Required Affirmations. IF SUBMITTED ELECTRONICALLY: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. IF SUBMITTED BY U.S. MAIL: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Dated: Signature: SETTLEMENT ADMINISTRATOR ADDRESS (where to send the completed form if submitting by mail): AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. This Claim Form may be submitted in one of three ways:
1. Electronically through www.[xxx].com.
2. Via email to [xxx]@[xxx].com. Please fill out the enclosed pages, scan the document in its entirety, and include the form as an attachment.
3. Mail to: AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. To be effective as a Claim under the proposed settlement, this form must be completed, signed, and sent, as outlined above, no later than [Month] [Day] [Year]. If this Form is not postmarked or received by this date, you will remain a member of the Settlement Class but will not receive any payment from the Settlement.
Required Affirmations. IF SUBMITTED ELECTRONICALLY: 🞎 I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address], [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. Dated: Signature: • A Settlement with a $1,670,000 cash fund has been reached in a class action lawsuit claiming that Change Healthcare Resources, LLC, under the brand My Advocate, calling on behalf of Blue Cross Blue Shield of North Carolina (“Defendants”), sent prerecorded voice messages to wireless telephone numbers without consent of the recipients in violation of the Telephone Consumer Protection Act, 47 U.S.C. § 227. Defendants deny the allegations in the lawsuit and the Court has not decided who is right. • If you are a Settlement Class Member, your legal rights are affected whether you act or do not act. Read this notice carefully. DO NOTHING If you do nothing but have been identified in Defendants’ records and have received a mailed notice about the Settlement, you will automatically receive a payment from the Settlement Fund and will give up your right to bring your own lawsuit against Defendants about the claims in this case. If you do nothing but have not been identified in Defendants’ records or have not received a mailed notice about the Settlement, you will not receive a payment from the Settlement Fund and will give up your right to bring your own lawsuit against Defendants about the claims in this case. MAKE A CLAIM If you have not been identified in Defendants’ records or have not received a mailed notice about the Settlement, you may make a claim to receive a payment from the Settlement Fund. If you have been identified in Defendants’ records and have received a mailed notice about the Settlement, you will automatically receive a payment from the Settlement Fund without making a claim. EXCLUDE YOURSELF You may request to be excluded from the Settlement. If you do, you will not receive a payment from the Settlement Fund but will not give up your right to bring your own lawsuit against Defendants about the claims in this case. OBJECT Write to the Court if you do not like the...
Required Affirmations. Etna Township
