Eligibility and Claim Requirements:

In order to be eligible for a Distribution¹ from the Purdue PI Trust (the "PI Trust") for a NAS PI Channeled Claim, a claimant will, among other things, be required to:

1. Hold a NAS PI Channeled Claim against one or more Debtors;
2. Have timely filed individual personal injury Proof of Claim for such NAS PI Channeled Claim against one or more Debtors in the Chapter 11 Cases;
3. Submit the required proof demonstrating a diagnosis by a licensed medical provider of a medical, physical, cognitive or emotional condition resulting from the NAS Child's intrauterine exposure to opioids or opioid replacement or treatment medication, including but not limited to the condition known as neonatal abstinence syndrome ("NAS").
   Important Note: If you provided the required documentation in connection with (i) the Mallinckrodt plc (Case No. 20-12522) (Bankr. D. Del.) bankruptcy, (ii) the Endo International plc (Case No. 22-22549) (Bankr. S.D.N.Y.) bankruptcy, or (iii) your Proof of Claim that was filed in the Debtors' Chapter 11 Cases, you do not need to resubmit the required documentation, but shall provide the PI Claims Administrator with a statement (or if filing in bulk by the Firm, with a list) confirming the previously filed Claim(s) for the PI Claims Administrator to review;

Additionally, each Holder of a NAS PI Claim seeking an Award from the PI Trust must complete, sign, and submit the following documents so that they are received on or before July 28, 2025 ("PI Claims Deadline"):²

1. This NAS PI Claim Form (the "NAS Claim Form");
2. The applicable HIPAA consent form provided below;
3. To the extent the NAS PI Channeled Claim concerns the injuries of a decedent of the Holder of such Claim, the Heirship Declaration, which can be found on the Purdue PI Trust website at https://www.purduepitrust.com, or valid estate documents authorizing the Holder of the Claim to act on behalf of the decedent's estate; and
4. For Holders of NAS PI Claims that are minors, a Proxy Form provided below, which can also be found in Exhibit D of the NAS PI TDP.

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Capitalized terms used but not defined herein have the meanings ascribed to them in the NAS Personal Injury Truist Distribution Procedures ("NAS PI TDP") or, if not defined therein, then the meanings ascribed to them in the Thirteenth Amended Joint Chapter 11 Plan of Reorganization of Purdue Pharma L.P. and Its Affiliated Debtors (the "Plan"). The NAS PI TDP and the Plan can be found at https://www.purduepitrust.com.

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Parties that previously filed claims and provided the required documentation in connection with (i) the Mallinckrodt plc (Case No. 20-12522) (Bankr. D. Del.) bankruptcy, ((ii) the Endo International plc (Case No. 22-22549) (Bankr. S.D.N.Y.) bankruptcy, or (iii) your Proof of Claim that was filed in the Debtors' Chapter 11 Cases do not need to provide further documentation, except as set forth herein. In the event of law firms with a large inventory doing bulk uploads, the PI Trustee shall establish procedures for bulk attestations.

FAILURE TO TIMELY SUBMIT THIS NAS CLAIM FORM ALONG WITH THE REQUIRED INFORMATION OUTLINED UNDER THE ELIGIBILITY SECTION ABOVE BY JULY 28, 2025, IN ACCORDANCE WITH THE NAS PI TDP MAY RESULT IN THE NAS PI CLAIM BEING DEEMED A DISPUTED CLAIM THAT WILL BE THE SUBJECT OF AN OBJECTION.

THE NAS PI TDP AND ANY FORMS REFERENCED IN THIS NAS CLAIM FORM CAN BE FOUND ON THE PI TRUST WEBSITE AT HTTP://WWW.PURDUEPITRUST.COM.³

Instructions for NAS Claim Form Submission:

If you represent the interests of an NAS Child and are seeking to recover money from the PI Trust on account of that NAS Child's NAS PI Channeled Claim(s), you must complete this NAS Claim Form and return the form as instructed below. If you do not complete the form, you MAY NOT qualify to receive funds on behalf of the NAS PI Claimant you represent, and your NAS PI Claim may be the subject of an objection, disallowance or a denial.

