Claimant Information
Confirmation
Class Action Settlement Exclusion Form

To be excluded from the settlement, you must fully complete and submit this form. If you do so, you will not be eligible to receive a settlement payment or benefits. You will retain the right to sue on your own regarding any claims that are part of the settlement. All information will be kept private. It will not be disclosed to anyone other than the Court, the Settlement Administrator, and the Parties in this case, and will be used only to administer this settlement.

Current Contact Information

You must provide the following information to excluded to the Settlement:

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