Submit a Claim - Page 1

Contact Information:

The Claim Administrator will use this information for all communications regarding this Claim Form and the Settlement. If this information changes prior to the distribution of payments and Credit Monitoring and Insurance Services, you must notify the Claims Administrator in writing at the address noted in the Claim Form Instructions.

If your claim is approved, settlement benefits will be sent to you using the information you provide here.

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Unique ID:

To continue your submission, please provide the Unique ID from your Notice, if applicable.