AR5-POC/1*
Claim Number:
Control Number:

CLAIM FORM
GENERAL INSTRUCTIONS
This Claim Form relates to In re Air Cargo Shipping Services Antitrust Litigation, MDL No. 1775 Master File 06-MD-1775 (BMC)
(VVP), in the United States District Court for the Eastern District of New York.
To be eligible to share in the settlements with Air China Ltd., Air China Cargo Company Ltd., Air India, Air New Zealand Ltd., Asiana
Airlines, Inc., Eva Airways Corporation, Nippon Cargo Airlines Co., Ltd., Polar Air Cargo LLC, Polar Air Cargo Worldwide, Inc., and
Atlas Air Worldwide Holdings, Inc., (the Settling Defendants) in the above-named class action, you must have purchased Airfreight
Shipping Services for shipments to, from, or within the United States directly from any of the Settling Defendants (listed above and in
the chart below), any other Defendant (listed in the chart below), or from any of their parents, predecessors, successors, subsidiaries,
or affiliates, at any time during the period from January 1, 2000 through September 30, 2006.
If you fit this description, you are a member of the class and are entitled to submit a claim to share in the settlement funds. Excluded
from the class are Defendants and Settling Defendants, their parents, predecessors, successors, subsidiaries, affiliates, as
well as government entities. Also, you may not share in the settlements if you asked to be excluded from all of these settlements and
the Litigation Class.
You may have received a Claim Form that looked similar to this form in 2011 in connection with settlements with All
Nippon Airways Co., Ltd., American Airlines, Inc., AMR Corporation, Cargolux Airlines International, S.A., Japan Airlines International
Co., Ltd., Koninklijke Luchtvaart Maatschappij N.V., Martinair Holland N.V., Qantas Airways Limited, SAS Cargo Group A/S,
Scandinavian Airlines System, Socit Air France, and Thai Airways International Public Company Limited (the Second
Settlements), which form was due July 26, 2011, or a similar form in 2012 in connection with settlements with British Airways Plc,
Lan Airlines, S.A., Lan Cargo, S.A., Aerolinhas Brasileiras, S.A., Malaysia Airlines, South African Airways Ltd., Saudi Arabian Airlines,
Ltd., El Al Israel Airlines Ltd., Emirates, Air Canada and AC Cargo LP (the Third Settlements), which form was due July 27, 2012,
or a similar form in 2014 in connection with the settlements with Singapore Airlines Limited and Singapore Airlines Cargo Pte, Ltd.,
Cathay Pacific Airways Ltd., Korean Air Lines Co., Ltd., and China Airlines, Ltd. (the Fourth Settlements), which form was due
January 6, 2015.
If you submitted a Claim Form in connection with the Lufthansa Settlement, but not the Second, Third, or Fourth Settlements, you
must complete this form in order to receive benefits from these settlements. You should not submit this claim if you submitted an
approved Claim Form in connection with the Second, Third, or Fourth Settlements, but if you would like to update your claim with
purchases you made from September 12, 2006 to September 30, 2006, then go to SECTION D of the Claim Form.
If you did not submit a Claim Form in connection with the Second, Third, or Fourth Settlements, you must complete and submit a
Claim Form in order to receive a payment. It must be POSTMARKED NO LATER THAN SEPTEMBER 9, 2016. Completed Claim
Forms must be mailed to the Claims Administrator at the above address. You should save all relevant documents, such as invoices,
that support your claim, as you may be required to provide them later. You must complete and submit a new Claim Form even if you
submitted a Claim Form for the Lufthansa Settlement, unless you submitted an approved Claim Form for the Second, Third, or Fourth
Settlements.
All inquiries regarding your claim should be made (1) in writing to the Claims Administrator at the address above, (2) by visiting
the settlement website, (3) via e-mail at administrator@aircargosettlement5.com, or (4) by calling the information helpline: U.S. &
Canada (Toll-Free) 1-855-382-6460; International (Toll): 1-513-795-0998.
Before you complete and mail this Claim Form you should read and be familiar with the notice describing the settlements and the Plan
of Allocation. By submitting this Claim Form, you acknowledge that you have read and understand the notices, and you agree to the
releases described in those notices. Copies of the notices are available for your review and can be downloaded at
www.aircargosettlement5.com.
Questions? Call U.S. & Canada (Toll-Free): 1-855-382-6460 International (Toll): 1-513-795-0998
or Visit www.AirCargoSettlement5.com
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 SECTION C - SCHEDULE OF QUALIFYING PURCHASES OF SHIPMENTS TO, FROM OR WITHIN
*P-AR5-POC/3*
THE UNITED STATES BETWEEN JANUARY 1, 2000 AND SEPTEMBER 11, 2006
Please provide a summary of all Airfreight Shipping Services that you have purchased from each Defendant or Settling
Defendant (listed below) for shipments to, from, or within the United States from January 1, 2000 to September 11, 2006. An inbound purchase is a purchase of
Airfreight Shipping Services for shipments to the United States. An outbound purchase is a purchase of Airfreight Shipping Services for shipments from the United
States. A purchase within the United States is a purchase for Airfreight Shipping Services with both an origin and a destination within the United States.
Please type or print neatly all information. Round the total purchase amount to the nearest dollar or whole unit of the
currency for which you are claiming. If your purchases are in multiple currencies, use separate pages for each currency. You may photocopy these pages as many
times as necessary.

