The Claim Form Clause Samples
The Claim Form. 2.4.1. The Claim Form must be verified by the Settlement Class Member with a statement that his or her claim is true and correct to the best of his or her knowledge and belief and is being made under penalty of perjury. Notarization shall not be required. The Settlement Class Member must reasonably attest that the out-of-pocket expenses and charges claimed were both actually incurred and plausibly arose from the Data Breach. Failure to provide supporting attestation and documentation as requested on the Claim Form and required under ¶¶ 2.1 or 2.2 shall result in denial of a claim. Disputes as to claims submitted under this paragraph are to be resolved pursuant to the provisions stated in ¶ 2.7.
2.4.2. Claimants seeking reimbursement under ¶¶ 2.1 or 2.2 must complete and submit the appropriate section of the Claim Form to the Claims Administrator, together with proof of such losses. Claimants must provide the Claims Administrator with sufficient information to evaluate the claim, including (1) the class member’s name and current address; (2) documentation supporting their claim; and (3) a brief description of the documentation describing the nature of the loss, if the nature of the loss is not apparent from the documentation alone. Documentation supporting out-of- pocket losses can include receipts or other documentation not “self-prepared” by the class member that documents the costs incurred. “Self-prepared” documents such as handwritten receipts are, by themselves, insufficient to receive reimbursement, but can be considered to add clarity to or support other submitted documentation.
2.4.3. Nothing in this Settlement Agreement shall be construed to provide for a double payment for the same loss or injury that was reimbursed or compensated by any other source.
2.4.4. To be valid, claims must be complete and submitted to the Claims Administrator on or before the Claims Deadline.
2.4.5. No payment shall be made for emotional distress, personal/bodily injury, or punitive damages, as all such amounts are not recoverable pursuant to the terms of the Settlement Agreement.
The Claim Form. 2.5.1. The Claim Form must be verified by the Settlement Class Member with a statement that his or her claim is true and correct to the best of his or her knowledge and belief. Notarization shall not be required. The Settlement Class Member must reasonably attest that the Out-of-Pocket Losses claimed were both actually incurred and plausibly arose from the Security Incident. Failure to provide supporting attestation and documentation for Out-of-Pocket Loss claims as requested on the Claim Form and required under ¶ 2.3.1 shall result in denial of the claim. Disputes as to claims submitted under this paragraph are to be resolved pursuant to the provisions stated in ¶ 2.7.
2.5.2. Nothing in this Settlement Agreement shall be construed to provide for a double payment for the same loss or injury that was reimbursed or compensated by any other source.
2.5.3. To be valid, claims must be complete and submitted to the Claims Administrator on or before the Claims Deadline.
2.5.4. No payment shall be made for emotional distress, personal/bodily injury, or punitive damages, as all such amounts are not recoverable pursuant to the terms of this Settlement Agreement.
2.5.5. Settlement Class Members who submit a Claim Form must designate the method for payment of their claim on the Claim Form, which will include the receipt of payment via check by mail, or via PayPal, Zelle, Venmo, or such other electronic payment platform deemed efficient and appropriate by the Claims Administrator. Claim Forms failing to clearly make a single designation will receive a check by mail to the last known address on file with the Claims Administrator. In the event an electronic payment platform returns a payment to the Claims Administrator, no later than fourteen (14) days after being notified of the return of such payment, the Claims Administrator will mail a check to the Settlement Class Member’s last known address on file with the Claims Administrator.
The Claim Form. 3.3.1 For Settlement Class Members who did not receive two or more Topcase Replacements, there will be one Claim Form, and each Class Computer purchased may be the subject of only one claim.
3.3.2 Where reasonably practicable, Claim Forms for Settlement Class Members in Groups 2 or 3 for whom Apple has records of repair will be pre-populated with Settlement Class Member contact and repair information.
3.3.3 The Claim Form will call for each Claimant to confirm or update their current contact information.
3.3.4 The Claim Form will require that the Claimant confirm the following under oath:
3.3.4.1 The Claimant purchased a Class Computer in the United States;
3.3.4.2 The Claimant did not purchase the Class Computer for resale;
3.3.4.3 The Claimant obtained a Qualifying Keyboard Repair; and
3.3.4.4 The Qualifying Keyboard Repair did not resolve the Claimants keyboard issues.
3.3.5 Settlement Class Members who receive a link to a Claim Form with pre-populated answers to questions 3.3.4.1 or 3.
The Claim Form. 2.8.1. The Claim Form must be verified by the Settlement Class Member with a statement that his or her claim is true and correct to the best of his or her knowledge and belief and is being made under penalty of perjury. Notarization shall not be required. The Settlement Class Member must reasonably attest that the out-of-pocket expenses and charges claimed were actually incurred, plausibly arose from the Data Security Incident, and, for claims for Extraordinary Losses, are fairly traceable to the Data Security Incident. Failure to provide supporting attestation and documentation as requested on the Claim Form and required under ¶¶ 2.5 or 2.7 shall result in denial of a claim. Disputes as to claims submitted under this paragraph are to be resolved pursuant to the provisions stated in ¶ 2.10.
