James River Group Holdings, Ltd. Securities Litigation

The Claims Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Claims Administrator in writing at the address above. Complete names of all persons and entities must be provided.

CLAIMANT IDENTIFICATION

Beneficial Owner Name (First, Middle, Last):

Joint Benefical Owner's Name (if applicable) :

Name of Representative, if applicable (executor, administrator, trustee, c/o, etc.), if different from Beneficial Owner:

Address 1 (street name and number): *

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

Country: *

City: *

State/Territory: *

Zip: *

Telephone Number (home): *

Telephone Number (work):

Email Address (If you provide an email address, you authorize the Claims Administrator to use it in providing you with information relevant to this claim.):

Claimant Account Type (check appropriate box): *

* Denotes required field

SCHEDULE OF TRANSACTIONS IN JAMES RIVER COMMON STOCK

The only eligible security is James River Group Holdings, Ltd. (“James River”) common stock (Ticker: NASDAQ: JRVR, CUSIP: G5005R107). Do not include information regarding any other securities. Please include proper documentation with your Claim Form as described in paragraph 6 of the General Instructions.

HOLDINGS AS OF FEBRUARY 22, 2019 – State the total number of shares of James River common stock held as of the opening of trading on February 22, 2019 (Must submit documentation.) If none, enter “0.”

PURCHASES/ACQUISITIONS FROM FEBRUARY 22, 2019 THROUGH JANUARY 21, 2022 – Separately list each and every purchase or acquisition (including free receipts) of James River common stock from February 22, 2019 through the close of trading on January 21, 2022. (Must be documented.)

SALES FROM FEBRUARY 22, 2019 THROUGH JANUARY 21, 2022 – Separately list each and every sale or disposition (including free deliveries) of James River common stock from February 22, 2019 through the close of trading on January 21, 2022. (Must be documented.)

HOLDINGS AS OF JANUARY 21, 2022 – State the total number of shares of James River common stock held as of the close of trading on January 21, 2022. (Must be documented.) If none, enter “0”

Sales of James River common stock during the period from October 26, 2021 through the close of trading on January 21, 2022 will be used for purposes of calculating Recognized Loss Amounts under the Plan of Allocation. Therefore, in order for the Claims Administrator to be able to balance your claim, the requested purchase information during this period must also be provided.

CLAIM DETAILS TRANSACTIONS

Security Type:

Transaction Type:

PURCHASES/ACQUISITIONS FROM FEBRUARY 22, 2019 THROUGH JANUARY 21, 2022 – Separately list each and every purchase or acquisition (including free receipts) of James River common stock from February 22, 2019 through the close of trading on January 21, 2022. (Must be documented.)

Trade Date: *

Number Of Shares Purchased/Acquired: *

Purchase/Acquisition Price Per Share: *

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

Confirm Proof Enclosed:

SALES FROM FEBRUARY 22, 2019 THROUGH JANUARY 21, 2022 – Separately list each and every sale or disposition (including free deliveries) of James River common stock from February 22, 2019 through the close of trading on January 21, 2022. (Must be documented.)

Trade Date: *

Number Of Shares Sold: *

Sale Price Per Share: *

Total Sale Price (Excluding Commissions, Taxes, and Fees) : *

Confirm Proof Enclosed:

Must click Add to save your information.

Security Type

Transaction Type

Trade Date

Quantity

Price

Net Amount

Proof of Purchase Enclosed

Action

UPLOAD SUPPORTING DOCUMENTS

All supporting documentation for your 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.

Select files

Files To Be Uploaded	Size	Action

YOU MUST ALSO READ THE RELEASE AND CERTIFICATION BELOW

I (we) hereby acknowledge that, pursuant to the terms set forth in the Stipulation, without further action by anyone, upon the Effective Date of the Settlement, I (we), on behalf of myself (ourselves) and my (our) (the claimant(s)’) heirs, executors, administrators, predecessors, successors, and assigns, in their capacities as such, shall be deemed to have, and by operation of law and of the judgment shall have, fully, finally, and forever compromised, settled, released, resolved, relinquished, waived, and discharged each and every Released Plaintiffs’ Claim against Defendants and the other Defendants’ Releasees, and shall forever be barred and enjoined from prosecuting any or all of the Released Plaintiffs’ Claims against any of the Defendants’ Releasees.

CERTIFICATION

By signing and submitting this Claim Form, the claimant(s) or the person(s) who represent(s) the claimant(s) agree(s) to the release above and certifies (certify) as follows:

1. That I (we) have read and understand the contents of the Notice and this Claim Form, including the releases provided for in the Settlement and the terms of the Plan of Allocation;

2. That the claimant(s) is a (are) Settlement Class Member(s), as defined in the Notice, and is (are) not excluded by definition from the Settlement Class as set forth in the Notice;

3. That the claimant(s) did not submit a request for exclusion from the Settlement Class;

4. That I (we) own(ed) the James River common stock identified in the Claim Form and have not assigned the claim against any of the Defendants or any of the other Defendants’ Releasees to another, or that, in signing and submitting this Claim Form, I (we) have the authority to act on behalf of the owner(s) thereof;

5. That the claimant(s) has (have) not submitted any other claim covering the same purchases of James River common stock and knows (know) of no other person having done so on the claimant’s (claimants’) behalf;

6. That the claimant(s) submit(s) to the jurisdiction of the Court with respect to claimant’s (claimants’) claim and for purposes of enforcing the releases set forth herein;

7. That I (we) agree to furnish such additional information with respect to this Claim Form as Lead Counsel, the Claims Administrator, or the Court may require;

8. That the claimant(s) waive(s) the right to trial by jury, to the extent it exists, and agree(s) to the determination by the Court of the validity or amount of this Claim, and waive(s) any right of appeal or review with respect to such determination;

9. That I (we) acknowledge that the claimant(s) will be bound by and subject to the terms of any judgment(s) that may be entered in the Action; and

10. That the claimant(s) is (are) NOT subject to backup withholding under the provisions of Section 3406(a)(1)(C) of the Internal Revenue Code because (i) the claimant(s) is (are) exempt from backup withholding or (ii) the claimant(s) has (have) not been notified by the IRS that he, she, or it is subject to backup withholding as a result of a failure to report all interest or dividends or (iii) the IRS has notified the claimant(s) that he, she, or it is no longer subject to backup withholding. If the IRS has notified the claimant(s) that he, she, it, or they is (are) subject to backup withholding, please strike out the language in the preceding sentence indicating that the claim is not subject to backup withholding in the certification above.

NOTE: If you have been notified by the I.R.S. that you are subject to backup withholding, please check this box.

Signature of Claimant: *

Joint Claimant Signature (if any):

Signature of person signing on behalf of Claimant:

Capacity of person signing on behalf of Claimant, if other than an individual (e.g., Administrator, Executor, Trustee, President, Custodian, Power of Attorney, etc.):