These are the terms the acknowledgment in section 4 refers to. Read them before you sign. They apply only if you choose Option B.
1. Election to forfeit allocation
By executing this election intake, the Holder expresses an intention to receive a financial reimbursement in exchange for the full forfeiture, cancellation and surrender of all legacy JIL ERC-20 tokens (contract 0x9347efffa3e8985e0d35536b408cab48599971e8), future native token rights, allocations or claims associated with JIL Sovereign Holdings, LLC and its affiliated entities (collectively, the "Company").
2. Verification and reconciliation mechanics
Holder acknowledges that processing is strictly contingent upon off-chain and on-chain ledger reconciliation. The Company reserves the right to verify original deposit receipts, on-chain transactions and contribution ledgers. Approved reimbursements will be processed following completion of administrative verification and execution of formal settlement instructions.
3. General release and settlement of claims
Upon disbursement and receipt of the agreed reimbursement amount, Holder agrees that such payment constitutes a full, final and complete compromise and settlement of any and all disputes concerning the legacy ERC-20 tokens. Holder releases and discharges the Company, its predecessors, successors, affiliates, officers and directors from any and all claims, demands, liabilities or causes of action arising out of or related to the initial acquisition, holding or surrender of the legacy token.
4. No admission of liability
Holder acknowledges and agrees that the availability of this election and any resulting reimbursement is offered strictly as a voluntary commercial accommodation and corporate restructuring step. Nothing contained herein, or in the processing of this election, shall be construed, deemed or implied as an admission of liability, fault, regulatory non-compliance or wrongdoing by the Company or its affiliates.
5. Compliance and sanctions screening
Disbursements are strictly conditioned upon successful compliance verification. Holder represents and warrants that neither the Holder nor any beneficial owner of the legacy assets is subject to economic or trade sanctions administered by OFAC, the United Nations or relevant international authorities. The Company reserves the right to withhold processing for failed anti-money-laundering (AML) or know-your-transaction (KYT) checks.
6. Governing law and jurisdiction
This election, and any non-contractual obligations arising out of or in connection with it, shall be governed by and construed in accordance with the laws of the State of Wyoming, without regard to its conflict of law principles. Any dispute arising under or in connection with this election shall be subject to the exclusive jurisdiction of the state or federal courts located in Wyoming.
What this page does not collect. No payout destination is requested or accepted here. Where reimbursement should be sent is settled by the formal settlement instructions referred to in section 2, which the Company sends after reconciling your submission against its records — never by an unsolicited message, and never on this form.