Tab 2 GENERAL RELEASE
United States v. Associates National Bank
In consideration of the receipt of a monetary payment of __________ dollars ($__________________________.00) to be paid to me/us by Associates National Bank ("ANB"), I/we ________________(name(s))_________________ hereby agree, effective upon receipt of the payment, to release and forever discharge ANB, and all current, former and future officers, directors, employees, agents, institutions, affiliated parties, parent companies, affiliates, and successors-in-interest, from all legal and equitable claims or causes of action that have been or might be asserted by me/us, as of the date of the execution of this Release, that arise out of any alleged discrimination with respect to ANB's Spanish-language credit card programs.
I/we acknowledge that I/we understand and am waiving my/our right to pursue my/our own legal action by accepting this payment. I/we further acknowledge that a copy of the Settlement Agreement between ANB and the United States has been made available to me/us.
I/we understand that there will be only one compensation payment even though there may have been two or more co-applicants on the credit card application and that the above-designated payment will be the total compensation paid to me/us arising out of the matter at issue.
This Release constitutes the entire agreement between myself, any co-applicants, and ANB and any successor institutions and their subsidiaries. This Release may not be amended or modified by oral agreement.
I/we have read this Release and understand the contents hereof, and I/we execute this Release of my/our own free act and deed.
Signed this _________ day of ___________________, 2001.
Social Security Number ________________
[signature of co-applicant, if applicable] Social Security Number ________________
STATE OF ____________
COUNTY OF ____________
PERSONALLY appeared before me, the undersigned authority in and for the jurisdiction aforesaid, the within named person(s) ______________________ ___________________________, who being duly sworn acknowledged that he/she/they signed and delivered the above and foregoing Release on the day and year therein mentioned.
GIVEN under my hand and official seal, this _________ day of _____________________, 2001.
My Commission Expires: _______________