ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): FOR COURT USE ONLY Telephone No.: E-Mail Address (Optional): ATTORNEY FOR (Name): Fax No. (Optional): Bar No: SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE Civil Complex Center - 751 W. Santa Ana Blvd., Bldg. 36, Santa Ana, CA 92701-4512 PLAINTIFF / PETITIONER: DEFENDANT / RESPONDENT: CLASS ACTION/B&P 17200 QUESTIONNAIRE (To be filed by counsel for plaintiff/s within 30 days of filing initial complaint) CASE NUMBER: DEPT: JUDGE: STATUS CONFERENCE DATE: In response to the conflict of interest issues raised in Apple Computer, Inc. v. The Superior Court of Los Angeles County (2005) 126 Cal. App. 4th 1253, counsel for each proposed class representative is to provide the following information under oath to the Court: 1. Is any proposed class representative an attorney? 2. Is any proposed class representative a spouse, child or family member of plaintiff's counsel or of a partner or associate of the law firm of which plaintiff's counsel is a member? Yes ____ No _____ Yes ____ No _____ If yes, explain relationship: ______________________________________________ 3. Within the last 5 years, has any proposed class representative filed prior class action lawsuits using the same plaintiff's counsel or firm as in the present case? Yes ____ No _____ If yes, explain: ______________________________________________ 4. Does any proposed class representative have a business relationship with plaintiff's counsel, including but not limited to, the relationship of law partner, associate, employee, principal, agent, independent contractor, or professional corporation? Yes ____ No _____ If yes, explain relationship: ______________________________________________ 5. If there is co-counsel, have the attorneys been co-counsel in other class actions? Yes ____ No _____ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. ____________________ DATE _______________________________________ SIGNATURE OF COUNSEL FOR PLAINTIFF(S) CLASS ACTION/B&P 17200 QUESTIONNAIRE Approved for Mandatory Use L277 [New June 1, 2005] American LegalNet, Inc. www.USCourtForms.com