Required Affirmations Clause Samples
The Required Affirmations clause obligates one or both parties to formally declare certain facts or assurances as true at the time of entering into the agreement. Typically, this involves confirming key information such as authority to sign, absence of legal impediments, or compliance with relevant laws. By requiring these affirmations, the clause helps ensure that both parties are entering the contract on a clear and reliable basis, reducing the risk of misunderstandings or misrepresentations that could undermine the agreement.
Required Affirmations. IF SUBMITTED ELECTRONICALLY: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. IF SUBMITTED BY U.S. MAIL: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Dated: Signature: SETTLEMENT ADMINISTRATOR ADDRESS (where to send the completed form if submitting by mail): AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. This Claim Form may be submitted in one of three ways:
1. Electronically through www.[xxx].com.
2. Via email to [xxx]@[xxx].com. Please fill out the enclosed pages, scan the document in its entirety, and include the form as an attachment.
3. Mail to: AAG TCPA Settlement, c/o , [Address], [City] [State], [Zip Code]. To be effective as a Claim under the proposed settlement, this form must be completed, signed, and sent, as outlined above, no later than [Month] [Day] [Year]. If this Form is not postmarked or received by this date, you will remain a member of the Settlement Class but will not receive any payment from the Settlement.
Required Affirmations. IF SUBMITTED ELECTRONICALLY: 🞎 I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address], [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. Dated: Signature: • A Settlement with a $1,670,000 cash fund has been reached in a class action lawsuit claiming that Change Healthcare Resources, LLC, under the brand My Advocate, calling on behalf of Blue Cross Blue Shield of North Carolina (“Defendants”), sent prerecorded voice messages to wireless telephone numbers without consent of the recipients in violation of the Telephone Consumer Protection Act, 47 U.S.C. § 227. Defendants deny the allegations in the lawsuit and the Court has not decided who is right. • If you are a Settlement Class Member, your legal rights are affected whether you act or do not act. Read this notice carefully. DO NOTHING If you do nothing but have been identified in Defendants’ records and have received a mailed notice about the Settlement, you will automatically receive a payment from the Settlement Fund and will give up your right to bring your own lawsuit against Defendants about the claims in this case. If you do nothing but have not been identified in Defendants’ records or have not received a mailed notice about the Settlement, you will not receive a payment from the Settlement Fund and will give up your right to bring your own lawsuit against Defendants about the claims in this case. MAKE A CLAIM If you have not been identified in Defendants’ records or have not received a mailed notice about the Settlement, you may make a claim to receive a payment from the Settlement Fund. If you have been identified in Defendants’ records and have received a mailed notice about the Settlement, you will automatically receive a payment from the Settlement Fund without making a claim. EXCLUDE YOURSELF You may request to be excluded from the Settlement. If you do, you will not receive a payment from the Settlement Fund but will not give up your right to bring your own lawsuit against Defendants about the claims in this case. OBJECT Write to the Court if you do not like the ...
Required Affirmations. IF SUBMITTED ELECTRONICALLY: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address], [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. IF SUBMITTED BY U.S. MAIL: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address], [City], [State] [Zip Code]. Dated: Signature: Settlement Administrator Address (where to send the completed form if submitting by mail): Paradise Exteriors TCPA Settlement, c/o , [Address], [City], [State] [Zip Code]. A court authorized this notice. You are not being sued. This is not a solicitation from a lawyer. • Call records indicate that you may be affected by a Settlement1 of a class action lawsuit claiming that Defendant Paradise Exteriors LLC (“Paradise Exteriors”) violated a federal law called the Telephone Consumer Protection Act (“TCPA”) by making pre-recorded calls to cellular telephone numbers. Paradise Exteriors denies that it violated the law. The lawsuit is called ▇▇▇▇ ▇▇▇▇▇ v. Paradise Exteriors LLC, Case. No 50-2023-CA-016414-XXXA- MB. The Court has decided that this settlement should be a class action on behalf of a Class, or group of people that could include you, and a Settlement has been reached affecting this Class. The Settlement offers payments to Class Members who file valid Claims. Your legal rights are affected whether you act or do not act. Read this notice carefully. YOUR LEGAL RIGHTS AND OPTIONS IN THIS SETTLEMENT: SUBMIT A CLAIM FORM If you are a member of the Class, you must submit a completed Claim Form to receive payment of up to $575. If the Court approves the Settlement and it becomes final and effective, and you remain in the Class, you will receive your payment by check. EXCLUDE YOURSELF You may req...
Required Affirmations. IF SUBMITTED ELECTRONICALLY: □ I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Checking this box constitutes my electronic signature on the date of its submission. IF SUBMITTED BY U.S. MAIL: I agree that, by submitting this Claim Form, the information in this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.[xxxx].com or by writing the Settlement Administrator at the email address [xxxx]@[xxxx].com or the postal address [Address] [City], [State] [Zip Code]. Dated: Signature: SETTLEMENT ADMINISTRATOR ADDRESS (where to send the completed form if submitting by mail): IHP Telemarketing Settlement, c/o , [Address], [City] [State], [Zip Code] UNITED STATES DISTRICT COURT FOR THE DISTRICT OF SOUTH CAROLINA CHARLESTON DIVISION ▇▇▇▇ ▇▇▇▇▇▇▇▇▇, individually and on behalf of all others similarly situated, Vs. Plaintiff, Case No. 2:19-cv-02993-▇▇▇ INDEPENDENT HOME PRODUCTS, LLC,
Required Affirmations. Etna Township