CONTACT INFORMATION
COMPANY
DEPARTMENT
CONTACT
ADDRESS 1
ADDRESS 2
CITY
STATE
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
ME
MD
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIP
E-MAIL
TELEPHONE
(XXX) XXX-XXXX or XXX-XXX-XXXX
FAX
(XXX) XXX-XXXX or XXX-XXX-XXXX
CASE INFORMATION
CASE NAME
CASE NUMBER
CASE TYPE
(securities, civil rights, environment, etc.)
ATTORNEYS
FOR SECURITIES:
TRANSFER AGENT PHONE
TRANSFER AGENT NAME
CUSIP #
SECURITY #
STOCK SYMBOL
NOTES:
SETTLEMENT AMOUNT $
OTHER
1. NOTICE
Yes
No
MAILING TIME FRAME
TYPE
Notice of Pendancy
Notice of Settlement
Other
- Would you like us to write the notice?
Yes
No
- Can you provide text and specifications for the notice documents?
Yes
No
Legal notice:
# of pages
double sided
formatting
Personalized letter/insert:
# of pages
double sided
formatting
Other doc
# of pages
double sided
formatting
Other doc
# of pages
double sided
formatting
Mail:
BRE (pre-paid)
courtesy envelope
self-mailer
first class mail
- Would you like us to process Opt-outs?
Yes
No
Return address:
A.B.Data
Client
- Do you need media notice?
Yes
No
- Estimated # of class members to be notified?
- Do you need us to compile lists?
Yes
No
- Do we need to do any data processing?
Yes
No
NOTES
2. CLAIMS ADMINISTRATION
Yes
No
- Should we design claim forms?
Yes
No
ClaimForm:
# of pages
double sided
formatting
Mail:
BRE
courtesy envelope
prepaid postage
first class mail
- Do you need claims processing and resolution?
Yes
No
- Was there a decision made on the eligibility criteria?
Yes
No
- Number of claims anticipated?
- Number of anticipated claims to be approved.
NOTES
3. TELEPHONY
Yes
No
- Inbound toll free lines
Yes
No
- Outbound toll free lines
Yes
No
- Do you need multilingual operators?
Language
Yes
No
- Would you like us to establish voice response systems which will allow potential class members to receive the case information and request class notice, claims, and other documentation without agent intervention
Yes
No
NOTES
4. WEB SERVICES
Yes
No
- Do you need us to design a notification site?
Yes
No
NOTES
5. FUND ADMINISTRATION
Yes
No
ESTIMATED AMOUNT:
- Checks,
estimated number
Yes
No
- Forms W9
Yes
No
- 1099s,
estimated number
type
Yes
No
- Tax services
Yes
No
6. TRANSLATION
Yes
No
LANGUAGE:
- Legal translation of notice, claims and supporting documents
Yes
No
- Translations of inbound and outbound correspondence
Yes
No
Bold
= Required Field