c U.S. dollars
c Other currency (please
specify):
______________________
(list only one currency per page)
Inbound Purchases Outbound Purchases Purchases Within the United States
Between January 1, 2000 and September 11, Between January 1, 2000 and September 11, Between January 1, 2000 and September 11,
2006 (where only destination is in the U.S.) 2006 (where only origin is in the U.S.) 2006 (both origin and destination in the U.S)
Total Purchase Amount Number of Total Purchase Amount Number of Total Purchase Amount Number of
(all freight charges and surcharges, (all freight charges and surcharges, (all freight charges and surcharges,
Airbills Airbills Airbills
excluding taxes on those charges) (Transactions) excluding taxes on those charges) (Transactions) excluding taxes on those charges) (Transactions)

Aerolinhas Brasileiras, S.A.

(ABSA) .XX .XX .XX
Air Canada or AC Cargo LP
.XX .XX .XX
Air China Cargo Company Ltd.
or Air China Ltd. .XX .XX .XX
Air India
.XX .XX .XX
Air France (Socit Air France)
.XX .XX .XX
Air Mauritius Ltd.
.XX .XX .XX
Air New Zealand (Airways Corp.
of New Zealand Ltd.) .XX .XX .XX
Alitalia Linee Aeree Italiane
S.p.A. .XX .XX .XX
All Nippon Airways Co., Ltd.
.XX .XX .XX
American Airlines, Inc. or AMR
Corporation .XX .XX .XX
(continued on next page)
Questions? Call U.S. & Canada (Toll-Free): 1-855-382-6460 International (Toll): 1-513-795-0998
or Visit www.AirCargoSettlement5.com
3

c U.S. dollars
c Other currency (please
specify):
______________________
(list only one currency per page)
*P-AR5-POC/4*
Inbound Purchases Outbound Purchases Purchases Within the United States
Between January 1, 2000 and September 11, Between January 1, 2000 and September 11, Between January 1, 2000 and September 11,
2006 (where only destination is in the U.S.) 2006 (where only origin is in the U.S.) 2006 (both origin and destination in the U.S)
Total Purchase Amount Number of Total Purchase Amount Number of Total Purchase Amount Number of
(all freight charges and surcharges, (all freight charges and surcharges, (all freight charges and surcharges,
Airbills Airbills Airbills
excluding taxes on those charges) (Transactions) excluding taxes on those charges) (Transactions) excluding taxes on those charges) (Transactions)

Asiana Airlines, Inc.

