Acknowledgement of Claimant. (s) Claimants must acknowledge that they have read and agree to the following by checking the boxes (mandatory): □ SUBMISSION TO JURISDICTION OF THE COURT. I (we) agree to submit to the exclusive jurisdiction of the United States District Court for the Middle District of Tennessee, Nashville Division, for all purposes associated with this Claim. □ VERIFICATION OF CLAIM. I (we) represent that I am (we are) the current or former owner(s) or lessee(s) of the vehicle identified in this Claim Form. □ VERIFICATION OF OUT OF POCKET PAYMENT. I (we) certify that no portion of the cost of replacement or repair for which I (we) seek reimbursement was previously paid for by Nissan, an authorized Nissan dealer, or an extended warranty or service contract provider.
Acknowledgement of Claimant. By submitting this form, the claimant acknowledges and agrees that she or he submits to the exclusive jurisdiction of the United States District Court for the Southern District of New York (the “Court”) for all purposes associated with the administration of this Proof of Claim. The claimant agrees to waive a trial by jury, to the extent such a right exists, and agrees to the Court’s summary disposition of the determination of the validity or the amount of the claim by this Proof of Claim form. The claimant further consents to the Claims Administrator and its agents’ use of any information provided in this Proof of Claim, including but not limited to, Social Security Number or Taxpayer ID, mailing address, email, wallet address and phone number to verify and process the claim, and understands that the information provided will be processed in the United States, protected by appropriate safeguards, stored for as long as is required to complete the claim verification process and during the pendency of any related judicial proceedings, and shared with agents of the Claims Administrator for purposes of verifying and responding to the claim. Release:
