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).

REIMBURSEMENT FORM

Eligible Settlement Class Members may submit one or more Claims for reimbursement for Lost Time or documented Economic Losses related to the Data Breach that have not been reimbursed by IDX or other third parties, up to an aggregate total of $1,500.00 per Settlement Class Member. You may make a self-certified claim for up to 3 hours of lost time, at $20/hour ($60.00 maximum), if at least one full hour was spent dealing with the Data Security Incident.

Alternatively, eligible Settlement Class Members may submit a Claim for an Alternative Cash Payment of up to $25.00 per Settlement Class Member.

Settlement Class Members who wish to make a timely and properly supported Claim for Lost Time or reimbursement of Economic Losses related to the Data Breach must provide to the Settlement Administrator the information required to evaluate the claim, including: (a) the Claimant’s name and current address; (b) the bills or invoices documenting the amount of the Claim and proof that the bills or invoices were paid; and (c) a statement signed under penalty of perjury indicating that: (i) the Economic Losses and/or Lost Time claimed are fairly traceable to the Data Breach; and (ii) the total amount claimed has not been reimbursed by any other person or entity.

Third-party documentation of Economic Losses is required to establish a Claim, but no documentation other than self-certification will be required for claims related to Lost Time. Economic Losses are those that are reasonable and customarily incurred when responding to the type of fraud or identity theft threatened to or suffered by the Settlement Class Member from the Data Breach.

Settlement Class Members must submit this documentation along with the form required below (1) electronically or (2) by mailing it to the following address:

North Shore Data Breach Settlement Administrator
1650 Arch Street, Suite 2210
Philadelphia PA, 19103

If you have any questions, call 1-855-554-5225 or email info@NorthShoreSettlement.com

Deadline: All Claims must be submitted to the Settlement Administrator on or before January 13, 2023.


CLAIMANT INFORMATION
👁

* Required Fields

I declare under penalty of perjury that:

You may submit one or more reimbursement requests, but all of your requests cannot exceed an aggregate $1,500. Only one (1) form is needed for multiple costs incurred from the Data Breach.

Documentary proof must be submitted to support your exact claim amount.

UPLOAD SUPPORTING DOCUMENTATION

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected.

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    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
    MI
    Last Name
    Mailing Address
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    Email Address
    Telephone Number
    Signature
    Date

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

    Click here to edit your Claim.

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