CLAIMANT INFORMATION. The Claims Administrator will use this information for all communications regarding this claim (including the check, if eligible for payment). If this information changes, you MUST notify the Claims Administrator in writing at the address above. Claimant Name(s): Street Address: City: State: Zip Code: Country: Last four digits of Social Security Number or Taxpayer Identification Number:
Appears in 2 contracts
Sources: Settlement Agreement, Settlement Agreement