Common use of Data Security Incident Clause in Contracts

Data Security Incident. PAYMENT SELECTION If you made a claim for a Out-of-Pocket Losses and/or Lost Time on this Claim Form, you can elect to receive your payment either electronically or by check. Please select only one of the options below. If no selection is made, or if the required information is not provided, Settlement benefit payments will be mailed to the address you provided above. □ PayPal - PayPal Account Email Address: □ Venmo - Venmo User Name: Venmo Account Email Address: Venmo Account Phone Number: □ Check (will be mailed to address above) V. AFFIRMATION AND SIGNATURE • I affirm and swear under the laws of the United States that the information supplied in this claim form and any supplemental documentation attached is true and correct to the best of my knowledge. • By signing this Claim Form you attest that the expenses listed above and/or time you spent were incurred as a result of the Data Security Incident. • I understand that I may be asked to provide more information by the Settlement Administrator before my claim is complete. Signature: Date: VoluCsiaosn ePr1iv:a2cy0S-cetvtl-e0m0en7t61-LY Document 39-1 Filed 04/12/22 Page FIRST CLASS MAIL US POSTAGE PAID Claimant ID Number: [xxxxxxxxxxxxxxxx] [BARCODE] [PRINTER ID] [NAME] [ADDRESS 1] [ADDRESS 2] [CITY], [STATE] [ZIP CODE] YCouaasree re1c:e2iv0in-gctvhi-s0n0ot7ice6t1o-inLfoYrm yDouoocf uyomur erignhtts3a9nd-1optioFnsileinda p0ro4p/o1s2ed/2se2ttlemPeantginea 4cla0ssoafct5io6n lawsuit called ▇▇▇▇▇ ▇▇▇▇▇ and ▇▇▇▇▇▇▇ ▇▇▇▇, et ▇▇ ▇. Volusion, LLC, W.D. Tex (the “Settlement”). Compensation for Out-of-Pocket Losses: Compensation for Out-of-Pocket Losses, up to a total of $1,500.00 per person for certain out-of-pocket expenses incurred because of the Data Security Incident. You must provide documentation of all Out-of-Pocket Losses claimed.