MoneyLion Stockholder Settlement

PART I: CLAIMANT IDENTIFICATION

NAME SECTION

Beneficial Owner’s Name (First, Middle, Last):

Record Owner’s Name (if different from beneficial owner listed above):

ADDRESS SECTION

Address 1 (street name and number): *

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

Country: *

City: *

State: *

Zip Code: *

CONTACT SECTION

Please select Preferred Contact Phone Number: *

Primary Phone Number: *

Please select Preferred Contact Phone Number:

Secondary Phone Number:

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 FAC CLASS A COMMON STOCK OR MONEYLION COMMON STOCK

NUMBER OF ELIGIBLE SHARES¹ –State the total number of shares of FAC Class A common stock held as of the close of trading on September 17, 2021. (Must be documented.) If none, write “zero” or “0.” *

Proof Provided

¹“Eligible Shares” means those shares of FAC Common Stock owned by Class Members immediately after the Redemption Deadline that were not submitted for redemption in connection with the Merger.

1. PURCHASES/ACQUISITIONS AFTER CLOSE OF THE MARKET ON SEPTEMBER 17, 2021 THROUGH CLOSE OF THE MARKET ON MARCH 28, 2024 – Separately list each and every purchase or acquisition (including free receipts) of FAC Class A common stock or MoneyLion common stock from after the opening of trading on September 18, 2021 through the close of trading on March 28, 2024. (Must be documented.). Do not attempt any calculations purportedly accounting for stock splits or reverse stock splits, i.e., identify the share price and share amount figures as they would appear in your contemporaneous brokerage statements at the time of the relevant occurrences.

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

Number of Shares Purchased or Acquired:

Purchase or Acquired Price Per Share:

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

Proof of Purchase Enclosed:

Must click Add Purchase to submit your transactions.

Date of Purchase or Acquisition

Number of Shares Purchased or Acquired

Purchase or Acquired Price Per Share

Total Purchase or Acquired Price

Proof of Purchase

Action

3. SALES FROM CLOSE OF THE MARKET ON SEPTEMBER 17, 2021, THROUGH CLOSE OF THE MARKET ON MARCH 28, 2024 – Separately list each and every sale or disposition (including free deliveries) of FAC Class A common stock or MoneyLion common stock after the opening of trading on September 18, 2021 through the close of trading on March 28, 2024. (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):

Confirm Proof of Sale Enclosed:

Must click Add Sale to submit your transactions.

Date of Sale

Number of Shares Sold

Sale Price Per Share

Total Sale Price

Proof of Sale

Action

5. HOLDINGS AS OF THE CLOSE OF THE MARKET ON MARCH 28, 2024 – State the total number of shares of MoneyLion common stock held as of the close of trading on March 28, 2024. (Must be documented.) If none, write “zero” or “0.”: *

Proof Provided

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.

ATTENTION: Failure to provide documentation could delay verification of your claim or result in rejection of your claim.

Select files

Files To Be Uploaded	Size	Action

IV. SUBMISSION TO JURISDICTION OF COURT AND ACKNOWLEDGMENTS

I (We) submit this Proof of Claim and Release under the terms of the Stipulation described in the Notice. I (We) also submit to the jurisdiction of the Court of Chancery of the State of Delaware 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 Settlement Administrator to support this claim if requested to do so. I (We) have not submitted any other claim in connection with the Action and know of no other person having done so on my (our) behalf.

V. RELEASE

1. I (We) hereby acknowledge full and complete satisfaction of, and do hereby fully, finally and forever settle, release and discharge from the Released Plaintiffs’ Claims each and all of the Released Defendant Parties as provided in the Stipulation.

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

3. 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.

4. I (We) hereby warrant and represent that I (we) have included the requested required information about all of my (our) holdings, purchases or acquisitions and sales or dispositions of Eligible Shares.

Signature of Claimant: *

If the claimant is other than an individual, or is not the person completing this form, the following also must be provided:

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

ACCURATE CLAIMS PROCESSING TAKES A
SIGNIFICANT AMOUNT OF TIME.
THANK YOU FOR YOUR PATIENCE.

Reminder Checklist:

1. Please sign the above release and acknowledgment.

2. Remember to attach copies of supporting documentation.

3. Do not send originals of certificates or other documentation as they will not be returned.

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

5. If you desire an acknowledgment of receipt of your Proof of Claim and Release, please send it Certified Mail, Return Receipt Requested.

6. If you move after submitting this Proof of Claim and Release, please notify the Settlement Administrator of the change in your address; otherwise you may not receive additional notices or payment.

7. Do not use red pen or highlighter on the Proof of Claim and Release or supporting documentation. You must use black or blue ink or your claim may be deemed deficient.