If you believe that the NAS Child you represent holds multiple NAS PI Channeled Claims against the Debtors on account of multiple injuries, you should submit only one NAS Claim Form.

If you represent the interests of more than one NAS Child, you must file a NAS Claim Form on behalf of each individual NAS Child. YOU CANNOT file one NAS Claim Form on behalf of multiple children.

Please follow the instructions of each section carefully to ensure that the NAS Claim Form is submitted correctly. Except as otherwise indicated, all words shall be given their ordinary meaning. Submitting this NAS Claim Form does not guarantee that your NAS PI Claim will be Allowed or that you will receive payment from the PI Trust.

It is the responsibility of the Holder of the NAS PI Claim or its representative to submit this NAS Claim Form along with the Required Information (i.e. the HIPAA Form AND Evidence demonstrating a diagnosis by a licensed medical provider or a medical, physical, cognitive, or emotional condition resulting from intrauterine exposure, to either opioids or opioid replacement/treatment medication as outlined in the NAS PI TDP) by the Claims Deadline.

If the NAS PI Claim is filed on behalf of an individual who is a minor, then a Proxy Form and supporting documentation, if required, authorizing the person to act on behalf of the Minor must be submitted as well.

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The NAS PI TDP that is currently on the PI Trust Website is substantially complete but will likely have changes. An updated NAS PI TDP will be filed with the Bankruptcy Court as part of the Plan Supplement and will be considered by the Bankruptcy Court for approval at the hearing to consider confirmation of the Debtors' Plan of Reorganization, on a date to be scheduled.

This NAS Claim Form along with the Required Information can be completed and submitted online at https://www.purduepitrust.com or by sending such completed Claim Form and Required Information by:

1. e-mail to purduepitrust@purduepitrust.com,
2. mail to Purdue PI Trust, P.O. Box 361930, Hoover, Alabama, 35236-1930, or
3. fax to PURDUE PI TRUST at 205-716-2364.

Law firms representing more than one Claimant, should visit the Law Firm Bulk Submittal tab on the https://www.purduepitrust.com website for additional information regarding submittal of claims for multiple, represented Claimants.

PLEASE CONFIRM THE ACCURACY OF ALL INFORMATION AS THE INFORMATION PROVIDED WILL BE USED TO BOTH EVALUATE YOUR CLAIM AND CONTACT YOU. PART ONE: PERSONAL INFORMATION OF NAS PI CLAIMANT AND HIS/HER REPRESENTATIVE Section 1.A: Fill out the information of the NAS Child below:     ** - if applicable   NAS Child's Full Social Security Number (or Taxpayer ID or Social Insurance Number)   Kroll/Prime Clerk Proof of Claim Number in Purdue's Chapter 11 Cases Section 1.B - Fill out your information below:     Your Social Security Number     Your Phone Number State whether you are the "natural parent", "legal guardian", or "other custodian" of the NAS Child     Representative Name (if applicable)     ** - if applicable

PART TWO: MEDICAL PROVIDER INFORMATION Section 2.A: This section concerns licensed medical providers who have diagnosed the NAS Child with any medical, physical, cognitive or emotional condition resulting from his/her intrauterine exposure to opioids or opioid replacement or treatment medication(s). The diagnoses may include, but are not limited to, the condition known as neonatal abstinence syndrome ("NAS"). Fill out and provide the following information, if known:

Section 2.B: Even if you do not know the information sought in Section 2.A, please include with your submission of this NAS Claim Form Competent Evidence that a licensed medical provider has diagnosed the NAS PI Claimant with any medical, physical, cognitive or emotional condition resulting from the NAS Child's intrauterine exposure to opioids or opioid replacement or treatment medication(s). The diagnoses may include, but are not limited to, the condition known as NAS. The diagnosis can be made by any licensed medical professional, specifically including physicians, nurses, physician assistants, mental health counselors or therapists, or professionals at a rehabilitation center. Evidence can include, among other things, medical records evidencing that the NAS Child had a NAS diagnosis, including post-natal treatment for symptoms caused by opioid exposure, symptoms of post-natal withdrawal from opioids, medical scoring for NAS or NOWS which is positive or indicates fetal opioid exposure, a positive toxicology screen of the birth mother or infant for opioids or opioid-weaning drugs, or medical evidence of maternal opioid use. Section 2.C: Was the NAS Child born in a medical facility? If so:

