Step 1 of 9 11% URLThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formhidden claimant id*This field is hidden when viewing the formhidden last name* CLAIM FORM Harley Bradford and Julie Hardin v. Nth Degree, Inc. Case No. 2EV012970 If Nth Degree notified you of a Data Security Incident or your Private Information was accessed or acquired as a result of the Data Security Incident and you are a resident of the United States, you may be eligible for benefits from a Proposed Class Action Settlement and may complete this Claim Form. GENERAL INSTRUCTIONS Settlement Class Members may complete and submit a Claim Form for the benefits described in the Notice. Claim Forms must be submitted or postmarked for mail on or before July 30, 2026. Please read the Claim Form carefully and answer all questions. Failure to provide the required information could result in a denial of your claim. The paper Claim Form can also be accessed and downloaded HERE which should be completed in black or blue ink, and mailed or emailed to the Settlement Administrator at the address below. Supporting documentation provided with mailed Claim Forms will not be returned, please retain copies of your documents for your personal records. Nth Degree Settlement c/o Atticus Administration PO Box 64053 St. Paul, MN 55164 Email: [email protected] I. SETTLEMENT CLASS MEMBER NAME AND CONTACT INFORMATIONClearly print your full name and contact information below. This information will be used to communicate with you about your Claim Form, if needed. You must notify the Settlement Administrator if your contact information changes after you submit this form. NAME:* First Last MAILING ADDRESS:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Notice ID*Telephone Number:*Email Address:* II. DOCUMENTED LOSSESDocumented Losses Checkbox Check this box if you wish to claim Documented Losses up to $3,500.00. I understand documentation to support the losses claimed is required and I have enclosed them with my Claim Form. DOCUMENTED Losses Documentation*Description of Each LossLoss DateLoss AmountDescription of Support Documentation Add RemoveSupporting Documents for DOCUMENTED LOSSES* Drop files here or Select files Accepted file types: pdf, jpg, jpeg, bmp, png, Max. file size: 24 MB. Lost time Checkbox Check this box if you wish for Documented Losses to include a claim for up to four (4) hours for lost time spent dealing with the Data Security Incident compensated at a rate of twenty dollars per hour ($20.00/hour). I understand that if at least one (1) full hour was spent in response to the Data Security Incident, that I must describe how the time was spent and certify the hours claimed. I claim the below hours of lost time and have provided a description of how the time was spent:*1 Hour ($20.00)2 Hours ($40.00)3 Hours ($60.00)4 Hours ($80.00)DOCUMENTED Lost Hours*Description of Each Data Security Incident Activity You Spent Time OnDateLength of Time (Hours) Add Remove The below certification is required to be eligible for lost time compensation (check the box). penalty of perjury,* I certify and affirm to the best of my knowledge and belief that the hour(s) of lost time claimed were spent dealing with the Data Security Incident experienced by Nth Degree in December of 2024. III. ALTERNATIVE CASH PAYMENTAlternative Cash Payment Checkbox I wish to claim the Alternative Cash Payment of fifty dollars ($50.00) in lieu of Documented Losses (including lost time). You cannot claim both the Documented Losses and the Alternative Cash Payment. This field is hidden when viewing the formhiddenTotalsValue IV. CALIFORNIA SUBCLASS STATUTORY PAYMENTCALIFORNIA SUBCLASS STATUTORY Checkbox I was a resident of California in December of 2024 when the Data Security Incident against Nth Degree occurred and wish to claim the California Subclass Statutory Payment of one hundred dollars ($100.00). My address at that time was:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code The address you selected is not in California, either uncheck that you were a resident in California or update the address above.This is my current address.* YES NO V. CREDIT MONITORING SERVICESCredit Monitoring Checkbox I wish to receive three (3) years of single-bureau Credit Monitoring Services. Benefits SummaryBelow is a summary of the claims you have elected on this Claim Form. Please verify before proceeding. If you did not elect any claim benefits, please go back and select your claim benefit before proceeding.*Compensation For ALTERNATIVE CASH PAYMENT.*Compensation For DOCUMENTED LOSSES.*Compensation For SUBCLASS STATUTORY PAYMENT*Compensation For CREDIT MONITORING SERVICES.No claims selected.* You have not selected any claim benefits. Please go back and select at least one claim benefit to proceed. PAYMENT SELECTIONPlease select one payment method for receipt of any Settlement payment to which you are determined eligible: This field is hidden when viewing the formPayment TokenPayment Method* YOU WILL RECEIVE A VERIFICATION EMAIL OR TEXT MESSAGE REGARDING YOUR DIGITAL PAYMENT. YOU MUST VERIFY AND AUTHENTICATE YOUR PAYMENT INFORMATION IN ORDER TO RECEIVE A DIGITAL PAYMENT. IF YOU DO NOT VERIFY AND AUTHENTICATE YOUR INFORMATION, A PAPER CHECK WILL BE SENT TO YOU. VI. ATTESTATION & SIGNATURESignature checkbox* I swear and affirm under the laws of my state that the information I have provided 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.I understand the Settlement Administrator may ask for supplemental information to determine the validity of my claim and may otherwise audit my Claim Form for accuracy and validity Printed Signature*Date* MM slash DD slash YYYY ClaimFormNo
