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To register in the Stellar coal mine class action, please fill out the short questionnaire below. We are interested in any circumstances of unfair treatment or underpayment in the mining industry.

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Unique ID
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Adero Notes
1. Name*
Prefix First Middle Last
2. Phone*
3. Email*
Enter Email Confirm Email
4. Address*
Street Address City State / Province / Region ZIP / Postal Code Country
5. Date Of Birth*
DD slash MM slash YYYY
6. Were you employed as a casual miner by Stellar in the black coal industry between 21 December 2012 and 21 December 2018?*
- Yes
- No
7. Enter the number of mine sites you worked at:*

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Disclosure Letter

By signing below and submitting this form you:
- reasonably believe that you will be eligible to participate in the action;
- warrant that;
  - the information you have provided is true and correct; and
  - you will not sign-up or register using any false or misleading details;
- hereby execute and agree to be bound by and comply with the terms of the;
  - Retainer Agreement; and
  - Funding Agreement
and consent to us entering the information you have provided to us into those documents
- have been given the opportunity to obtain independent legal advice as to the nature and effect of the Retainer Agreement and Funding Agreement, and you agree to be bound and comply with the terms of the Retainer Agreement and Funding Agreement;
  - after obtaining, and in reliance on such independent legal advice; or
  - having elected not to obtain independent legal advice; and
    - you have read and understood the nature and effect of the Retainer Agreement and Funding Agreement; and
    - you do not require any explanation or advice in relation to those documents;
  - consent and authorise us to use the information provided to assess whether or not you may be eligible to participate in the action; and
  - consent to receive further communications from us regarding any continued participation in the action.
Signature*
Consent*
I agree to the terms and conditions
If you would prefer to sign a hard copy of this agreement, please print out a copy of the Retainer Agreement and Funding Agreement, complete the Claimant Details in the document, sign it, and then scan it as a PDF and email it to: stellaraction@aderolaw.com.au.

I understand that the Retainer Agreement and the Funding Agreement are confidential documents. I understand that I am not permitted to share these documents or the information contained therein with any third party or for any purpose other than participating in the proposed proceedings. If you would prefer to sign a hard copy of these agreements, please print out copies of the Retainer Agreement and Funding Agreement, complete the Claimant Details in each document, sign them, and then scan them as a PDF and email them to: stellaraction@aderolaw.com.au

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Stellar | Expression of Interest

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By signing below and submitting this form you: