If you received a personalized notice in the mail or via email with a Notice ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Notice ID exactly as it appears on your personalized Notice, (i.e. 12345678).

Please select which settlement benefit you would like to recieve:

If you received Notice of this Settlement, the Settlement Administrator identified you as a person who previously received a notice from Lower in or around mid-2022 that your Personal Identifying Information (“PII”) may have been accessed or exposed during the Data Incident which occurred between September 2, 2021, and December 16, 2021, and resulted in the potential compromise of individuals’ PII.

As a member of the Settlement Class, you are eligible to complete this Claim Form to claim (1) a $100 pro-rata Cash Payment (in lieu of any other cash benefits) 2) up to $2,500 for (i) reimbursement for documented out-of-pocket expenses and/or (ii) up to 10 hours of lost time compensable at $20 per hour; (3) up to $7,500 for documented extraordinary losses, which are unreimbursed losses from fraud or identity theft.

You may also claim 24-months of three-bureau credit monitoring benefits through CyEx with up to $1 million in reimbursement insurance coverage.

Please refer to the Settlement Notice (Long Notice) for more information on information on submitting a Claim and information on the aggregate cap on claims.

To receive any of these benefits, you must submit the Claim Form below by December 11, 2023.

Cash Payment: All members of the Settlement Class who submit a Valid Claim using the Claim Form are Eligible for a cash payment of $100. The Settlement Administrator will make pro rata settlement payments, which may increase or decrease the $100 Cash Payment, subject to the total amount of the Common Fund ($1.425 million). Class members who select this $100 Cash Payment may not claim any of the other benefits offered herein.

Ordinary Loss Reimbursement: All members of the Settlement Class who submit a Valid Claim using the Claim Form are eligible to claim reimbursement for documented out-of-pocket expenses, not to exceed $2,500 per member of the Settlement Class, that were incurred as a result of the Data Incident. Examples of reimbursable expenses incurred as a result of the Data Incident include bank fees, long distance phone charges, cell phone charges (only if charged by the minute), data charges (only if charged based on the amount of data used), postage, or gasoline for local travel; fees for credit reports, credit monitoring, or other identity theft insurance products purchased on or after September 2021 that were caused or otherwise incurred as a result of the Data Incident. 

Time Spent Dealing With the Data Incident: As part of an expense reimbursement claim, you may claim up to 10 hours of lost time, at $20/hour, for time spent dealing with the effects of the Data Incident. This amount is subject to the $2,500 per Class Member cap on ordinary losses.

Extraordinary Loss Reimbursement: All members of the Settlement Class who submit a Valid Claim using the Claim Form are eligible to claim reimbursement for documented extraordinary losses, not to exceed $7,500 per member of the Settlement Class. Extraordinary losses must be an actual, documented, and unreimbursed monetary loss that was more likely than not caused by the Data Incident that is not already covered by the ordinary loss category.

Credit Monitoring: You may also claim 24 months of three-bureau credit monitoring.

Please read the claim form carefully and answer all questions. Failure to provide the required information could result in a denial of your claim.

This Claim Form may be submitted electronically via this portal or completed and mailed to the address below. Please type or legibly print all requested information, in blue or black ink. Mail your completed Claim Form, including any supporting documentation, by U.S. mail to:

Lower LLC Settlement Administrator
1650 Arch Street, Suite 2210
Philadelphia, PA 19103

I. CLASS MEMBER NAME AND CONTACT INFORMATION

Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form.

* Required Fields

II. PROOF OF CLASS MEMBERSHIP
III. PRO RATA CASH PAYMENT

This amount may increase or decrease on a pro rata basis, depending upon the number of claims filed and approved.

IF YOU SELECT THIS CASH BENEFIT, YOU MAY NOT CLAIM ANY OF THE OTHER CASH SETTLEMENT BENEFITS. YOU MAY STILL CLAIM CREDIT MONITORING.

IV. IDENTITY THEFT PROTECTION
V. COMPENSATION FOR LOST TIME

All members of the Settlement Class who have spent time dealing with the Data Incident may claim up to ten (10) hours for lost time at a rate of $20.00 per hour. Any payment for lost time is included in the $2,500 cap per Settlement Class member (no documentation is required).

Hours claimed (up to 10 hours – check one box)

In order to receive this payment, you must describe what you did and how the claimed lost time was spent related to the Data Incident. Check all activities below, which apply.

VI. REIMBURSEMENT FOR OUT-OF-POCKET EXPENSES

All members of the Settlement Class who submit a Valid Claim using this Claim Form are eligible for reimbursement of the following documented out-of-pocket expenses, not to exceed $2,500 per member of the Settlement Class, that were incurred as a result of the Data Incident:

Cost Type
(Fill all that apply)		 Approximate Date of Loss Amount of Loss
Examples of Supporting Third Party Documentation: Telephone bills, cell phone bills, gas receipts, postage receipts, bank account statements reflecting out-of-pocket expenses. Please note that these examples of reimbursable documented out-of-pocket losses are not meant to be exhaustive, but exemplary. You may make claims for any documented out-of-pocket losses that you believe are reasonably related to the Data Incident or to mitigating the effects of the Data Incident.
Examples of Supporting Documentation: Receipts or account statements reflecting purchases made for Credit Monitoring or Identity Theft Insurance Services.
Examples of Supporting Documentation: Invoices or statements reflecting payments made for professional fees/services.
VII. REIMBURSEMENT FOR EXTRAORDINARY LOSS EXPENSES

All members of the Settlement Class who submit a Valid Claim using this Claim Form are eligible for reimbursement of the following documented extraordinary loss expenses, not to exceed $7,500 per member of the Settlement Class, that were incurred as a result of the Data Security Incident. Generally, an extraordinary loss expense is unreimbursed financial loss as the direct result of financial fraud or stolen identity.

An extraordinary loss must meet the following criteria: (i) The loss is an actual, documented, and unreimbursed monetary loss arising from fraud or misuse; (ii) The loss was more likely than not caused by the Data Incident; (iii.) The loss occurred between September 2, 2021, and the Claims Deadline; (iv) The loss is not already covered by one or more of the ordinary loss compensation categories under Section V; and the Settlement Class Member made reasonable efforts to avoid, or seek reimbursement for, the loss, including but not limited to exhaustion of all available credit monitoring insurance and identity theft insurance.

Cost Type
(Fill all that apply)		 Approximate Date of Loss Amount of Loss

YOU MUST SUBMIT DOCUMENTATION OF YOUR EXTRAORDINARY LOSS EXPENSES.

Examples of Supporting Documentation: Bank statements, credit card statement, letters from the IRS or other tax authorities, letters from state unemployment agencies, and police reports.
VIII. UPLOAD SUPPORTING DOCUMENTATION

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected.

Please confirm in the grid below that your file has been successfully uploaded.

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    IX. PAYMENT SELECTION

    Please select one of the following payment options, which will be used should you be eligible to receive a settlement payment:

    You have successfully requested a payment. Click here if you would like to choose a different payment method.

    X. ATTESTATION & SIGNATURE

    I swear and affirm under the laws of my state that the information I have supplied in this Claim Form is true and correct to the best of my recollection, and that this form was executed on the date set forth below.

    Your Claim Form has been updated successfully.

    Please print this page for your records.

    Your Claim Details
    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    Street Address 2
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    Email Address
    Telephone Number
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@LowerDataIncidentSettlement.com

    Click here to edit your Claim.

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