This form will ask for your contact information. You can then fill out one or both of the sections that follow depending on which benefits you want to claim:
1. If you spent time recovering from the breach during the Extended Claims Period, you can request payment, or skip to the next section.
2. If you lost or spent money because of the breach during the Extended Claims Period, you can request payment, or skip to the next section.
3. Finally, you will confirm how you’d like to get your payment for your Extended Claims Period claim.
You can file claims for some or all of the benefits in Sections 1 and/or 2 if you are eligible. Before you start, make sure you have your supporting documents ready to upload if you plan to request payment in Section 1 (if claiming more than 10 hours total) and/or 2. Click here to see the types of documentation that you may need.
Your claim will only be received by the Settlement Administrator after you sign the form electronically and click the "submit" button. Please note that, if you make a claim for a cash payment, your payment may be significantly reduced based upon the number of claims filed.