If you received a personalized notice in the mail or via email with a Notice ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Notice ID exactly as it appears on your personalized Notice, (i.e. 12345678).

If you do not have your Notice ID and Confirmation Code, click below to verify your eligibility by looking up your information in the Class List.

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GENERAL CLAIM FORM INFORMATION

This Claim Form must be submitted by no later than July 17, 2023.

I. CLAIMANT INFORMATION

Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form.

* Required Fields

II. BENEFIT SELECTION

Credit and Identity Monitoring Services

Pursuant to Section 4.1 of the Settlement Agreement, members of the Settlement Class are eligible for credit and identity monitoring services and are defined as: “All persons who were notified by SEPTA that his or her personal information might have been compromised in the data security incident that occurred in or about August 2020.”

If you received Notice of this Settlement, you have been identified by the Settlement Administrator as a Settlement Class Member.

By initialing here, I certify that I received Notice of this Settlement and I request the free one-year of credit and identity monitoring services provided by Equifax, which includes single bureau credit monitoring, automatic fraud alerts, $1,000,000 in reimbursement insurance, and identity restoration services.

Monetary Compensation

Pursuant to Section 4.2 of the Settlement Agreement, members of the Settlement Class may be eligible for monetary compensation. More detailed information about the monetary claims can be found in Section 4.2 of the Settlement Agreement.

Documented Economic Losses

By initialing here, I request the reimbursement of documented economic losses in the amount of $ (up to $1,000.00). Documented Economic Losses incurred as a result of the Data Security Incident may include unreimbursed losses relating to fraud or identity theft, professional fees including attorneys’ fees, accountants’ fees, 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; and fees for credit reports, credit monitoring, or other identity theft insurance product purchased following the expiration of the credit monitoring and identify theft insurance coverage that was offered at the time of notification. I understand that I am required to provide supporting third-party documentation.

Please provide copies of any receipts, bank statements, reports, or other documentation supporting your claim. This can include receipts or other documentation not “self-prepared” by you. “Self-prepared” documents such as handwritten receipts are, by themselves, insufficient to receive reimbursement, but can be considered to add clarity or support to other submitted documentation. The Settlement Administrator may contact you for additional information before processing your claim.

You may mark out any information that is not relevant to your claim before sending in the documentation.

Documented Economic Losses Certification: By signing below under penalty of perjury, I certify that the Economic Losses claimed are fairly traceable to the Data Breach and that the total amount claimed has not been reimbursed by any other person or entity (i.e., reimbursed by a bank or removed from credit card bill following a dispute). Signing below also indicates that you are submitting this Claim for Economic Losses and your representations of these Losses are true and correct to the best of your knowledge and belief and are being made under penalty of perjury.

Lost Time

Please provide an attestation setting forth the amount of time (up to four hours) spent dealing with the Data Security Incident and an explanation of how the time was spent on preventative, remedial or other measures related to the Data Security Incident. Time spent could include, for example, a statement of how the time was spent such as obtaining credit reports, dealing with a credit freeze, dealing with bank or credit card fee issues, monitoring accounts, or updating automatic payment programs because a card number was changed.

Lost Time Certification: Signing below indicates that you are submitting this Claim for lost time and your representations are true and correct to the best of your knowledge and belief and are being made under penalty of perjury.

III. UPLOAD SUPPORTING DOCUMENTATION

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected.

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    IV. PAYMENT METHOD SELECTION

    You have successfully requested a payment. Click here if you would like to choose a different payment method.

    V. CERTIFICATION

    Claim Certification: By signing below and submitting this Claim Form, I hereby swear under penalty of perjury that I am the person identified above and the information provided in this Claim Form, including supporting documentation is true and correct to the best of my knowledge and belief.

    Your Claim Form has been submitted successfully.

    Please print this page for your records.

    Your Claim Details
    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
    Last Name
    Street Address
    Street Address 2
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    Email Address
    Phone Number
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@SEPTADataSettlement.com

    Click here to edit your Claim.