PROOF OF CLAIM DECLARATION

This form is to be submitted by creditors, employees, or anyone else who believes they are owed money by Peter Pan Seafood, LLC or any of its affiliates or subsidiaries identified on the last page of this form (referred to as the “Receivership Entities”).

Important Note: Only those creditors who submit this form and do so accurately can become eligible to receive distributions from the recoveries and liquidation of assets of the Receivership Entities. Please submit this form within 90 days after receipt. A Claims Bar Date will be set by the Court.

INSTRUCTIONS

Instructions for completing this form (Please read these instructions carefully and follow them closely):

You must complete and submit a separate Proof of Claim Declaration form for each of the Receivership Entities you believe owe you money.
Complete all sections of this form and provide copies of all supporting documents such as contracts, check copies (front and back), wire transfer documents, and correspondence that show the amounts you believe you are owed.
If a particular item does not apply to you, write “not applicable.” If you do not know the answer to a particular item, write “not known.” Please do not leave a question blank.
You must certify the accuracy of the Proof of Claim Declaration on the final page.
The Receiver reserves the right to request additional information from you.
The Receiver may reject any claim that has not been completed accurately or completely or that is not supported by documentation.
In the event that any information provided in this Proof of Claim Declaration changes or becomes inaccurate or incomplete, you are obligated to advise the Receiver. Failure to do so would make your Proof of Claim Declaration inaccurate or misleading. It is your responsibility to notify the Receiver if your address changes.
The fact that you have received this Proof of Claim Declaration from the Receiver, or that the Receiver accepts your return of the form, does not constitute a determination by the Receiver that you are in fact an eligible claimant to share in any distributions from the Initials Receivership Estate. The Receiver will review the claims received and compare the information you submit to the records of the Receivership Entities. Final approval of claims and distributions, if any, are dependent upon the procedures established by, and orders of, the Court. You will receive notice from the Receiver if your claim is rejected or disputed in whole or in part. If the Receiver rejects the validity or amount of your claim, you will be given an opportunity to provide additional information or evidence and to obtain a hearing from the Court. Distributions will be made after Court approval
Privacy. The information submitted in this form will only be used to verify claims, for any tax reporting required, to comply with any other legal reporting requirements, and for other permissible legal uses.
The Receiver and his attorneys cannot give you personal legal advice concerning your Proof of Claim Declaration; any such advice must come from your own attorney or other advisor. Likewise, information communicated by you to the Receiver or his attorneys is not confidential and will be utilized by the Receiver in administering the Receivership Estate, including the resolution of any claim you may make against the Receivership Estate.
A summary of your claim will be emailed to you upon your successful completion of this form. Please keep a copy of this summary for your file.
Please submit all claims in United States Dollars (“USD”). Claims will be paid in USD. The exchange rate to be applied to your claim will be the rate existing on the date of your contribution if such contributions were made in anything other than USD.
Please submit a W-9.

If you have questions, please email [email protected] or call (213) 823-1788.

Claim Type(Required)

Is this a new claim?(Required)

Claimant Name(Required)

Claim Contact's Name

First Last

Person of contact if the claimant is an entity

This is a Claim for a debt owed by: (Entity Name)(Required)

Your Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone Number(Required)

Your Fax Number

Your Email Address(Required)

Upload your W9(Required)

Max. file size: 300 MB.

IRS website https://www.irs.gov/pub/irs-pdf/fw9.pdf

Attorney Information (if applicable):

First Last

Firm Name

Attorney Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attorney Phone

Attorney Fax Number

Attorney Email

Address where goods or services rendered (If Applicable)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How much is the claim?(Required)

Does this amount include any interest, attorney fees, late fees, or other charges? If so, please identify.

What is the basis for your claim?(Required)

Is all or part of the claim secured? If so, identify the nature of the security and provide a filing number.

Setoffs. In calculating your claim, have any sums owed by you to Northwest Fish Company, LLC, or Peter Pan Seafood Company, LLC, Alaska Fish Holdings, LLC and/or Raymond Machine Shop, LLC (the “Respondents”) been offset against sums owed by the Respondents to you?

Yes

If "Yes" State the amount of the offset:

Briefly describe the nature of the offsetting debt(s):

Supporting Documents (You must attach copies of documents in support of this claim, such as purchase orders, invoices, account statements, court judgments, and evidence of any security interests or liens and of any agreement as to the interest to be paid to you. If the documents are not available, explain. If the documents are voluminous, attach a summary. This form should not be used to make a claim for expenses incurred on or after April 25, 2024, the date this receivership case commenced.)(Required)

Drop files here or

Max. file size: 300 MB.

Reminder: If you move, please send us your updated contact information.

Signature(Required)

Todays Date

Untitled

Receivership Entities

Northwest Fish Company, LLC
Peter Pan Seafood Company, LLC
Alaska Fish Holdings, LLC
Raymond Machine Shop, LLC