UNREIMBURSED LOSSES. All members of the Settlement Class who submit a Valid Claim using this Claim Form are eligible for reimbursement of the following documented out-of-pocket expenses, not to exceed $4,000 per member of the Settlement Class, that were incurred as a result of the Cyberattack: (Fill all that apply) Cost Type Approximate Date of Loss Amount of Loss / / $ . ⭘ Out-of-pocket expenses incurred as a result of the Cyberattack, including bank fees, long distance phone charges, cell phone charges (only if charged by the minute), data charges (only if charged based on the amount of data used), postage, or gasoline for local travel. (mm/dd/yy)
UNREIMBURSED LOSSES. All members of the California Subclass who submit a Valid Claim using this Claim Form are eligible for reimbursement of the following documented out-of-pocket expenses, not to exceed $4,000 per member of the Settlement Class, that were incurred as a result of the Cyberattack: (Fill all that apply) Cost Type Approximate Date of Loss Amount of Loss / / $ . ⭘ Out-of-pocket expenses incurred as a result of the Cyberattack, including bank fees, long distance phone charges, cell phone charges (only if charged by the minute), data charges (only if charged based on the amount of data used), postage, or gasoline for local travel. (mm/dd/yy)
UNREIMBURSED LOSSES. $ . All members of the Settlement Class who submit a Valid Claim using this Claim Form are eligible for reimbursement of the following documented out-of-pocket expenses, not to exceed $3,500 per member of the Settlement Class, that were incurred as a result of the Cyberattack: Cost Type Approximate Date of Loss Amount of Loss (Fill all that apply) Out of pocket expenses incurred as a result of the Cyberattack, including bank fees, long distance phone charges, cell phone charges (only if charged by the minute), data charges (only if charged based (mm/dd/yy) on the amount of data used), postage, or gasoline for local travel. CREATIVE- A Your claim must be submitted online or postmarked by: MONTH DD, 2023 CLAIM FORM FOR CREATIVE VENTURES, INC. CYBERATTACK SETTLEMENT Xxxxxx Xxxxx v. Creative Ventures, Inc., d/b/a Pro Wrestling Tees / / $ . Case No. 2023LA000177
UNREIMBURSED LOSSES. All members of the California Subclass who submit a Valid Claim using this Claim Form are eligible for reimbursement of the following documented out-of-pocket expenses, not to exceed / / $ . $3,500 per member of the Settlement Class, that were incurred as a result of the Cyberattack: Cost Type Approximate Date of Loss Amount of Loss (Fill all that apply)
UNREIMBURSED LOSSES. All members of the Settlement Class, who did not select the alternative cash payment above, who submit a Valid / / $ . / / $ . / / $ . Claim using this Claim Form are eligible for reimbursement of the following documented out-of-pocket expenses, not to exceed $5,000.00 per member of the Settlement Class, that were incurred as a result of the Data Incident: Cost Type Approximate Date of Loss Amount of Loss (Fill all that apply)
UNREIMBURSED LOSSES. All members of the Settlement Class who submit a Valid Claim using this Claim Form and supporting documentation are eligible for reimbursement of documented out-of-pocket expenses that were incurred as a result of the Data Incident, so long as you did not select the Alternative Cash Payment above. Check the box for each category of benefits you would like to claim. You must reasonably describe the Unreimbursed Losses, provide supporting documentation, and attest that the losses were incurred as a result of the Data Incident. Please provide as much information as you can to help us figure out if you are entitled to a settlement payment.
