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Submit A Claim

The document is a claim form submitted by Brandon Evans to the Equifax data breach settlement. Evans is seeking compensation for losses and expenses related to the data breach that occurred between January 23, 2020 and January 22, 2024. Specifically, Evans is claiming $1 for costs due to identity theft or fraud, $250 for lawyer fees to address identity theft issues, and $50 for mileage to meet with his lawyer. Evans has selected to receive any cash payment by check and has signed the claim form electronically to submit it to the settlement administrator.

Uploaded by

Tina Evans
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© © All Rights Reserved
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225 views3 pages

Submit A Claim

The document is a claim form submitted by Brandon Evans to the Equifax data breach settlement. Evans is seeking compensation for losses and expenses related to the data breach that occurred between January 23, 2020 and January 22, 2024. Specifically, Evans is claiming $1 for costs due to identity theft or fraud, $250 for lawyer fees to address identity theft issues, and $50 for mileage to meet with his lawyer. Evans has selected to receive any cash payment by check and has signed the claim form electronically to submit it to the settlement administrator.

Uploaded by

Tina Evans
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EQUIFAX DATA BREACH

SETTLEMENT

Your Claim Summary

Your Information

Initial Claims Period Claim


Number(s)

First Name Brandon

Last Name Evans

Middle Initial M

Alternative Name

Mailing Address 923 main street

Apt No

City Nashua

Country United States of America

State Iowa

Zip Code 50658

Phone Number (641) 210-1891

Email Address benis3434@gmail.com

Year of Birth 1982

Cash Payment: Time Spent

Explanation of Time Spent Approx Approx Year Hours and


Traveling back and forth to lawyer as well as lawyer Month 2020 Minutes
fees April 5 hours 0
minutes Privacy - Terms
Cash Payment: Money You Lost or Spent

Loss Type Amount and Description of Loss or Money Spent and Supporting
Costs, expenses, and losses due Date Documents
to identity theft, fraud, or $1.00 0
misuse of your personal
2020-04-03
information incurred between
January 23, 2020 and January
22, 2024.

Loss Type Amount and Description of Loss or Money Spent and Supporting
Professional fees paid to Date Documents
address identity theft incurred $250.00 Lawyer fees
between January 23, 2020 and
2020-04-03
January 22, 2024.

Loss Type Amount and Description of Loss or Money Spent and Supporting
Other expenses such as notary, Date Documents
fax, postage, copying, mileage, $50.00 Mileage to and from lawyer
and long-distance telephone
2020-04-03
charges related to the data
breach incurred between
January 23, 2020 and January
22, 2024.

Supporting Documents

 No documents selected

How Would You Like to Receive Your Cash Payment

 Check

Your Signature
Your claim will not be received by the Settlement Administrator until you click the "submit" button after your electronic
signature. For security reasons, once you hit submit, you will not be able to make any changes to your claim form
through this portal. However, you will still be able to go into the portal to upload supporting documentation if you
haven’t done so. If you later decide you need to change any of the information on your claim form, you will need to
reach out to the Settlement Administrator directly.

 I affirm under the laws of the United States that the information I have supplied in this claim form and any copies of
documents that I am sending to support my claim are true and correct to the best of my knowledge and that I have not
already received reimbursement for the claimed loss through other means.

 I understand that I may be asked to provide more information by the Settlement Administrator before my claim is
complete.

Date: November 7, 2021 BRANDON EVANS

SUCCESS 

Your claim form has been submitted successfully


Your claim number is:  PCYRZ-S7E42

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