2.8.2. To be valid, claims must be complete and submitted to the Claims Administrator on or before the Claims Deadline.
The Claim Form. 2.9.1. The Claim Form must be verified by the Settlement Class Member with a statement that his or her claim is true and correct to the best of his or her knowledge and belief and is being made under penalty of perjury. Notarization shall not be required. The Settlement Class Member must reasonably attest that the out-of-pocket expenses and charges claimed were both actually incurred and plausibly arose from the Ransomware Attack. Failure to provide supporting attestation and documentation as requested on the Claim Form and required under ¶¶ 2.3 or 2.4 shall result in denial of a claim. Disputes as to claims submitted under this paragraph are to be resolved pursuant to the provisions stated in ¶ 2.10.
2.9.2. To be valid, claims must be complete and submitted to the Claims Administrator on or before the Claims Deadline.
2.9.3. No payment shall be made for emotional distress, personal/bodily injury, or punitive damages, as all such amounts are not recoverable pursuant to the terms of this Settlement Agreement.
The Claim Form. 2.7.1. The Claim Form must be verified by the Settlement Class Member with a statement that his or her claim is true and correct to the best of his or her knowledge and belief and is being made under penalty of perjury. Notarization shall not be required if the foregoing verification language is included in the Claim Form. The Settlement Class Member must reasonably attest that the out-of-pocket expenses and charges claimed were both actually incurred and plausibly arose from the Cybersecurity Event. Failure to provide supporting attestation and documentation as requested on the Claim Form and required under ¶¶ 2.2 or 2.3 shall result in denial of a claim. Disputes as to claims submitted under this paragraph are to be resolved pursuant to the provisions stated in ¶ 2.9 concerning Dispute Resolution for Claims..
2.7.2. To be valid, claims must be complete and submitted to the Claims Administrator on or before the Claims Deadline.
2.7.3. No payment shall be made for emotional distress, personal/bodily injury, or punitive damages, as all such amounts are not recoverable pursuant to the terms of this Settlement Agreement.
The Claim Form. A. There will be one Claim Form, and each Pixel2 purchased may be the subject of only one claim. Class members who purchased multiple Pixels may submit a separate claim for each Pixel purchased.
B. To the fullest extent practicable, Claim Forms will be pre-populated with Class member names and email addresses.
C. The Claim Form will require each Claimant to confirm his or her current contact information and desired payment option, and to certify that he or she is within the United States and purchased a new Pixel, not for resale, and that all information provided is true and correct to the best of his or her knowledge.
D. The Claim Form will clearly state that a Claimant need not have experienced the alleged Audio Defect to make a claim and be eligible for payment.
E. The Claim Form will include the following questions, which shall be answered under oath:
1. Whether the Claimant is in the United States and purchased a Pixel,
2. Whether the Claimant purchased the Pixel not for resale.3
3. Whether the Pixel that the Claimant purchased experienced the alleged Audio Defect.4
The Claim Form. 2.7.1. The Claim Form must be verified by the Settlement Class Member with a statement that his or her claim is true and correct to the best of his or her knowledge and belief and is being made under penalty of perjury. Notarization shall not be required. The Settlement Class Member must reasonably attest that they believe any Out-of-Pocket Losses claimed were both actually incurred and plausibly arose from the Security Incident. Failure to provide supporting attestation and documentation as requested on the Claim Form and required under ¶¶ 2.3 or 2.4 shall result in denial of a claim. Disputes as to claims submitted under this paragraph are to be resolved pursuant to the provisions stated in ¶ 2.8.
2.7.2. Nothing in this Settlement Agreement shall be construed to provide for a double payment for the same loss or injury that was reimbursed or compensated by any other source.
2.7.3. To be valid, claims must be complete and submitted to the Claims Administrator (electronically or by mail) on or before the Claims Deadline.
2.7.4. No payment shall be made for emotional distress, personal/bodily injury, or punitive damages, as all such amounts are not recoverable pursuant to the terms of this Settlement Agreement.
2.7.5. Settlement Class Members who submit a Claim Form must designate the method for payment of their claim on the Claim Form, which will include the receipt of payment via check by mail, or via PayPal, Zelle, Venmo, or such other electronic payment platform deemed efficient and appropriate by the Claims Administrator. Claim Forms failing to clearly make a single designation will receive a check by mail to the last known address on file with the Claims Administrator. In the event an electronic payment platform returns a payment to the Claims Administrator, no later than fourteen (14) days after being notified of the return of such payment, the Claims Administrator will mail a check to the Settlement Class Member’s last known address on file with the Claims Administrator.