Submit Claim | Allconnect Settlement

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Eligible Settlement Class Members may submit one or more Claims for reimbursement for documented Economic Losses related to the Data Breach that have not been reimbursed by AllClear ID or other third parties, up to an aggregate total of $4,000.00 per Settlement Class Member, provided, however, that no Settlement Class Member may submit a Reimbursement Form unless said Settlement Class Member has first submitted a Reimbursement Claim to AllClear ID, AllClear ID has denied the claim, and said Settlement Class Member has exhausted AllClear ID’s claims process. Any Settlement Class Member whose Reimbursement Claim to AllClear ID is rejected for failure to submit a claim within AllClear ID’s required time period may not submit a Claim for reimbursement under this process. If a Settlement Class Member submitted a timely Reimbursement Claim to AllClear ID and AllClear ID denied the claim for failure to provide sufficient supporting materials, then the loss may not be claimed for reimbursement hereunder.

Settlement Class Members who wish to make a timely and properly supported Claim for reimbursement of Economic Losses related to the Data Breach must provide to the Settlement Administrator the information required to evaluate the claim, including: (a) the Claimant’s name and current address; (b) if applicable, a signed copy of IRS Form 14039 along with a statement under penalty of perjury that the form was submitted to the Internal Revenue Service; (c) the bills or invoices documenting the amount of the Claim and proof that the bills or invoices were paid; (d) documentation showing that the claim was submitted to AllClear ID, denied by AllClear ID, and that the AllClear ID claims process was exhausted; and (e) a statement signed under penalty of perjury indicating that: (i) the Economic Losses claimed are fairly traceable to the Data Breach; and (ii) the total amount claimed has not been reimbursed by any other person or entity. Third-party documentation of Economic Losses is required to establish a Claim. Economic Losses that are compensated under this Settlement are those that are reasonable and customarily incurred when responding to the type of fraud or identity theft suffered by the Settlement Class Member from the Data Breach.

You must accurately complete all required portions of this Claim Form and submit the Claim Form under penalty of perjury.

YOU MUST SUBMIT YOUR CLAIM FORM NO LATER THAN OCTOBER 28, 2021, OR 2 YEARS AFTER THE SETTLEMENT EFFECTIVE DATE.

CLAIMANT INFORMATION

First Name

Last Name

Street Address *

Street Address 2

City *

State *

Zip Code *

* Required Fields

Additional Information

Social Security Number (Last Four Digits) *

Email Address *

Confirm Email Address *

Telephone Number *

I declare under penalty of perjury that:*

The economic loss I have claimed on this form is related to the Data Breach; and

The total amount claimed has not been reimbursed by AllClear ID or any other third party.

You may submit one or more reimbursement requests, but all of your requests cannot exceed an aggregate $4,000. Only one (1) form is needed for multiple costs incurred from the Data Breach.

$Amount Requested *

Please provide a brief description of economic loss requested in this Claim, as well as an explanation of how such losses are related to the Data Incident. *

Documentary proof must be submitted to support your exact claim amount.

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

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Signature (Type your name here to electronically sign your Claim Form) *

Date

Your claim will be submitted to the Settlement Administrator for review. If your Reimbursement Form is incomplete, untimely, or contains false information, it may be rejected by the Settlement Administrator. If your claim is approved, you will be mailed a check at the street address you provide. This process takes time; please be patient.

McKenzie et al. v. Allconnect, Inc.

No. 5:18-cv-00359-JMH (E.D. Ky.)

United States District Court for the Eastern District of Kentucky

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Your Claim Form has been submitted successfully.

Submitted Claim ID:
Confirmation Code:
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
CLAIM INFORMATION
First Name
MI
Last Name
Street Address
Street Address 2
City
State
Zip Code
Email Address
Phone Number