Contact Information

Please complete all required fields. The Claims Administrator will use this information for all communications regarding this request.

Notice List Uploader

Using the provided template, also available here, provide a list of names, addresses, and email addresses (if available) of beneficial owners to the Claims Administrator for the Claims Administrator to mail the Postcard Notice to such beneficial owners.

Do not make any edits to the template as your file will be rejected.

Certification & Signature

By signing below, I declare under penalty of perjury under the laws of the United States of America that all of the information I provided on this form and my uploaded file(s) is (are) true, correct and complete to the best of my knowledge.