PLEASE PROVIDE THE INFORMATION LISTED BELOW. Check the box for each category of out-of-pocket expenses or lost time that you incurred as a result of the Data Incident. Please be sure to fill in the total amount you are claiming for each category and to attach documentation as described (if you provide account statements as part of proof for any part of your claim, you may mark out any unrelated transactions if you wish).
Appears in 2 contracts
Samples: Settlement Agreement, Settlement Agreement
PLEASE PROVIDE THE INFORMATION LISTED BELOW. Check the box for each category of out-of-pocket expenses or lost time that you incurred as a result of the Data Incident. Please be sure to fill in the total amount you are claiming for each category and to attach documentation of the charges as described in bold type (if you are asked to provide account statements as part of proof required for any part of your claim, you may mark xxxx out any unrelated transactions if you wish).
Appears in 1 contract
Samples: Settlement Agreement and Release
PLEASE PROVIDE THE INFORMATION LISTED BELOW. Check the box for each category of out-of-pocket expenses or lost time that you incurred as a result of the Data Incident. Please be sure to fill in the total amount you are claiming for each category and to attach documentation of the charges as described in bold type (if you are asked to provide account statements as part of proof required for any part of your claim, you may mark out any unrelated transactions if you wish).
Appears in 1 contract
Samples: Settlement Agreement and Release