Amount Requested Sample Clauses

Amount Requested. ❑ The Grantee confirms that the advance is necessary due to a lack of cash on hand to administer the grant on a cost-reimbursable basis.

Amount Requested. $ Only one (1) form is needed for multiple costs incurred from the Incident. Please provide a brief description of economic loss requested in this Claim, as well as an explanation of how such losses are related to the Data Incident. (You may attach additional pages if necessary). Signature: Date: Your claim will be submitted to the Settlement Print Name: Administrator for review. If your Reimbursement Form is incomplete, untimely, or contains false information, it may be rejected by the Settlement Administrator. If your claim is approved, you will be issued a payment using the email or street address you provide. This process takes time; please be patient. I declare under penalty of perjury that: 🞎 The Attested Time is related to the Incident. Only one (1) form is needed for all Attested Time incurred from the Incident.

Amount Requested. $ , . Please provide a brief description of economic costs requested in this Claim, as well as an explanation of how such losses are related to the Data Incident. (You may attach additional pages if necessary). Date: Your claim will be submitted to the Settlement Administrator for review. If your Reimbursement Form is incomplete, untimely, or contains false information, it may be rejected by the Settlement Administrator. If your claim is approved, you will be mailed a check at the street address you provide. This process takes time; please be patient. Print Name: Signature: ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇ LUSTIGSON, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇, and ▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, individually and on behalf of all others similarly situated, Plaintiffs,