Common use of Documented Loss Payment Clause in Contracts

Documented Loss Payment. Please check off this box for this section if you are electing to seek reimbursement for up to $10,000 of documented losses you incurred that are more likely than not traceable to the Data Breach and not otherwise reimbursed by any other source. Documented losses include unreimbursed losses and consequential expenses that are more likely than not related to the Data Breach and incurred on or after June 6, 2024. In order to make a claim for a Documented Loss Payment, you must (i) fill out the information below and/or on a separate sheet submitted with this Claim Form; (ii) sign the attestation at the end of this Claim Form (section VIII); and (iii) include Reasonable Documentation supporting each claimed cost along with this Claim Form. Documented losses need to be deemed more likely than not due to the Data Breach by the Settlement Administrator based on the documentation you provide and the facts of the Data Incident. Failure to meet the requirements of this section may result in your claim being rejected by the Settlement Administrator. If your claim for a Documented Loss Payment is rejected and you fail to cure the defect, your claim will automatically be considered as a claim for a Cash Fund Payment. ⭘ Unreimbursed fraud losses or charges ⭘ Professional fees incurred in connection with identity theft or falsified tax returns ⭘ Lost interest or other damages resulting from a delayed state and/or federal tax refund in connection with fraudulent tax return filing ⭘ Credit freeze (mm/dd/yy) / / (mm/dd/yy) / / (mm/dd/yy) / / (mm/dd/yy)