.XX .XX .XX
British Airways PLC
.XX .XX .XX
Cargolux Airlines
International, S.A. .XX .XX .XX
Cathay Pacific Airways, Ltd.
.XX .XX .XX
China Airlines, Ltd.
.XX .XX .XX
DAS Air Ltd. (DAS Air Cargo)
.XX .XX .XX
El Al Israel Airlines
.XX .XX .XX
Emirates Airlines
.XX .XX .XX
Ethiopian Airlines Corp.
.XX .XX .XX
EVA Airways Corporation
.XX .XX .XX
Japan Airlines
International Co., Ltd. .XX .XX .XX
Kenya Airways Limited
.XX .XX .XX
Koninklijke Luchtvaart
Maatschappij N.V. (KLM) .XX .XX .XX
Korean Air Lines Co., Ltd.
.XX .XX .XX
(continued on next page)

Questions? Call U.S. & Canada (Toll-Free): 1-855-382-6460 International (Toll): 1-513-795-0998
or Visit www.A rCargoSettlement5.com
4

c U.S. dollars
c Other currency (please
specify):
______________________
(list only one currency per page)
*P-AR5-POC/5*
Inbound Purchases Outbound Purchases Purchases Within the United States
Between January 1, 2000 and September 11, Between January 1, 2000 and September 11, Between January 1, 2000 and September 11,
2006 (where only destination is in the U.S.) 2006 (where only origin is in the U.S.) 2006 (both origin and destination in the U.S)
Total Purchase Amount Number of Total Purchase Amount Number of Total Purchase Amount Number of
(all freight charges and surcharges, (all freight charges and surcharges, (all freight charges and surcharges,
Airbills Airbills Airbills
excluding taxes on those charges) (Transactions) excluding taxes on those charges) (Transactions) excluding taxes on those charges) (Transactions)

Lan Airlines, S.A. (Lan Chile)

or Lan Cargo, S.A. .XX .XX .XX
Lufthansa Cargo AG or
Deutsche Lufthansa AG .XX .XX .XX
Malaysia Airlines
.XX .XX .XX
Martinair Holland N.V.
.XX .XX .XX
Nippon Cargo Airlines Co., Ltd.
.XX .XX .XX
Polar Air Cargo, LLC, Polar Air
Cargo Worldwide, Inc. or Atlas
Air Worldwide Holdings, Inc.
.XX .XX .XX

Qantas Airways Limited

.XX .XX .XX
SAS Cargo Group A/S or
Scandinavian Airlines System .XX .XX .XX
Saudi Arabian Airlines, Ltd.
.XX .XX .XX
Singapore Airlines Cargo Pte,
Ltd. or Singapore Airlines, Ltd. .XX .XX .XX
South African Airways
(Proprietary), Ltd. .XX .XX .XX
Swiss International Air Lines,
Ltd. .XX .XX .XX
Thai Airways International Pub-
lic Company Limited .XX .XX .XX
Viao Area Rio-Grandense,
S.A. (Varig) .XX .XX .XX
Questions? Call U.S. & Canada (Toll-Free): 1-855-382-6460 International (Toll): 1-513-795-0998
or Visit www.AirCargoSettlement5.com
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 *P-AR5-POC/6*
SECTION D - SCHEDULE OF QUALIFYING PURCHASES OF SHIPMENTS TO OR FROM
THE UNITED STATES BETWEEN SEPTEMBER 12, 2006 AND SEPTEMBER 30, 2006

Please provide a summary of all Airfreight Shipping Services that you have purchased from each Defendant or Settling
Defendant (listed above) for shipments to or from the United States from September 12, 2006 to September 30, 2006.

c U.S. dollars Inbound Purchases Between Outbound Purchases Between

c Other currency (please specify):
______________________
(list only one currency per page)
September 12, 2006 and September 30, 2006 September 12, 2006 and September 30, 2006
Total Purchase Amount Number of Total Purchase Amount Number of
(all freight charges and surcharges, (all freight charges and surcharges,
Airbills Airbills
excluding taxes on those charges) (Transactions) excluding taxes on those charges) (Transactions)

All Airline Purchases Combined

If you need to provide an explanation for any of the purchase information listed above (for example, if you relied on estimates
for some or all of the period or if you purchased from a parent, predecessor, successor, subsidiary, or affiliate of a Defendant
or Settling Defendant but that entity is not listed), please do so below:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Questions? Call U.S. & Canada (Toll-Free): 1-855-382-6460 International (Toll): 1-513-795-0998
or Visit www.A rCargoSettlement5.com
6