If You Change Your Name or Address. You agree to notify us in writing within twenty days if you change your name, your home or mailing address, or home or business telephone number.
If You Change Your Name or Address. If, for future reference and mailings from the Court or Claims Administrator, you wish to change the name or address listed on the envelope in which this Class Notice was mailed to you, you must fully complete, execute, and mail the Change of Name and/or Address Information Form, attached to this Class Notice at Form 1-B, to the Claims Administrator. PLEASE DO NOT CALL OR WRITE THE COURT ABOUT THIS NOTICE. FORM 1-A CLAIM AND CONSENT TO JOIN SETTLEMENT FORM CLAIM AND CONSENT TO JOIN SETTLEMENT FORM To be eligible to receive an Individual Settlement Award, you MUST complete and sign this Claim and Consent to Join Settlement Form and send it to the Claims Administrator (address listed below) so that it is postmarked no later than [DATE]. If you have any questions about completing this Claim and Consent to Join Settlement Form, please contact the Claims Administrator at: JCPenney Settlement Administration c/o [To Be Determined] By signing, dating, and submitting this Claim and Consent to Join Settlement Form, you will be eligible to receive an Individual Settlement Award—as described in the Class Notice to which this Form 1-A is attached—which shall constitute 70% of the amount of disputed wages previously paid to you pursuant to JCPenney’s investigation in 2015. As a Participating Claimant and in exchange for the Individual Settlement Award, you will be releasing the “Released Claims” against Defendant Releasees as described in the Class Notice. You may use the enclosed addressed, pre-paid envelope to mail your Claim and Consent to Join Settlement Form. This is the address/contact information we have on file for you: [CLASS MEMBER NAME] [CLASS MEMBER STREET ADDRESS] [CLASS MEMBER CITY, STATE ZIP CODE] If this information is incorrect or it changes, please notify the Claims Administrator of your new address by completing the Change of Name and/or Address Form attached to the Class Notice at Form 1-B and sending it to the Claims Administrator. According to JCPenney’s records, the estimate of your Individual Settlement Awards is: $[AMOUNT]. This is only an estimate. The actual value may be higher or lower depending on the formula used by the Parties and approved by the Court as stated in the Class Notice to which this Form is attached. I certify that I am one of the 53 Merchandise Assistants employed by JCPenney in the Merchandise Department who claimed unrecorded hours worked and who, as a result of JCPenney’s investigation in 2014 and 2015, was paid for disput...
If You Change Your Name or Address. If your name and/or mailing address information changes after you submit either a Consent Form or an Election to Opt Out of Settlement and Class Action form, you must fully complete, execute, and mail the Change of Name and/or Address Information Form (enclosed with this Notice as Form B). PLEASE DO NOT CALL OR WRITE THE COURT ABOUT THIS NOTICE. FORM 1-A CONSENT TO JOIN SETTLEMENT FORM CLAIM FORM AND RELEASE FOR XXXXXXXX v. NBCUNIVERSAL SETTLEMENT Instructions: Please complete this Consent to Join Settlement Form if you want to receive a payment in the Settlement that is described in the Class Notice that accompanies this Form. If you want to receive a payment under the Settlement, you must complete, sign and submit this Form and the attached W-4 Form no later than [** INSERT DATE 60 DAYS FROM NOTICE MAILING **]. In order to receive a payment from the Settlement, you must complete all of the information requested (including your Social Security Number, so that your information can be matched with NBCUniversal Media LLC’s records). This information will remain confidential and will only be used to process your settlement payment.
