If you received a personalized notice in the mail or via email with a Notice ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Notice ID exactly as it appears on your personalized Notice, (i.e. 12345678).

If you are a Settlement Class Member, and you did not receive a personalized notice in the mail or via email with a Notice ID and Confirmation Code, please contact the Settlement Administrator and we will provide one to you.

Email Settlement Administrator

The deadline for submitting this proof of claim form is

I. CLASS MEMBER NAME AND CONTACT INFORMATION

* Required Fields

II. COMPENSATION FOR ORDINARY LOSSES AND EXTRAORDINARY LOSSES

Check the box for each category of benefits you would like to claim. Categories include: (1) Compensation for Ordinary Losses: Unreimbursed losses, up to a total of $375 (includes ordinary Out-of-Pocket Expenses and reimbursement of Lost Time up to three (3) hours at $20 per hour spent responding to issues raised by the Data Breach); and (2) Compensation for Extraordinary Losses: Up to $5,000 in compensation for proven monetary losses.

Ordinary Losses Resulting from the Data Breach

Examples: Fees for credit reports, bank fees, long distance phone charges, cell phone charges (only if charged by the minute), data charges (only if charged based on the amount of data used), postage, or gasoline for local travel.

All ordinary Out-of-Pocket Expenses must be attributable to the Data Breach.

$

Supporting documentation must be provided. You may mark out any transactions that are not relevant to your claim before sending in the documentation.

Compensation for Lost Time

Examples: You spent time calling customer service lines, writing letters or emails, or on the Internet in order to get fraudulent charges reversed or in updating automatic payment programs because your card number changed.

Hours (up to 3 hours):
Extraordinary Losses Resulting from the Data Breach
$

Documentation of the extraordinary loss is required. The loss must be more likely than not the result of the Data Breach and must not already be covered by the ordinary reimbursement category.

III. PAYMENT OPTIONS

You have successfully requested a payment. Click here if you would like to choose a different payment method.

IV. SIGN AND DATE YOUR CLAIM FORM

I affirm under the laws of the United States and the laws of my State of residence that the information supplied in this claim form by the undersigned is true and correct.

I understand that I may be asked to provide supplemental information by the Claims Administrator before my claim will be considered complete and valid.

Your Claim Form has been submitted successfully.

Please print this page for your records.

Your Claim Details
Submitted Claim ID:
Confirmation Code:
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
CLAIM INFORMATION
First Name
Last Name
Street Address
Street Address 2
City
State
Zip Code
Email Address
Phone Number
Signature
Date

If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@SturdySettlement.com

Click here to edit your Claim.