Carroll v. Macy’s Inc.

Claim Form

SETTLEMENT OVERVIEW

Documented Losses and Time

If you have documentation establishing that you experienced out-of-pocket losses as a result of the Macy’s Cyber Attack (as defined in the Settlement) or spent time dealing with the repercussions of the Cyber Attack, you can make a claim for reimbursement up to $1,500.00, including up to 5 hours of documented time at $15.00 per hour. You must submit supporting documentation for this claim.

Self-Certifying Time

If you do not have documentation, you will still be eligible to self-certify your time spent dealing with the repercussions of the Cyber Attack at $15.00 per hour for up to 2 hours.

The total amount for both Documented Losses and Time and Self-Certifying Time is capped at $1,530.00 per claimant.

CLAIMANT INFORMATION

DOCUMENTED CLAIMS FOR OUT-OF-POCKET LOSSES OR TIME SPENT DEALING WITH THE REPERCUSSIONS OF THE CYBER ATTACK

1. Do you have documents supporting that you experienced out-of-pocket losses as a result of the Cyber Attack or spent time dealing with the repercussions of the Cyber Attack?
You may submit a claim, with supporting documentation, for up to $1,500.00 in out-of-pocket losses or time spent dealing with the repercussions of the Cyber Attack.



Loss Type (select all that apply)

Examples: Receipt or account statement reflecting fuel costs for driving to bank or filing police report; receipt for hiring service to assist you in addressing identity theft

Examples: Receipts or account statements reflecting purchases made for credit monitoring services or to place a credit freeze

Examples: Phone bill reflecting time spent on phone with bank. You may make a claim for up to 5 hours of documented time at $15.00 per hour

Please provide detailed description and supporting documentation


Upload Documentation

Click the "Browse" or “Choose File” button and select the relevant file from your computer. The selected files will be uploaded when the "Agree and Submit" button is clicked.

Required documentation may be uploaded in .pdf,.jpg,.jpeg,.tif,.tiff,.gif,.png format only.

You may upload up to 10 files.

A single file cannot be larger than 10 MB.

SELF-CERTIFIED CLAIMS FOR TIME

2. Did you spend time or additional time other than what is documented above dealing with the repercussions of the Cyber Attack?
You may make a claim for up to 2 hours of undocumented time at $15.00 per hour.



I spent
 
hours dealing with the repercussions of the Cyber Attack to be reimbursed at a rate of $15.00 per hour.

(skip to the attestation and signature)

ATTESTATION

Required