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Consent Form

I hereby authorize Anchor Fundings, its agents and/or contractors (“Anchor”) to contact my Qualified Settlement Fund Administrator and/or my attorney to confirm the amount, status, or details of any settlement, award, or claim I may be entitled to under the terms of the settlement of my lawsuit.

I understand and acknowledge that this consent allows the release of information related to my claims and the settlement of my lawsuit and that any such released information may be disclosed by Anchor to third parties including Anchor’s affiliates and financing partners and I hereby consent to such disclosure. I understand that I have the right to revoke this consent, in writing, at any time, by contacting Anchor at .

A photocopy or facsimile of this consent shall be valid and given the same force and effect as the original.