Morgan Peachtree

AUTHORIZATION FOR RELEASE OF

EMPLOYEE WELFARE BENEFIT PLAN INFORMATION

Pursuant to 29 U.S.C. §1024(b)(4), the undersigned hereby authorizes my Employer/Former Employer to furnish to my attorneys, MORGAN & MORGAN, 191 Peachtree St., NE, Suite 4200, Atlanta, Georgia 30303,Telephone: 404-***-****; Facsimile: 404-***-****, a copy of all employee welfare benefit plan documents in existence during my employment. This authorization includes any and all documents enumerated in Section 1024(b)(4), including but not limited to the latest updated summary plan descriptions, plan descriptions, latest annual reports, terminal reports, applicable collective bargaining agreements, trust agreements, contracts or other instruments under which any of the plans at issue were established or are presently operated. NOTICE: Neither the employee welfare benefits plan administrators nor my employer/former employer is authorized to disclose to any third party including insurance adjusters, insurance companies, or any other person or entity, any personal information pertaining to me or the medical treatment I received or the cost thereof. The undersigned claims every confidentiality privilege whether federal of state and whether created by statute, rule or case law. Such personal information includes any information in my personnel file or any other information obtained by my employer/former employer, the plan or its agents in the course of administering the plan and paying benefits pursuant to the plan.

ALL PRIOR AUTHORIZATIONS ARE HEREBY CANCELED, and I hereby waive any privilege I have regarding release of said information to my attorneys. A photocopy of this authorization shall be considered the same as the original. Employee/Plan Participant:

Date:

Witness:

MORGAN & MORGAN

(M&M #41AT GA)

DocuSign Envelope ID: 9902F625-B7EC-4A2C-8F0F-A4437B864344