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Dispute Notice

MoonDAO™ Initial Dispute Notice

First Name:* _____________________________________________________________

Last Name:* _____________________________________________________________

Street Address:* ________________________________________________________

City:* ___________________________________________________________________

State:* __________________________________________________________________

Zip Code:* ______________________________________________________________

Email Address:* ________________________________________________________

Telephone Number:* __________________________________________________

Description of Dispute:* _______________________________________________

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Desired Outcome: _____________________________________________________

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Mail or Email Notice to: LuckDAO Limited d/b/a MoonDAO

398B Capp St.

San Francisco, CA, 94110

dispute@moondao.com

(*Required fields) {00136660;1}