PART THREE: MEDICAL LIENS Section 3.A: Did any insurance company pay for medical treatment for the NAS Child's opioid-related injuries? Yes:        No:      Section 3.B: In the last 20 years, was the NAS Child eligible for coverage by any of the following providers? Please answer the question above by indicating "Yes" or "No" next to each insurance provider name and provide the requested information as to each. If any insurance carrier who provided coverage to the NAS Child is not listed below, please fill in that provider's name and information at the bottom of the chart. You may submit the information on additional paper, if needed, in order to provide all of the information requested. ALL sections must be checked as "Yes" or "No" before the form can be submitted for processing. You will not be able to return to complete or update this information.

Medicare Was the opioid user eligible for Medicare coverage and/or did Medicare pay for any opioid-related health costs?  Yes  No Medicaid Did the opioid user have Medicaid coverage and/or did Medicaid pay for any opioid-related health costs?  Yes  No Tricare Did the opioid user have Tricare coverage and/or did Tricare pay for any opioid-related health costs?  Yes  No VA Did the opioid user have VA coverage and/or did the VA pay for any opioid-related health costs?  Yes  No Champus Did the opioid user have Champus coverage and/or did Champus pay for any opioid-related health costs?  Yes  No Private Insurers   Private (1) Did the opioid user have coverage under a Private Insurer and/or did a Private Insurer pay for any opioid-related health costs?  Yes  No Private (2) Did the opioid user have coverage under a 2nd Private Insurer and/or did a 2nd Private Insurer pay for any opioid-related health costs?  Yes  No Private (3) Did the opioid user have coverage under a 3rd Private Insurer and/or did a 3rd Private Insurer pay for any opioid-related health costs?  Yes  No Private (4) Did the opioid user have coverage under a 4th Private Insurer and/or did a 4th Private Insurer pay for any opioid-related health costs?  Yes  No Private (5) Did the opioid user have coverage under a 5th Private Insurer and/or did a 5th Private Insurer pay for any opioid-related health costs?  Yes  No Private (6) Did the opioid user have coverage under a 6th Private Insurer and/or did a 6th Private Insurer pay for any opioid-related health costs?  Yes  No

Select File to Upload:

If you do not attach files at this time or have additional files that need to be added later, you will need to provide the documents utilizing one of the following: email to purduepitrust@purduepitrust.com with "Portal Claim Documents" in the subject line, or fax to Purdue PI Trust - Portal Claim Documents at 205-716-2364, or mail to Purdue PI Trust - Portal Claim Documents at P.O. Box 361930, Hoover, AL 35236-1930 Important Reminder: As previously communicated, failure to timely submit the NAS Claim Form along with the required information outlined under the Eligibility and Claim Requirements section above for receipt by the PI Trust on or before the PI Claims Deadline of July 28, 2025, may result in the NAS Claim being deemed a disputed claim that will be the subject of an objection.

PART ONE: PERSONAL INFORMATION OF NAS CHILD AND THEIR PROXY NAS Child Information (Fill out the information for the NAS Child)

	NAS Child's Full Social Security Number (or Taxpayer ID or Social Insurance Number)
Proxy Information (Fill out this information if you are the Purported Proxy of a NAS Child)
	Proxy's Full Social Security Number (or Taxpayer ID or Social Insurance Number)
	Proxy's Phone Number

PART TWO: PROXY TYPE (you must supply the following evidence to the Trust) ONLY SELECT ONE: Please check the one section that applies to you, fill out the information included and provide the required information and evidence, if applicable. I Am A Custodial Parent Please fill out this section if you are the custodial parent of a NAS Child. I, , am the Custodial Parent (biological mother/father with whom the child currently lives) of the NAS Child, . I declare, under penalty of perjury, that the representations made and the information provided on this Proxy form are true, correct, and complete to the best of my knowledge. I Am A Court Appointed Legal Guardian Please fill out this section and provide the applicable order if you are the legal guardian of a NAS Child. I, , have been appointed by the court as the guardian of the NAS Child, , and am providing the order appointing me as the legal guardian of the NAS Child. I declare, under penalty of perjury, that the representations made and the information provided on this Proxy form are true, correct, and complete to the best of my knowledge. Signature of the Purported Proxy acting on behalf of the NAS Child: I am providing custody and care for the NAS Child, but I am neither the Custodial Parent nor the Court Appointed Legal Guardian. Please fill out this section and provide the applicable statements and/or records if you are providing custody and care for the Minor Claimant but are neither the custodial parent nor the court appointed legal guardian of the NAS Child. I, , am providing custody and care to the NAS Child, . I have been providing custody and care to the NAS Child since (date). My relationship with the NAS Child is: The circumstances around the provisions and care of the NAS Child are: I am providing one or more of the statements and/or records marked below as a form of evidence to the Trust to support my statement under penalty of perjury: Records/statements from the NAS Child's school or childcare provider Records/statements from my landlord or property manager Records/statements from the placement agency which put the NAS Child in my care Records/statements from a governmental social services agency Records/statements from Indian tribe officials Records/statements from my employer Records/statements from NAS Child's medical/healthcare provider I declare, under penalty of perjury, that the representations made and the information provided on this Proxy form are true, correct, and complete to the best of my knowledge. I Am An Adult I, , (the NAS Child), am an adult having reached the age of majority in my state of residence and, therefore, do not a require a Proxy.

SIGNATURE (CLAIM FORM AND HIPAA RELEASE)

This NAS Claim Form must be signed by the Holder of the NAS Claim or its Representative or Counsel of Record.

By checking the box to the right, I confirm that I am including the required evidence that demonstrates that a licensed medical provider has diagnosed the NAS PI Claimant with any medical, physical, cognitive or emotional condition resulting from the NAS Child's intrauterine exposure to opioids or opioid replacement or treatment medication(s), as required under PART TWO above in my submission of this Claim: Did you previously file a NAS PI Claim with the Mallinckrodt plc (Case No. 20-12522) (Bankr. Del.) bankruptcy NAS Personal Injury Trust (the "MNK NAS PI Trust") or the Endo International plc (Case No. 22-22549) (Bankr. SDNY) bankruptcy NAS Personal Injury Trust (the "Endo NAS PI Trust"), or you previously provided evidence that demonstrates that a licensed medical provider has diagnosed the NAS PI Claimant with any medical, physical, cognitive or emotional condition resulting from the NAS Child's intrauterine exposure to opioids or opioid replacement treatment medication(s) with a Proof of Claim that was filed in the Debtors' Chapter 11 Cases? Yes: No: If you answered yes above to filing a NAS PI Claim in the MNK NAS PI Trust or the Endo NAS PI Trust, please indicate which one you filed with: MNK NAS PI Trust: Endo NAS PI Trust REMINDER: Unless as stated above, evidence demonstrating that a licensed medical provider has diagnosed the NAS PI Claimant with any medical, physical, cognitive or emotional condition resulting from the NAS Child's intrauterine exposure to opioids or opioid replacement or treatment medication(s), as outlined in the NAS PI TDP MUST BE SUBMITTED WITH THIS NAS CLAIM FORM by the Claims Deadline. Failure to do so will result in the NAS PI Claim being deficient as outlined in the NAS PI TDP and may be the subject of an objection, disallowance or denial.

SELECT ONE IF SIGNING AS THE NAS PI CLAIMANT OR INDIVIDUAL ACTING ON BEHALF OF THE NAS PI CLAIMANT: I declare under penalty of perjury that the representations made and the information provided on this NAS PI Claim Form are true, correct and complete to the best of my knowledge. IF SIGNING AS COUNSEL OF RECORD: I, as Counsel for the Holder of the NAS PI Claim or its representative PI Claimant, hereby swear under penalty of perjury that the information contained herein is true and accurate to the best of my knowledge made after conducting due diligence, and that this NAS PI Claim Form is being filed with the consent of my client, or the authority to file on my client's behalf under applicable law, and/or with appropriate power of attorney.